1
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Thomas D, McDonald VM, Gibson PG. Realignment of clinical research after the COVID-19 era. THE LANCET. RESPIRATORY MEDICINE 2024; 12:428-430. [PMID: 38614105 DOI: 10.1016/s2213-2600(24)00080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Dennis Thomas
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW 2305, Australia.
| | - Vanessa M McDonald
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW 2305, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter G Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW 2305, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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2
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Haemmerle R, Paludo J, Haddad TC, Pritchett JC. The Growing Role of Digital Health Tools in the Care of Patients with Cancer: Current Use, Future Opportunities, and Barriers to Effective Implementation. Curr Oncol Rep 2024; 26:593-600. [PMID: 38652424 DOI: 10.1007/s11912-024-01534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW This article aims to describe the ways in which digital health technologies are currently being used to improve the delivery of cancer care, highlight opportunities to expand their use, and discuss barriers to effective and equitable implementation. RECENT FINDINGS The utilization of digital health tools and development of novel care delivery models that leverage such tools is expanding. Recent studies have shown feasibility and increased implementation in the setting of oncologic care. With technological advances and key policy changes, utilization of digital health tools has greatly increased over the past two decades and transformed how cancer care is delivered. As digital health tools are expanded and refined, there is potential for improved access to and quality and efficiency of cancer care. However, careful consideration should be given to key barriers of digital health tool adoption, such as infrastructural, patient-level, and health systems-level challenges, to ensure equitable access to care and improvement in health outcomes.
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Affiliation(s)
| | - Jonas Paludo
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
- Center for Digital Health, Mayo Clinic, Rochester, USA
| | - Joshua C Pritchett
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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3
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Terao M, Mittal N, Roth M, Saha A, Super L, Reichek J. Utilization of Teleconsent for Adolescent and Young Adult Cancer Clinical Trials, a Report from the Children's Oncology Group. J Adolesc Young Adult Oncol 2024; 13:132-137. [PMID: 37540127 PMCID: PMC10877395 DOI: 10.1089/jayao.2023.0085] [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] [Indexed: 08/05/2023] Open
Abstract
Purpose: Adolescents and young adults (AYAs, ages 15-39 years) are underrepresented in oncology clinical trials. Reasons for this include accessibility of the trial and whether the trial is presented to AYAs. The coronavirus disease 2019 (COVID-19) pandemic not only amplified these enrollment challenges but also presented opportunities for improving the enrollment process through virtual methods such as electronic informed consent and teleconsent. While AYAs are well positioned to take advantage of these opportunities, the extent to which institutions utilize remote enrollment processes is unclear. The goal of this study was to identify the utilization of and barriers to using teleconsent for AYA oncology clinical trials. Methods: The Children's Oncology Group (COG) AYA Responsible Investigator (RI) Network Teleconsent Working Group sought to understand teleconsent utilization both before and during the pandemic. The working group developed an online survey distributed via email to COG AYA RI Network members (n = 197). Results: The survey received 49 responses (25%) from 40 different institutions. Before the pandemic, 13% of respondents reported that their institution allowed study enrollment via teleconsent. After the pandemic, 23% reported using teleconsent for clinical trial enrollment and 38% reported changes in institutional Review Board policies and procedures allowing teleconsent. Respondents reported that the greatest benefit of teleconsent was patient convenience and the greatest barrier was institutional restrictions on teleconsent utilization. Respondents reported that sharing institutional guidelines would be the most helpful intervention to improve teleconsent adoption. Conclusion: Teleconsent is a promising but underutilized approach. Institutions should work together to address common challenges to accessibility and acceptance of clinical trials by AYA cancer patients.
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Affiliation(s)
- Michael Terao
- Office of Student Learning and Academic Advising, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Nupur Mittal
- Department of Pediatrics, Rush University Medical Center, Chicago, Chicago, USA
| | - Michael Roth
- Department of Pediatrics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Aniket Saha
- Department of Pediatrics, Prisma Health Upstate Children's Hospital, Greenville, South Carolina, USA
| | - Leanne Super
- Department of Pediatrics, Children's Cancer Centre, Monash Children's Hospital and Royal Children's Hospital, Melbourne, Australia
| | - Jennifer Reichek
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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4
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Cummins MR, Soni H, Ivanova J, Ong T, Barrera J, Wilczewski H, Welch B, Bunnell BE. Narrative review of telemedicine applications in decentralized research. J Clin Transl Sci 2024; 8:e30. [PMID: 38384915 PMCID: PMC10880018 DOI: 10.1017/cts.2024.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
Telemedicine enables critical human communication and interaction between researchers and participants in decentralized research studies. There is a need to better understand the overall scope of telemedicine applications in clinical research as the basis for further research. This narrative, nonsystematic review of the literature sought to review and discuss applications of telemedicine, in the form of synchronous videoconferencing, in clinical research. We searched PubMed to identify relevant literature published between January 1, 2013, and June 30, 2023. Two independent screeners assessed titles and abstracts for inclusion, followed by single-reviewer full-text screening, and we organized the literature into core themes through consensus discussion. We screened 1044 publications for inclusion. Forty-eight publications met our inclusion and exclusion criteria. We identified six core themes to serve as the structure for the narrative review: infrastructure and training, recruitment, informed consent, assessment, monitoring, and engagement. Telemedicine applications span all stages of clinical research from initial planning and recruitment to informed consent and data collection. While the evidence base for using telemedicine in clinical research is not well-developed, existing evidence suggests that telemedicine is a potentially powerful tool in clinical research.
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Affiliation(s)
- Mollie R. Cummins
- University of Utah, College of Nursing, Salt Lake City, UT, USA
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | | | - Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | - Janelle Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | | | - Brandon Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
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5
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Phillips H, Deshpandey M, Staveski S. Consenting in the time of the COVID-19 pandemic. J Pediatr Nurs 2024; 74:129-131. [PMID: 37739861 PMCID: PMC10201309 DOI: 10.1016/j.pedn.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Heather Phillips
- University of California, San Francisco, School of Nursing, Department of Family Health Care Nursing, United States of America
| | - Manasi Deshpandey
- University of California, San Francisco, School of Nursing, Department of Family Health Care Nursing, United States of America
| | - Sandra Staveski
- University of California, San Francisco, School of Nursing, Department of Family Health Care Nursing, United States of America.
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6
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Sawant S, Madathil KC, Molloseau M, Obeid J. Overcoming recruitment hurdles in clinical trials: An investigation of remote consenting modalities and their impact on workload, workflow, and usability. APPLIED ERGONOMICS 2024; 114:104135. [PMID: 37713927 PMCID: PMC10843021 DOI: 10.1016/j.apergo.2023.104135] [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: 04/26/2023] [Revised: 08/01/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
Travel constraints can hinder the recruitment of eligible research participants in clinical trials, causing research timeline extensions, added costs, underpowered results, and early termination. Remote consenting can help solve these issues by allowing researchers and potential participants to connect remotely. This controlled experimental study investigates the effect of remote consenting on workload, workflow, usability, and barriers and facilitators to its implementation. Using a mixed experimental design, simulated consenting sessions were conducted with three different modalities (remote paper consent, eConsent, and teleconsent) with 23 researchers and 93 research participants. Each session involved a single researcher who experienced all three modalities, while three different research participants were assigned to each modality individually. Research participants and researchers completed surveys measuring workload and usability. Remote consenting allows researchers and participants to connect at their preferred location and time, and teleconsenting was found to be the preferred modality by the researchers, primarily due to its ability to exchange visual cues. However, challenges such as training requirements and technology dependence need to be addressed for widespread implementation. Future research should aim to eliminate these barriers and improve remote consenting modalities to facilitate clinical research participation.
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Affiliation(s)
- Sarvesh Sawant
- Department of Industrial Engineering, Clemson University, USA
| | | | - Maria Molloseau
- Department of Industrial Engineering, Clemson University, USA
| | - Jihad Obeid
- Department of Public Health Sciences, Medical University of South Carolina, USA.
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Cummins MR, Burr J, Young L, Yeatts SD, Ecklund DJ, Bunnell BE, Dwyer JP, VanBuren JM. Decentralized research technology use in multicenter clinical research studies based at U.S. academic research centers. J Clin Transl Sci 2023; 7:e250. [PMID: 38229901 PMCID: PMC10790101 DOI: 10.1017/cts.2023.678] [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: 03/27/2023] [Revised: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction During the COVID-19 pandemic, research organizations accelerated adoption of technologies that enable remote participation. Now, there's a pressing need to evaluate current decentralization practices and develop appropriate research, education, and operations infrastructure. The purpose of this study was to examine current adoption of decentralization technologies in a sample of clinical research studies conducted by academic research organizations (AROs). Methods The setting was three data coordinating centers in the U.S. These centers initiated coordination of 44 clinical research studies during or after 2020, with national recruitment and enrollment, and entailing coordination between one and one hundred sites. We determined the decentralization technologies used in these studies. Results We obtained data for 44/44 (100%) trials coordinated by the three centers. Three technologies have been adopted across nearly all studies (98-100%): eIRB, eSource, and Clinical Trial Management Systems. Commonly used technologies included e-Signature (32/44, 73%), Online Payments Portals (26/44, 59%), ePROs (23/44, 53%), Interactive Response Technology (22/44, 50%), Telemedicine (19/44, 43%), and eConsent (18/44, 41%). Wearables (7/44,16%) and Online Recruitment Portals (5/44,11%) were less common. Rarely utilized technologies included Direct-to-Patient Portals (1/44, 2%) and Home Health Nurse Portals (1/44, 2%). Conclusions All studies incorporated some type of decentralization technology, with more extensive adoption than found in previous research. However, adoption may be strongly influenced by institution-specific IT and informatics infrastructure and support. There are inherent needs, responsibilities, and challenges when incorporating decentralization technology into a research study, and AROs must ensure that infrastructure and informatics staff are adequate.
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Affiliation(s)
- Mollie R. Cummins
- University of Utah, Salt Lake City, UT, USA
- Doxy.me Inc., Rochester, NY, USA
| | - Jeri Burr
- University of Utah, Salt Lake City, UT, USA
| | - Lisa Young
- University of Utah, Salt Lake City, UT, USA
| | | | | | - Brian E. Bunnell
- Doxy.me Inc., Rochester, NY, USA
- University of South Florida, Tampa, FL, USA
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Loh KP, Wang Y, Yilmaz S, Nightingale CL, Parsons SK, Braun-Inglis C, Gada U, Montes A, Magnuson A, Culakova E, Strause S, Kamen C, Dressler E, Mustian K, Morrow G, Mohile S. Information Technology and Telemedicine Services in Community Oncology Practices. JCO Clin Cancer Inform 2023; 7:e2300086. [PMID: 37540817 PMCID: PMC10569779 DOI: 10.1200/cci.23.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE We described information technology support and use of telemedicine for cancer care and research purposes at community oncology practices within the National Cancer Institute Community Oncology Research Program (NCORP). METHODS We used data from the NCORP 2017 and 2022 Landscape Assessments. Separate logistic regression models were used to assess factors associated with the use of telemedicine for delivery of cancer care in 2017 and for research purposes in 2022 (cancer care delivery not assessed in 2022). RESULTS Information was available from 210 and 259 practice groups excluding pediatric-only groups in 2017 and 2022, respectively. In 2017, 30% of practice groups used telemedicine for delivery of cancer care; half of these (15% overall) could use telemedicine for research purposes. In 2022, telemedicine was used for research purposes in 73% of practice groups. In multivariable models, self-identifying as a safety-net hospital was associated with a lower odd of telemedicine use for delivery of cancer care (adjusted odds ratio [AOR], 0.39; 95% CI, 0.17 to 0.93), whereas affiliation with a designated critical access hospital was associated with a higher odd of telemedicine use for delivery of cancer care (AOR, 2.29; 95% CI, 1.10 to 4.76). Having a general survivorship clinic (AOR, 1.92; 95% CI, 1.04 to 3.54) and number of oncology providers (increase per 10 providers; AOR, 1.32; 95% CI, 1.05 to 1.65) were associated with telemedicine use for research purposes. CONCLUSION Almost one third of NCORP practice groups used telemedicine for cancer care delivery in 2017. In 2022, there is high capacity among NCORP practices (almost three-quarters) to use telemedicine for research purposes, especially among practices with a general survivorship clinic and a greater provider number.
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Affiliation(s)
- Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Ying Wang
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Sule Yilmaz
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Chandylen L. Nightingale
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - Susan K. Parsons
- Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Christa Braun-Inglis
- University of Hawaii Cancer Center/Hawaii Minority/Underserved NCORP, Honolulu, HI
| | - Umang Gada
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Alexander Montes
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Eva Culakova
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Sarah Strause
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Charles Kamen
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Emily Dressler
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC
| | - Karen Mustian
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Gary Morrow
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Supriya Mohile
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
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Pritchett JC, Patt D, Thanarajasingam G, Schuster A, Snyder C. Patient-Reported Outcomes, Digital Health, and the Quest to Improve Health Equity. Am Soc Clin Oncol Educ Book 2023; 43:e390678. [PMID: 37290027 DOI: 10.1200/edbk_390678] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The theme of the 2023 American Society of Clinical Oncology Annual Meeting is Partnering With Patients: The Cornerstone of Cancer Care and Research. As we aim to partner with patients to improve their health care, digital tools have the potential to enhance patient-centered cancer care and make clinical research more accessible and generalizable. Using electronic patient-reported outcomes (ePROs) to collect patients' reports of symptoms, functioning, and well-being facilitates patient-clinician communication and improves care and outcomes. Early studies suggest that racial and ethnic minority populations, older patients, and patients with less education may benefit even more from ePRO implementation. Clinical practices looking to implement ePROs can refer to the resources of the PROTEUS Consortium (Patient-Reported Outcomes Tools: Engaging Users & Stakeholders). Beyond ePROs, in response to the COVID-19 pandemic, cancer practices have rapidly adopted other digital tools (eg, telemedicine, remote patient monitoring). As implementation grows, we must be aware of the limitations of these tools and implement them in ways to promote optimal function, access, and ease of use. Infrastructure, patient, provider, and system-level barriers need to be addressed. Partnerships across all levels can inform development and implementation of digital tools to meet the needs of diverse groups. In this article, we describe how we use ePROs and other digital health tools in cancer care, how digital tools can expand access to and generalizability of oncology care and research, and prospects for broader implementation and use.
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Affiliation(s)
- Joshua C Pritchett
- Division of Hematology, Mayo Clinic, Rochester, MN
- Department of Oncology, Mayo Clinic, Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Debra Patt
- Texas Oncology, Dallas Texas and Dell Medical School at The University of Texas at Austin, Austin, TX
| | | | - Anne Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH
| | - Claire Snyder
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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10
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Gupta G, Mahor R, Pawar N, Gumashta R, Gumashta J. Program management challenges of clinical studies: A qualitative critical assessment. J Family Med Prim Care 2023; 12:625-631. [PMID: 37312779 PMCID: PMC10259540 DOI: 10.4103/jfmpc.jfmpc_1151_22] [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: 05/28/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 06/15/2023] Open
Abstract
Background Organization, coordination, and discipline are required to complete any intricate operation, conducting a clinical experiment is no different. There are usually many moving components, from designing a plan, to conveying changes, to calculating risk, and excellent project management which are necessary to guarantee the study works successfully. Past evidence suggested that roadblock at any level hampers the progress of the clinical research. Understanding program management challenges hence becomes the key for timely and effective completion of clinical research. Methods A cross-sectional qualitative enquiry involving stakeholders in clinical research program management. We used problem tree-based approach wherein we documented views of various stakeholders to understand the interaction, interdependence, and related interventional needs of bottlenecks for long-term research gains using modern management methods applicable in clinical settings. The best fit approach was also explored to augment maximum benefit in limited resource settings. Results Non-alignment with state policy aims, a lack of effective coordination and communication among members, challenging logistic management, limited use of technology, a need for training, and an inefficient monitoring mechanism were among the major issues highlighted, and solutions were proposed. Conclusion Study concludes that an Integrated Process-cum-Timeline-Based Management strategy with multisectoral emphasis is ideal for program management of clinical projects.
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Affiliation(s)
- Girjesh Gupta
- Department of Community Medicine, PCMS and RC, Bhopal, Madhya Pradesh, India
| | - Rajendra Mahor
- Department of Community Medicine, PCMS and RC, Bhopal, Madhya Pradesh, India
| | - Neeraj Pawar
- Department of Community and Family Medicine, AIIMS Raebareli, Uttar Pradesh, India
| | - Raghvendra Gumashta
- Department of Community Medicine, PCMS and RC, Bhopal, Madhya Pradesh, India
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11
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Garjani A, Liu BJY, Allen CM, Gunzler DD, Gerry SW, Planchon SM, das Nair R, Chataway J, Tallantyre EC, Ontaneda D, Evangelou N. Decentralised clinical trials in multiple sclerosis research. Mult Scler 2023; 29:317-325. [PMID: 35735014 PMCID: PMC9972228 DOI: 10.1177/13524585221100401] [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] [Indexed: 11/15/2022]
Abstract
Randomised controlled trials (RCTs) play an important role in multiple sclerosis (MS) research, ensuring that new interventions are safe and efficacious before their introduction into clinical practice. Trials have been evolving to improve the robustness of their designs and the efficiency of their conduct. Advances in digital and mobile technologies in recent years have facilitated this process and the first RCTs with decentralised elements became possible. Decentralised clinical trials (DCTs) are conducted remotely, enabling participation of a more heterogeneous population who can participate in research activities from different locations and at their convenience. DCTs also rely on digital and mobile technologies which allows for more flexible and frequent assessments. While hospitals quickly adapted to e-health and telehealth assessments during the COVID-19 pandemic, the conduct of conventional RCTs was profoundly disrupted. In this paper, we review the existing evidence and gaps in knowledge in the design and conduct of DCTs in MS.
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Affiliation(s)
- Afagh Garjani
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Christopher Martin Allen
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Academic Neurology, Nottingham University Hospitals NHS Trust,
Nottingham, UK
| | | | - Stephen William Gerry
- Centre for Statistics in Medicine, Nuffield
Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,
University of Oxford, Oxford, UK
| | | | - Roshan das Nair
- Mental Health and Clinical Neurosciences
Academic Unit, School of Medicine, University of Nottingham, Nottingham,
UK/Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation
Trust, Nottingham, UK
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre,
Department of Neuroinflammation, UCL Queen Square Institute of Neurology,
Faculty of Brain Sciences, University College London, London, UK/National
Institute for Health Research, University College London Hospitals
Biomedical Research Centre, London, UK/MRC CTU at UCL, Institute of Clinical
Trials and Methodology, University College London, London, UK
| | - Emma C Tallantyre
- Helen Durham Neuro-Inflammatory Unit,
University Hospital of Wales, Cardiff, UK/Division of Psychological Medicine
and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis,
Cleveland Clinic, Cleveland, OH, USA
| | - Nikos Evangelou
- N Evangelou Academic Neurology, Nottingham
University Hospitals NHS Trust, C Floor, South Block, Queen’s Medical Centre,
Nottingham NG7 2UH, UK. ;
@nikosevangelou3
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12
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Yusof MYPM, Teo CH, Ng CJ. Electronic informed consent criteria for research ethics review: a scoping review. BMC Med Ethics 2022; 23:117. [DOI: 10.1186/s12910-022-00849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The research shows a growing trend in using an electronic platform to supplement or replace traditional paper-based informed consent processes. Instead of the traditionally written informed consent document, electronic informed consent (eConsent) may be used to assess the research subject’s comprehension of the information presented. By doing so, respect for persons as one of the research ethical principles can be upheld. Furthermore, these electronic methods may reduce potential airborne infection exposures, particularly during the pandemic, thereby adhering to the beneficence and nonmaleficence principle. This scoping review aims to identify the ethics related criteria that have been included in electronic informed consent processes and to synthesize and map these criteria to research ethics principles, in order to identify the gaps, if any, in current electronic informed consent processes.
Methods
The search was performed based on internet search and three main databases: PubMed, SCOPUS and EBSCO. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation guideline was used to report this work.
Results
Of 34 studies that met the inclusion criteria, 242 essential original constructs were collated, and 7 concepts were derived. Digital content showed the highest percentage of collated original constructs (27%, n = 65) followed by accessibility (24%, n = 56), comprehension engagement (18%, n = 43), autonomy (14%, n = 34), confidentiality (11%, n = 25), language (5%, n = 13), and parental consent (1%, n = 2). Twenty-five new items were synthesized for eConsent criteria which may provide guidance for ethical review of research involving eConsent.
Conclusion
The current study adds significant value to the corpus of knowledge in research ethics by providing ethical criteria on electronic informed consent based on evidence-based data. The new synthesized items in the criteria can be readily used as an initial guide by the IRB/REC members during a review process on electronic informed consent and useful to the future preparation of a checklist.
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13
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Nyholm Gaarskjær A, Crookshanks Duroux M, Hogreffe R. Participant comprehension and perspectives regarding the convenience, security, and satisfaction with teleconsent compared to in-person consent: A parallel-group pilot study among Danish citizens. Contemp Clin Trials Commun 2022; 28:100927. [PMID: 35669485 PMCID: PMC9163420 DOI: 10.1016/j.conctc.2022.100927] [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: 11/19/2021] [Revised: 03/09/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Teleconsent via video conferencing enables decentralized trials with remote consent and has the additional benefit of allowing a real-time reaction to potential misunderstandings. However, participant acceptance of and satisfaction with teleconsent versus in-person consent processes are unknown. Methods We conducted a parallel-group pilot study to evaluate participant comprehension and perspectives regarding the convenience, security, and satisfaction with teleconsent compared to in-person consent among Danish citizens for a hypothetical research study. Results There were no statistically significant differences in perceptions of security or satisfaction between teleconsent and in-person consent arms. However, participants viewed teleconsent as more convenient than in-person consent, as no transportation was needed and the process was less time-consuming. Recruitment was also faster in the teleconsent arm, and more people dropped out of the in-person arm, citing difficulties with transportation and time. Conclusion Decentralized clinical trials have been demonstrated to increase recruitment and enrollment rates, improve trial efficiency, and decrease dropout rates and trial delays. We add to this literature by suggesting that patients perceive teleconsent as similar to in-person consent, suggesting this is a feasible and acceptable substitution for in-person consent in multisite, decentralized trials. Future work should include patient perspectives from a larger, more diverse group of participants.
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Affiliation(s)
- Anne Nyholm Gaarskjær
- Molecular Pharmacology, Department of Health Science and Technology (HST), Faculty of Medicine, Aalborg University, Denmark
| | - Meg Crookshanks Duroux
- Molecular Pharmacology, Department of Health Science and Technology (HST), Faculty of Medicine, Aalborg University, Denmark
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14
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Almeida-Magana R, Maroof H, Grierson J, Clow R, Dinneen E, Al-Hammouri T, Muirhead N, Brew-Graves C, Kelly J, Shaw G. E-Consent-a guide to maintain recruitment in clinical trials during the COVID-19 pandemic. Trials 2022; 23:388. [PMID: 35550639 PMCID: PMC9096749 DOI: 10.1186/s13063-022-06333-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/23/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed daunting challenges when conducting clinical research. Adopting new technologies such as remote electronic consent (e-Consent) can help overcome them. However, guidelines for e-Consent implementation in ongoing clinical trials are currently lacking. The NeuroSAFE PROOF trial is a randomized clinical trial evaluating the role of frozen section analysis during RARP for prostate cancer. In response to the COVID-19 crisis, recruitment was halted, and a remote e-Consent solution was designed. The aim of this paper is to describe the process of implementation, impact on recruitment rate, and patients' experience using e-Consent. METHODS A substantial amendment of the protocol granted the creation of a remote e-Consent framework based on the REDCap environment, following the structure and content of the already approved paper consent form. Although e-Consent obviated the need for in-person meeting, there was nonetheless counselling sessions performed interactively online. This new pathway offered continuous support to patients through remote consultations. The whole process was judged to be compliant with regulatory requirements before implementation. RESULTS Before the first recruitment suspension, NeuroSAFE PROOF was recruiting an average of 9 patients per month. After e-Consent implementation, 63 new patients (4/month) have been enrolled despite a second lockdown, none of whom would have been recruited using the old methods given restrictions on face-to-face consultations. Patients have given positive feedback on the use of the platform. Limited troubleshooting has been required after implementation. CONCLUSION Remote e-Consent-based recruitment was critical for the continuation of the NeuroSAFE PROOF trial during the COVID-19 pandemic. The described pathway complies with ethical and regulatory guidelines for informed consent, while minimizing face-to-face interactions that increase the risk of COVID-19 transmission. This guide will help researchers integrate e-Consent to ongoing or planned clinical trials while uncertainty about the course of the pandemic continues. TRIAL REGISTRATION NeuroSAFE PROOF trial NCT03317990 . Registered on 23 October 2017. Regional Ethics Committee reference 17/LO/1978.
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Affiliation(s)
- Ricardo Almeida-Magana
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Hanna Maroof
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Rosie Clow
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Eoin Dinneen
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Tarek Al-Hammouri
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Nicola Muirhead
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Chris Brew-Graves
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - John Kelly
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Greg Shaw
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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15
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Zimmermann BM, Willem T, Bredthauer CJ, Buyx A. Ethical Issues in Social Media Recruitment for Clinical Studies: Ethical Analysis and Framework. J Med Internet Res 2022; 24:e31231. [PMID: 35503247 PMCID: PMC9115665 DOI: 10.2196/31231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/11/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social media recruitment for clinical studies holds the promise of being a cost-effective way of attracting traditionally marginalized populations and promoting patient engagement with researchers and a particular study. However, using social media for recruiting clinical study participants also poses a range of ethical issues. OBJECTIVE This study aims to provide a comprehensive overview of the ethical benefits and risks to be considered for social media recruitment in clinical studies and develop practical recommendations on how to implement these considerations. METHODS On the basis of established principles of clinical ethics and research ethics, we reviewed the conceptual and empirical literature for ethical benefits and challenges related to social media recruitment. From these, we derived a conceptual framework to evaluate the eligibility of social media use for recruitment for a specific clinical study. RESULTS We identified three eligibility criteria for social media recruitment for clinical studies: information and consent, risks for target groups, and recruitment effectiveness. These criteria can be used to evaluate the implementation of a social media recruitment strategy at its planning stage. We have discussed the practical implications of these criteria for researchers. CONCLUSIONS The ethical challenges related to social media recruitment are context sensitive. Therefore, social media recruitment should be planned rigorously, taking into account the target group, the appropriateness of social media as a recruitment channel, and the resources available to execute the strategy.
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Affiliation(s)
- Bettina M Zimmermann
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany.,Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Theresa Willem
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany.,Department of Science, Technology and Society, School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - Carl Justus Bredthauer
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alena Buyx
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
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16
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Peng ZE, Waz S, Buss E, Shen Y, Richards V, Bharadwaj H, Stecker GC, Beim JA, Bosen AK, Braza MD, Diedesch AC, Dorey CM, Dykstra AR, Gallun FJ, Goldsworthy RL, Gray L, Hoover EC, Ihlefeld A, Koelewijn T, Kopun JG, Mesik J, Shub DE, Venezia JH. FORUM: Remote testing for psychological and physiological acoustics. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:3116. [PMID: 35649891 PMCID: PMC9305596 DOI: 10.1121/10.0010422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/22/2022] [Accepted: 04/22/2022] [Indexed: 05/30/2023]
Abstract
Acoustics research involving human participants typically takes place in specialized laboratory settings. Listening studies, for example, may present controlled sounds using calibrated transducers in sound-attenuating or anechoic chambers. In contrast, remote testing takes place outside of the laboratory in everyday settings (e.g., participants' homes). Remote testing could provide greater access to participants, larger sample sizes, and opportunities to characterize performance in typical listening environments at the cost of reduced control of environmental conditions, less precise calibration, and inconsistency in attentional state and/or response behaviors from relatively smaller sample sizes and unintuitive experimental tasks. The Acoustical Society of America Technical Committee on Psychological and Physiological Acoustics launched the Task Force on Remote Testing (https://tcppasa.org/remotetesting/) in May 2020 with goals of surveying approaches and platforms available to support remote testing and identifying challenges and considerations for prospective investigators. The results of this task force survey were made available online in the form of a set of Wiki pages and summarized in this report. This report outlines the state-of-the-art of remote testing in auditory-related research as of August 2021, which is based on the Wiki and a literature search of papers published in this area since 2020, and provides three case studies to demonstrate feasibility during practice.
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Affiliation(s)
- Z Ellen Peng
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Sebastian Waz
- University of California, Irvine, Irvine, California 92697, USA
| | - Emily Buss
- The University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Yi Shen
- University of Washington, Seattle, Washington 98195, USA
| | | | | | | | - Jordan A Beim
- University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Adam K Bosen
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Meredith D Braza
- The University of North Carolina, Chapel Hill, North Carolina, 27599, USA
| | - Anna C Diedesch
- Western Washington University, Bellingham, Washington 98225, USA
| | | | | | | | | | - Lincoln Gray
- James Madison University, Harrisburg, Virginia 22807, USA
| | - Eric C Hoover
- University of Maryland, College Park, Maryland 20742, USA
| | - Antje Ihlefeld
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | | | - Judy G Kopun
- Boys Town National Research Hospital, Omaha, Nebraska 68131, USA
| | - Juraj Mesik
- University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Daniel E Shub
- Walter Reed National Military Medical Center, Bethesda, Maryland 20814, USA
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17
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Avutu V, Monga V, Mittal N, Saha A, Andolina JR, Bell DE, Fair DB, Flerlage JE, Frediani JN, Heath JL, Kahn JM, Reichek JL, Super L, Terao MA, Freyer DR, Roth ME. Use of Communication Technology to Improve Clinical Trial Participation in Adolescents and Young Adults With Cancer: Consensus Statement From the Children's Oncology Group Adolescent and Young Adult Responsible Investigator Network. JCO Oncol Pract 2022; 18:224-231. [PMID: 34905405 PMCID: PMC8932547 DOI: 10.1200/op.21.00554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adolescents and young adults (AYAs; age 15-39 years) with cancer are under-represented in cancer clinical trials because of patient, provider, and institutional barriers. Health care technology is increasingly available to and highly used among AYAs and has the potential to improve cancer care delivery. The COVID-19 pandemic forced institutions to rapidly adopt novel approaches for enrollment and monitoring of patients on cancer clinical trials, many of which have the potential for improving AYA trial participation overall. This consensus statement from the Children's Oncology Group AYA Oncology Discipline Committee reviews opportunities to use technology to optimize AYA trial enrollment and study conduct, as well as considerations for widespread implementation of these practices. The use of remote patient eligibility screening, electronic informed consent, virtual tumor boards, remote study visits, and remote patient monitoring are recommended to increase AYA access to trials and decrease the burden of participation. Widespread adoption of these strategies will require new policies focusing on reimbursement for telehealth, license portability, facile communication between electronic health record systems and advanced safeguards to maintain patient privacy and security. Studies are needed to determine optimal approaches to further incorporate technology at every stage of the clinical trial process, from enrollment through study completion.
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Affiliation(s)
- Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center; New York, NY,Viswatej Avutu, MD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th Floor 14, New York, NY 10065; e-mail:
| | - Varun Monga
- Division of Medical Oncology, Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Nupur Mittal
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aniket Saha
- Division of Pediatric Hematology-Oncology, University of South Carolina School of Medicine, Greenville, SC
| | - Jeffrey R. Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Danielle E. Bell
- Department of Pediatrics, Ascension St John Hospital, Detroit, MI
| | - Douglas B. Fair
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, UT
| | - Jamie E. Flerlage
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Jessica L. Heath
- Departments of Pediatrics and Biochemistry, University of Vermont, Burlington, VT
| | - Justine M. Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
| | - Jennifer L. Reichek
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Leanne Super
- Department of Paediatrics, School of Medicine, Monash University, Melbourne, Australia
| | - Michael A. Terao
- Division of Pediatric Adolescent and Young Adult Hematology and Oncology, Department of Pediatrics, Medstar Georgetown University Hospital, Washington, DC
| | - David R. Freyer
- Departments of Pediatrics, Medicine, and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Tele-consent using mixed reality glasses (NREAL) in pediatric inguinal herniorrhaphy: a preliminary study. Sci Rep 2022; 12:3105. [PMID: 35210442 PMCID: PMC8873334 DOI: 10.1038/s41598-022-06653-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/27/2022] [Indexed: 11/08/2022] Open
Abstract
There is an increasing demand and need for patients and caregivers to actively participate in the treatment process. However, when there are unexpected findings during pediatrics surgery, access restrictions in the operating room may lead to a lack of understanding of the medical condition, as the caregivers are forced to indirectly hear about it. To overcome this, we designed a tele-consent system that operates through a specially constructed mixed reality (MR) environment during surgery. We enrolled 11 patients with unilateral inguinal hernia and their caregivers among the patients undergoing laparoscopic inguinal herniorrhaphy between January through February 2021. The caregivers were informed of the intraoperative findings in real-time through MR glasses outside the operating room. After surgery, we conducted questionnaire surveys to evaluate the satisfaction and usefulness of tele-consent. We identified contralateral patent processus vaginalis in seven out of 11 patients, and then additionally performed surgery on the contralateral side with tele-consent from their caregivers. Most caregivers and surgeons answered positively about the satisfaction and usefulness of tele-consent. This study found that tele-consent with caregivers using MR glasses not only increased the satisfaction of caregivers and surgeons, but also helped to accommodate real-time findings by adapting surgical plan through the tele-consent.
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19
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De Sutter E, Geerts D, Borry P, Coteur K, Bamps D, Marynissen H, Ampe E, Geenens E, Depré M, Huys I. Co-creation with research participants to inform the design of electronic informed consent. Digit Health 2022; 8:20552076221109068. [PMID: 35783466 PMCID: PMC9243370 DOI: 10.1177/20552076221109068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to provide recommendations for a personalized electronic informed consent interface that is adapted to research participants’ needs and could enable a longitudinal interaction between the participants and the research team. Methods The co-creation process consisted of three co-creation workshops, one focus group discussion, and four semi-structured interviews. In total, 24 participants, who had taken part in four disparate clinical studies in Belgium, were involved. Descriptive statistics and qualitative content analysis were applied to analyze the survey data and audio recordings. Results Varying perceptions on the type and amount of information described in an informed consent form were reported. Other findings were related to the structure and presentation of information, setting preferences for data sharing, and electronically signing new informed consent versions. Regarding the long-term interaction, most of the participants wanted to receive progress updates, including the results, of the study in which they had taken part. They proposed to receive a notification, preferably via email, in case new information is made available on the electronic informed consent interface. Conclusions To optimally support the design of an electronic informed consent interface, it is key to understand the research participants’ needs. Study findings suggest that an electronic informed consent interface may be a promising technological application to interactively provide study-related information and to keep participants informed during and after the clinical study.
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Affiliation(s)
- Evelien De Sutter
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - David Geerts
- KU Leuven Digital Society Institute, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, Center for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Kristien Coteur
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Dorien Bamps
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Heleen Marynissen
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Els Ampe
- Center for Clinical Pharmacology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Els Geenens
- Center for Clinical Pharmacology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marleen Depré
- Center for Clinical Pharmacology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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20
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Fisher LB, Tuchman S, Curreri A, Markgraf M, Nyer MB, Cassano P, Iverson G, Fava M, Zafonte R, Pedrelli P. Conducting Clinical Research Remotely for Individuals with Traumatic Brain Injury (TBI) and Depression during the COVID-19 Pandemic: Transitioning from In-Person to Remote Implementation. JMIR Form Res 2021; 5:e28734. [PMID: 34662285 PMCID: PMC8638786 DOI: 10.2196/28734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/18/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070
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Affiliation(s)
- Lauren B Fisher
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Sylvie Tuchman
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US
| | - Andrew Curreri
- Center for Anxiety and Related Disorders, Boston University, Boston, US
| | - Maggie Markgraf
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US
| | - Maren B Nyer
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Paolo Cassano
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Grant Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, US.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, US.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, US
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, US.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, US.,Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, US.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, US
| | - Paola Pedrelli
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square6th Floor, Boston, US.,Department of Psychiatry, Harvard Medical School, Boston, US
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21
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Eng C, Chen EY, Rogers J, Lewis M, Strosberg J, Thota R, Krishnamurthi S, Oberstein P, Govindarajan R, Buchschacher G, Patel S, Sohal D, Al-Toubah T, Philip P, Dasari A, Kennecke H, Stein S. Moving Beyond the Momentum: Innovative Approaches to Clinical Trial Implementation. JCO Oncol Pract 2021; 17:607-614. [PMID: 33534616 PMCID: PMC8791825 DOI: 10.1200/op.20.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Despite efforts to enhance enrollment and the merger of national cooperative groups, < 5% of patients with cancer will enroll into a clinical trial. Additionally, clinical trials are affected by a lack of diversity inclusive of minority patients, rural residents, or low-income individuals. COVID-19 further exacerbated known barriers of reduced physician-patient interaction, physician availability, trial activation and enrollment, financial resources, and capacity for conducting research. Based on the cumulative insight of academic and community clinical researchers, we have created a white paper identifying existing challenges in clinical trial conduct and have provided specific recommendations of sustainable modifications to improve efficiency in the activation and conduct of clinical trials with an overarching goal of providing improved access and care to our patients with cancer.
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Affiliation(s)
- Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN,Cathy Eng, MD, Vanderbilt-Ingram Cancer Center, Gastrointestinal Cancer Research Program, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN 37232; e-mail:
| | - Emerson Y. Chen
- Division of Hematology and Oncology, Oregon Health and Science University, Knight Cancer Institute, Portland, OR
| | - Jane Rogers
- University of Texas MD Anderson Cancer Center Pharmacy Clinical Programs, Houston, TX
| | | | | | | | | | | | - Rang Govindarajan
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas, Little Rock, AR
| | | | - Sandip Patel
- Moores Cancer Center, UC San Diego Health, La Jolla, CA
| | - Davendra Sohal
- University of Cincinnati Health Barrett Cancer Center, Cincinnati, OH
| | | | | | - Arvind Dasari
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Stacey Stein
- Smilow Cancer Center, Yale School of Medicine, New Haven, CT
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22
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Alvarez-Perea A, Dimov V, Popescu FD, Zubeldia JM. The applications of eHealth technologies in the management of asthma and allergic diseases. Clin Transl Allergy 2021; 11:e12061. [PMID: 34504682 PMCID: PMC8420996 DOI: 10.1002/clt2.12061] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 01/14/2023] Open
Abstract
Portable devices, such as smartphones and mobile Internet access have become ubiquitous in the last decades. The term 'eHealth' stands for electronic health. The tools included in the eHealth concept utilize phones, computers and the Internet and related applications to improve the health care industry. Implementation of eHealth technologies has been documented for the management of different chronic diseases, including asthma and allergic conditions. Clinicians and patients have gained opportunity to communicate in new ways, which could be used cost-effectively to improve disease control and quality of life of those affected. Additionally, these innovations bring new opportunities to academic researchers. For example, eHealth has allowed researchers to compile data points that were previously unavailable or difficult to access, and analyse them using novel tools, collectively described as 'big data'. The role of eHealth become more important since early 2020, due to the physical distancing rules and the restrictions on mobility that have been applied worldwide as a response to the coronavirus disease 2019 pandemic. In this review, we summarize the most recent developments in various eHealth platforms and their relevance to the speciality of allergy and immunology, from the point of view of three major stakeholders: clinicians, patients and researchers.
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Affiliation(s)
- Alberto Alvarez-Perea
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain
| | - Ves Dimov
- Cleveland Clinic Florida FAU Charles E. Schmidt College of Medicine Weston Florida USA
| | - Florin-Dan Popescu
- Department of Allergology 'Nicolae Malaxa' Clinical Hospital 'Carol Davila' University of Medicine and Pharmacy Bucharest Romania
| | - José Manuel Zubeldia
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain.,Biomedical Research Network on Rare Diseases (CIBERER)-U761 Madrid Spain
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Wang Z, Du A, Li M, Zang S, Liu X, Zhang D, Chen G, Zhang L, Zhang Y, Wang J. Application of a Cloud Video Conference Method for Recruiting Healthy Subjects Into an Early-Phase Clinical Trial During the COVID-19 Pandemic. Front Public Health 2021; 9:657804. [PMID: 34490177 PMCID: PMC8416603 DOI: 10.3389/fpubh.2021.657804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: Our objective is to explore the effect of applying cloud video conferencing methods to the informed consent process in an early-phase clinical trial during the COVID-19 pandemic. Methods: All participants who intended to participate in the trial were informed via a cloud video conference before signing the informed consent forms (ICF). Then, the attitudes of the participants with the cloud video conference and their understanding of the trial were evaluated using a questionnaire when they visited to sign the ICF onsite. Results: A total of 165 subjects participated in the cloud video conference process, and 142 visited the site to sign and date the ICFs at the center during the appointment time. The survey showed that nearly 100% of the subjects evaluated the video-based informed consent process as very good or good and gave correct answers to questions about the trial. Furthermore, 136 (95.8%) subjects believed that the knowledge about the trial derived via the video-based informed consent process was consistent with the onsite reality, and 139 (97.9%) subjects expressed their willingness to participate in an informed consent procedure undertaken through an online video conference. Conclusions: The video-based informed consent process achieved the same effects as an onsite informed consent process. The former saves time and cost of transportation for the subject and exhibits good public acceptance; especially in light of the COVID-19 pandemic, this process is conducive for reducing the risk of subject infection due to travel and would also help avoid crowding on site.
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Affiliation(s)
- Zejuan Wang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Aihua Du
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Min Li
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Siqi Zang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Xiaona Liu
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Dan Zhang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Gang Chen
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Lina Zhang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Yanan Zhang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
| | - Jin Wang
- Department of Clinical Pharmacology, Aerospace Center Hospital, Beijing, China
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Kasherman L, Madariaga A, Liu Q, Bonilla L, McMullen M, Liu SL, Wang L, Fazelzad R, Karakasis K, Heesters AM, Oza AM. Ethical frameworks in clinical research processes during COVID-19: a scoping review. BMJ Open 2021; 11:e047076. [PMID: 34301656 PMCID: PMC8313312 DOI: 10.1136/bmjopen-2020-047076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES In response to the COVID-19 pandemic there have been significant developments in research, its conduct and the supporting ethical framework. While many protocols have been delayed, halted or modified, other research efforts have been accelerated, generating controversy. The goal of this paper is to determine the rates of references surrounding the ethical oversight of research as reported in current COVID-19-related research publications. DESIGN Scoping review. SETTING Population-based observational or interventional studies from December 2019 to May 2020 with sample size of two or more. Studies were searched through electronic databases including Medline, EMBASE, and Cochrane CENTRAL Register of Controlled Trials. PARTICIPANTS Eligibility criteria included participants within published studies who tested positive for COVID-19. MAIN OUTCOMES AND MEASURES Data were extracted and charting methods included taking note of references to ethical frameworks, institutional review board (IRB), ethics committee (EC) or research ethics board (REB) involvement, consent processes, and other variables. RESULTS 11 556 articles were screened, with 656 included in the final analysis. References to ethics were present in 530 (80.8%) studies, with 491 (74.8%) involving IRB/ECs/REBs and 126 (19.2%) not referencing ethics. Consent processes were outlined in 201 (30.6%) studies, with 198 (30.2%) reporting that they obtained consent waivers, however, 257 (39.2%) did not mention consent at all. Differences (p<0.001) in ethics-related references were apparent when analysed by continent, publication type, sample size and IF. CONCLUSIONS The majority of published articles pertaining to COVID-19 research made mention of ethical considerations, however, national and regional variations in research ethics review requirements introduce heterogeneity between studies and raise important questions about the conduct of scientific research during global public emergencies. TRIAL REGISTRATION NUMBER Open Science Framework: https://osfio/z67wb.
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Affiliation(s)
- Lawrence Kasherman
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, Australia
- St George and Sutherland Clinical Schools, University of New South Wales, Kogarah, New South Wales, Australia
| | - Ainhoa Madariaga
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Autonomous University of Barcelona, Barcelona, Spain
| | - Qin Liu
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Haematology, St George Hospital, Kogarah, New South Wales, Australia
| | - Luisa Bonilla
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Michelle McMullen
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Shiru Lucy Liu
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- British Columbia Cancer Agency, Surrey, British Columbia, Canada
| | - Lisa Wang
- University of Toronto, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Katherine Karakasis
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Ann M Heesters
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
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Boughey JC, Snyder RA, Kantor O, Zheng L, Chawla A, Nguyen TT, Hillman SL, Hahn OM, Mandrekar SJ, Roland CL. Impact of the COVID-19 Pandemic on Cancer Clinical Trials. Ann Surg Oncol 2021; 28:7311-7316. [PMID: 34236550 PMCID: PMC8265286 DOI: 10.1245/s10434-021-10406-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022]
Abstract
The COVID-19 pandemic has had widespread impact on healthcare, resulting in modifications to how we perform cancer research, including clinical trials for cancer. The impact of some healthcare workers and study coordinators working remotely and patients minimizing visits to medical facilities impacted clinical trial participation. Clinical trial accrual dropped at the onset of the pandemic, with improvement over time. Adjustments were made to some trial protocols, allowing telephone or video-enabled consent. Certain study activities were permitted to be performed by local healthcare providers or at local laboratories to maximize patients' ability to continue on study during these challenging times. We discuss the impact of COVID-19 on cancer clinical trials and changes at the local, cooperative group, and national level.
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Affiliation(s)
| | - Rebecca A Snyder
- Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Olga Kantor
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Linda Zheng
- American College of Surgeons Cancer Research Program, Chicago, IL, USA
| | - Akhil Chawla
- Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Shauna L Hillman
- Department of Health Sciences Research, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Olwen M Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL, USA
| | - Sumithra J Mandrekar
- Department of Health Sciences Research, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Christina L Roland
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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26
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Bunnell BE, Kazantzis N, Paige SR, Barrera J, Thakkar RN, Turner D, Welch BM. Provision of Care by "Real World" Telemental Health Providers. Front Psychol 2021; 12:653652. [PMID: 34025519 PMCID: PMC8138039 DOI: 10.3389/fpsyg.2021.653652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Despite its effectiveness, limited research has examined the provision of telemental health (TMH) and how practices may vary according to treatment paradigm. We surveyed 276 community mental health providers registered with a commercial telemedicine platform. Most providers reported primarily offering TMH services to adults with anxiety, depression, and trauma-and stressor-related disorders in individual therapy formats. Approximately 82% of TMH providers reported endorsing the use of Cognitive Behavioral Therapy (CBT) in their remote practice. The most commonly used in-session and between-session (i.e., homework) exercises included coping and emotion regulation, problem solving, mindfulness, interpersonal skills, relaxation, and modifying and addressing core beliefs. CBT TMH providers had a higher odds of using in-session and homework exercises and assigning them through postal mail, email or fax methods, as compared to non-CBT TMH providers. TMH providers, regardless of treatment paradigm, felt that assigning homework was neither easy nor difficult and they believed their patients were somewhat-to-moderately compliant to their assigned exercises. CBT TMH providers also collected clinical information from their patients more often than non-CBT TMH providers. They reported being less satisfied with their method, which was identified most often as paper-based surveys and forms. Overall, TMH providers employ evidence-based treatments to their patients remotely, with CBT TMH providers most likely to do so. Findings highlight the need for innovative solutions to improve how TMH providers that endorse following the CBT treatment paradigm remotely assign homework and collect clinical data to increase their satisfaction via telemedicine.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Institute for Social Neuroscience Psychology, Melbourne, VIC, Australia
| | | | - Janelle Barrera
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Rajvi N. Thakkar
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Dylan Turner
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me, Inc., Rochester, NYUnited States
- Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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Shah ND, Krupinski EA, Bernard J, Moyer MF. The evolution and utilization of telehealth in ambulatory nutrition practice. Nutr Clin Pract 2021; 36:739-749. [PMID: 33734469 DOI: 10.1002/ncp.10641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The term telehealth is often used interchangeably with telemedicine. Telemedicine involves the electronic exchange of medical information between two remote sites for the optimization of patient care, whereas telehealth is the application of all electronic communication and delivery systems in the provision of healthcare. Telehealth gives patients an opportunity to communicate with their healthcare providers and, overall, access ambulatory care that otherwise is not available in their area of residence. Several telehealth delivery systems are available for electronic communication. Telehealth and other communications technologies used in the delivery of healthcare services are regulated at both the federal and state levels. Coverage and payment policies vary among the different insurers (e.g., Medicare, Medicaid, and private plans), and policies may further be defined by state telehealth parity laws. Telenutrition involves the use of digital technology to provide nutrition care to patients and caregivers and shows potential to optimize nutrition care and outcomes. The coronavirus disease 2019 pandemic has contributed to sweeping legislative and regulatory changes that allowed the temporary expansion of telehealth delivery and reimbursement to maintain continuity of care for patients who were not able to come in for an in-person office visit with their healthcare provider. The purpose of this review is to introduce key concepts of telehealth delivery systems including policy, legal, and regulatory considerations for ambulatory care as well as the role of telenutrition in nutrition care, and highlight the evolving role of telehealth in optimizing patient and nutrition care during a pandemic and beyond.
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Affiliation(s)
- Neha D Shah
- Department of Nutrition and Food Services, University of San Francisco, San Francisco, California, USA.,Neha Shah Nutrition, San Francisco, California, USA
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | | | - Meagan F Moyer
- Department of Clinical Nutrition Services, Stanford Health Care, Stanford, California, USA
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28
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Knudsen KE, Willman C, Winn R. Optimizing the Use of Telemedicine in Oncology Care: Postpandemic Opportunities. Clin Cancer Res 2021; 27:933-936. [PMID: 33229457 PMCID: PMC7887011 DOI: 10.1158/1078-0432.ccr-20-3758] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022]
Abstract
Utilization of telehealth as part of the cancer care delivery continuum dramatically escalated in response to the COVID-19 pandemic at major cancer centers across the globe. The rapid shift toward telehealth visits for nontreatment cancer care provided immediate benefit through reducing unnecessary risk of exposure, overcoming transportation barriers faced by both patients and caregivers, and fast-tracking care transformation. As such, delineating the impact of telehealth on access, health equity, quality, and outcomes will be essential for refining the use of digital strategies and telehealth toward optimizing cancer care. Herein, experiences to date with telehealth usage for oncology care are reviewed, and priorities are outlined for postpandemic opportunities to improve the lives of patients with cancer through telemedicine.
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Affiliation(s)
- Karen E Knudsen
- Sidney Kimmel Cancer Center at Jefferson Health and Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Cheryl Willman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Robert Winn
- Virginia Commonwealth University Massey Cancer Center, Richmond, Virginia
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29
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Dahne J, Tomko RL, McClure EA, Obeid JS, Carpenter MJ. Remote Methods for Conducting Tobacco-Focused Clinical Trials. Nicotine Tob Res 2020; 22:2134-2140. [PMID: 32531046 PMCID: PMC7454765 DOI: 10.1093/ntr/ntaa105] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/08/2020] [Indexed: 01/07/2023]
Abstract
Most tobacco-focused clinical trials are based on locally conducted studies that face significant challenges to implementation and successful execution. These challenges include the need for large, diverse, yet still representative study samples. This often means a protracted, costly, and inefficient recruitment process. Multisite clinical trials can overcome some of these hurdles but incur their own unique challenges. With recent advances in mobile health and digital technologies, there is now a promising alternative: Remote Trials. These trials are led and coordinated by a local investigative team, but are based remotely, within a given community, state, or even nation. The remote approach affords many of the benefits of multisite trials (more efficient recruitment of larger study samples) without the same barriers (cost, multisite management, and regulatory hurdles). The Coronavirus Disease 2019 (COVID-19) global health pandemic has resulted in rapid requirements to shift ongoing clinical trials to remote delivery and assessment platforms, making methods for the conduct of remote trials even more timely. The purpose of the present review is to provide an overview of available methods for the conduct of remote tobacco-focused clinical trials as well as illustrative examples of how these methods have been implemented across recently completed and ongoing tobacco studies. We focus on key aspects of the clinical trial pipeline including remote: (1) study recruitment and screening, (2) informed consent, (3) assessment, (4) biomarker collection, and (5) medication adherence monitoring. Implications With recent advances in mobile health and digital technologies, remote trials now offer a promising alternative to traditional in-person clinical trials. Remote trials afford expedient recruitment of large, demographically representative study samples, without undo burden to a research team. The present review provides an overview of available methods for the conduct of remote tobacco-focused clinical trials across key aspects of the clinical trial pipeline.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Jihad S Obeid
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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31
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Brezing CA, Luo SX, Mariani JJ, Levin FR. Digital Clinical Trials for Substance Use Disorders in the Age of Covid-19. J Addict Med 2020; 14:e297-e302. [PMID: 32956164 PMCID: PMC7647443 DOI: 10.1097/adm.0000000000000733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
: As a result of the coronavirus 2019 (Covid-19) pandemic, clinical research for substance use disorders (SUDs) has been impeded due to widespread stay-at-home mandates limiting the operations of "non-essential" work. Although appropriate to proceed with an abundance of caution to prevent viral spread, there will be detrimental consequences for patients with SUDs if clinical trials research cannot adapt and continue uninterrupted. The field of digital health has strong evidence for its feasibility and effectiveness and offers tools that can facilitate the continuation of SUD clinical trials research remotely in accordance with Covid-19 precautions. Some digital tools have been used as components of SUD research in the past; however, no published clinical trial in SUDs to-date has been entirely virtual. This has important implications for disrupted clinical care, as providers seek guidelines for best digital practices. This paper provides a roadmap for integrating the fields of digital health and SUD clinical trials by proposing methods to complete recruitment, screening, informed consent, other study procedures, and internal lab operations digitally. The immediate future of SUD research depends on the ability to comply with social distancing. Investment in research of digital clinical trials for SUDs provides an opportunity to cultivate benefits for research and clinical care long-term as we can (1) define regulatory requirements for the implementation of digital systems, (2) develop consensus on system-wide standards and protocols in the appropriate use of technology, and (3) gain experience that can translate to the treatment of patients with SUDs through telehealth in the community.
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Affiliation(s)
- Christina A Brezing
- New York State Psychiatric Institute, Division of Substance Use Disorders, 1051 Riverside Drive, New York, NY(CB, SL, JM, FL); Department of Psychiatry, Columbia University Irving Medical Center, New York, NY (CB, SL, JM, FL)
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Acceptability of Telemedicine Features to Promote Its Uptake in Practice: A Survey of Community Telemental Health Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228525. [PMID: 33212979 PMCID: PMC7698537 DOI: 10.3390/ijerph17228525] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
Understanding what motivates mental health providers to use telemedicine (i.e., telemental health) is critical for optimizing its uptake, especially during unprecedented times (e.g., the COVID-19 pandemic). Drawing from the Technology Acceptance Model (TAM), this report examined the characteristics of telemental health providers and how the acceptability of telemedicine features contributes to their intention to use the technology more often in practice. Telemental health providers (N = 177) completed an online survey between March and May 2019. Most providers (75%) spent less than 25% of their work-week using telemedicine, but 70% reported an intention to use telemedicine more in the future. The belief that telemedicine affords greater access to patients, work-life balance, flexibility in providing care, and the opportunity to be at the forefront of innovative care were significant predictors of intentions to use the technology more in the future. Other significant predictors included needing assistance to coordinate insurance reimbursements, manage a successful telemedicine practice, and integrate the telemedicine program with other health IT software. Findings have important implications for increasing the frequency of telemedicine use among telemental health providers. Future research and practice should leverage providers' positive beliefs about telemedicine acceptability and consider their needs to enhance its uptake.
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Skelton E, Drey N, Rutherford M, Ayers S, Malamateniou C. Electronic consenting for conducting research remotely: A review of current practice and key recommendations for using e-consenting. Int J Med Inform 2020; 143:104271. [PMID: 32979650 PMCID: PMC7487205 DOI: 10.1016/j.ijmedinf.2020.104271] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Electronic approaches are becoming more widely used to obtain informed consent for research participation. Electronic consent (e-consent) provides an accessible and versatile approach to the consenting process, which can be enhanced with audio-visual and interactive features to improve participant engagement and comprehension of study procedures. Best practice guidance underpinned by ethical principles is required to ensure effective implementation of e-consent for use in research. AIM To identify the key considerations for successful and ethical implementation of e-consent in the recruitment of participants to research projects which are conducted remotely. METHODS Electronic database searches of CINAHL, Medline, Embase, DARE, HTA, PubMed, the Cochrane Library, Scopus, Web of Science, NHS Evidence, and hand-searches of reference lists were performed. Primary research studies of adult (≥ 18 years old) research participants using e-consent, published in English language, peer-reviewed journals between 2010-2020 were eligible for inclusion. RESULTS Of the initial 665 identified studies, 18 met the inclusion criteria: 6 cohort studies, 5 qualitative studies, 4 randomised control trials, 2 mixed-methods studies and one case-control study. Critical appraisal of included studies using Critical Appraisal Skills Program (CASP) tools suggested a low to moderate risk of bias in most studies (n = 15). Key practice recommendations for researchers using e-consent were identified around five primary themes: 1) accessibility and user-friendliness of e-consent, 2) user engagement and comprehension, 3) customisability to participant preferences and demographics, 4) data security and 5) impact on research teams. CONCLUSION E-consenting approaches are generally well received by participants, with most studies reporting user-friendly interfaces and sufficient participant comprehension of consenting documentation. IMPLICATIONS FOR PRACTICE E-consent may facilitate remotely-conducted research by offering a feasible and robust alternative to face-to-face consenting approaches, however paper-based options should still be offered, based on participant preference. Customising e-consenting platforms may improve accessibility for individuals with specific needs, and increase engagement with study information. Research teams must offer prospective participants opportunities to discuss study information in real-time.
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Affiliation(s)
- Emily Skelton
- Division of Radiography and Midwifery, City, University of London, UK; Department of Perinatal Imaging and Health, King's College London, UK.
| | | | - Mary Rutherford
- Department of Perinatal Imaging and Health, King's College London, UK
| | - Susan Ayers
- Division of Radiography and Midwifery, City, University of London, UK
| | - Christina Malamateniou
- Division of Radiography and Midwifery, City, University of London, UK; Department of Perinatal Imaging and Health, King's College London, UK
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Pung J, Rienhoff O. Key components and IT assistance of participant management in clinical research: a scoping review. JAMIA Open 2020; 3:449-458. [PMID: 33215078 PMCID: PMC7660951 DOI: 10.1093/jamiaopen/ooaa041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 01/05/2023] Open
Abstract
Objectives Managing participants and their data are fundamental for the success of a clinical trial. Our review identifies and describes processes that deal with management of trial participants and highlights information technology (IT) assistance for clinical research in the context of participant management. Methods A scoping literature review design, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, was used to identify literature on trial participant-related proceedings, work procedures, or workflows, and assisting electronic systems. Results The literature search identified 1329 articles of which 111 were included for analysis. Participant-related procedures were categorized into 4 major trial processes: recruitment, obtaining informed consent, managing identities, and managing administrative data. Our results demonstrated that management of trial participants is considered in nearly every step of clinical trials, and that IT was successfully introduced to all participant-related areas of a clinical trial to facilitate processes. Discussion There is no precise definition of participant management, so a broad search strategy was necessary, resulting in a high number of articles that had to be excluded. Nevertheless, this review provides a comprehensive overview of participant management-related components, which was lacking so far. The review contributes to a better understanding of how computer-assisted management of participants in clinical trials is possible.
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Affiliation(s)
- Johannes Pung
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
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Saini KS, de las Heras B, Plummer R, Moreno V, Romano M, de Castro J, Aftimos P, Fredriksson J, Bhattacharyya GS, Olivo MS, Schiavon G, Punie K, Garcia-Foncillas J, Rogata E, Pfeiffer R, Orbegoso C, Morrison K, Curigliano G, Chin L, Saini ML, Rekdal Ø, Anderson S, Cortes J, Leone M, Dancey J, Twelves C, Awada A. Reimagining Global Oncology Clinical Trials for the Postpandemic Era: A Call to Arms. JCO Glob Oncol 2020; 6:1357-1362. [PMID: 32897732 PMCID: PMC7529519 DOI: 10.1200/go.20.00346] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Kamal S. Saini
- Covance, Princeton, NJ,East Suffolk and North Essex NHS Foundation Trust, Ipswich, United Kingdom,Kamal S. Saini, MD, MBBS, Covance, 206 Carnegie Center, Princeton, NJ 08540-6233; Twitter: @KSainiMD; e-mail:
| | | | - Ruth Plummer
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Victor Moreno
- START Madrid-FJD, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Philippe Aftimos
- Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | - Gaia Schiavon
- R&D Oncology, AstraZeneca, Cambridge, United Kingdom
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jesus Garcia-Foncillas
- University Hospital Fundacion Jimenez Diaz, Autonomous University of Madrid, Madrid, Spain
| | - Ernesto Rogata
- Leeds Cancer Centre, Patient and Public Involvement Group, Leeds, United Kingdom
| | | | | | | | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy,University of Milano, Milan, Italy
| | - Lynda Chin
- Apricity Health, Houston, TX,Dell Medical School at the University of Texas at Austin, Austin, TX
| | | | | | | | - Javier Cortes
- IOB Institute of Oncology, Quiron Group, Madrid, Spain
| | | | - Janet Dancey
- Canadian Cancer Trials Group, Queen’s University, Kingston, Ontario, Canada
| | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Ahmad Awada
- Oncology Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Strujo E, Sanders M, Fiscella K, Thomas M, Johnson B, Deets A, Sanchez Lucas C, Holder T, Johal N, Luque A, Cassells A, Williams S, Tobin JN. COVID-19 impact on multi-site recruitment and enrollment. Clin Trials 2020; 17:501-504. [PMID: 32815379 DOI: 10.1177/1740774520946270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Emma Strujo
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Mechelle Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Marie Thomas
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brent Johnson
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alex Deets
- University of Texas Southwestern Medical Center/Parkland Health and Hospital System, Dallas, TX, USA
| | - Claudia Sanchez Lucas
- University of Texas Southwestern Medical Center/Parkland Health and Hospital System, Dallas, TX, USA
| | - Tameir Holder
- Clinical Directors Network, Inc. (CDN), New York, NY, USA
| | - Nina Johal
- Clinical Directors Network, Inc. (CDN), New York, NY, USA
| | - Amneris Luque
- University of Texas Southwestern Medical Center/Parkland Health and Hospital System, Dallas, TX, USA
| | | | | | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY, USA.,The Rockefeller University Center for Clinical and Translational Science, New York, NY, USA
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Giordano NJ, Alanis N, Frey JA, Hall GL, Coates WC. The Fine Balance: Adapting Clinical Research Into COVID-19 Response. Acad Emerg Med 2020; 27:767-770. [PMID: 32557907 PMCID: PMC7323078 DOI: 10.1111/acem.14059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas J. Giordano
- From the Department of Emergency Medicine Harvard Medical SchoolMassachusetts General Hospital Boston MA
| | - Naomi Alanis
- the Department of Emergency Medicine Integrative Emergency Services, TCU and UNTHSC School of Medicine Fort Worth TX
| | - Jennifer A. Frey
- the Department of Emergency Medicine The Ohio State University Columbus OH
| | - Grace L. Hall
- the Divisions of Trauma and Emergency Medicine Department of Surgery Duke University School of Medicine Durham NC
| | - Wendy C. Coates
- and the Department of Emergency Medicine Los Angeles David Geffen School of Medicine University of California Los Angeles CA
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38
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Stiles-Shields C, Plevinsky JM, Psihogios AM, Holmbeck GN. Considerations and Future Directions for Conducting Clinical Research With Pediatric Populations During the COVID-19 Pandemic. J Pediatr Psychol 2020; 45:720-724. [PMID: 32676670 PMCID: PMC7381185 DOI: 10.1093/jpepsy/jsaa055] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | - Jill M Plevinsky
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Adherence and Self-Management
| | - Alexandra M Psihogios
- The Children’s Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania
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39
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Binder AF, Handley NR, Wilde L, Palmisiano N, Lopez AM. Treating Hematologic Malignancies During a Pandemic: Utilizing Telehealth and Digital Technology to Optimize Care. Front Oncol 2020; 10:1183. [PMID: 32676459 PMCID: PMC7333768 DOI: 10.3389/fonc.2020.01183] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 12/19/2022] Open
Abstract
In late January 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) was reported as an outbreak in Wuhan, China. Within 2 months it became a global pandemic. Patients with cancer are at highest risk for both contracting and suffering complications of its resultant disease, Coronavirus 19 (COVID-19). Healthcare systems across the world had to adapt quickly to mitigate this risk, while continuing to provide potentially lifesaving treatment to patients. Bringing care to the home through the use of telehealth, home based chemotherapy, and remote patient monitoring technologies can help minimize risk to the patient and healthcare workers without sacrificing quality of care delivered. These care models provide the right treatment, to the right patient, at the right time, in the right place. Whether these patient-centered models of care will continue to be embraced by key stakeholders after the pandemic remains uncertain.
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Affiliation(s)
- Adam F Binder
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Nathan R Handley
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Lindsay Wilde
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Neil Palmisiano
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Ana Maria Lopez
- Department of Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
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Abstract
A severe coronavirus disease 2019 patient admitted to our institution for medical management was enrolled in a randomized placebo-controlled trial of an investigational therapeutic for coronavirus disease 2019. We leveraged existing video-telecommunication equipment to obtain informed consent. We found video-telecommunication use closely mirrored person-to-person contact for research consent by maintaining engagement and ensuring understanding. Video-telecommunication use facilitated clinical research while minimizing unnecessary exposure to coronavirus disease 2019 and conserving personal protective equipment. Prior to the coronavirus disease 2019 pandemic, research regulatory agencies were essentially silent on the matter of video-telecommunication consent. Regulatory guidance became available during the pandemic in response to increased isolation and social distancing practices. Virtual health and telemedicine use expanded greatly during the pandemic, and this increase will likely persist after the pandemic ends. We anticipate video-telecommunication adoption and implementation for research consent will also continue to grow after the coronavirus disease 2019 pandemic is over.
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41
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Chen C, Lee PI, Pain KJ, Delgado D, Cole CL, Campion TR. Replacing Paper Informed Consent with Electronic Informed Consent for Research in Academic Medical Centers: A Scoping Review. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2020; 2020:80-88. [PMID: 32477626 PMCID: PMC7233043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although experts have identified benefits to replacing paper with electronic consent (eConsent) for research, a comprehensive understanding of strategies to overcome barriers to adoption is unknown. To address this gap, we performed a scoping review of the literature describing eConsent in academic medical centers. Of 69 studies that met inclusion criteria, 81% (n=56) addressed ethical, legal, and social issues; 67% (n=46) described user interface/user experience considerations; 39% (n=27) compared electronic versus paper approaches; 33% (n=23) discussed approaches to enterprise scalability; and 25% (n=17) described changes to consent elections. Findings indicate a lack of a leading commercial eConsent vendor, as articles described a myriad of homegrown systems and extensions of vendor EHR patient portals. Opportunities appear to exist for researchers and commercial software vendors to develop eConsent approaches that address the five critical areas identified in this review.
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Affiliation(s)
- Cindy Chen
- Information Technologies & Services Department, Weill Cornell Medicine, New York, NY
| | - Pou-I Lee
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Kevin J Pain
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Curtis L Cole
- Information Technologies & Services Department, Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Thomas R Campion
- Information Technologies & Services Department, Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
- Clinical & Translational Science Center, Weill Cornell Medicine, New York, NY
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42
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Carr DJ, Adia AC, Wray TB, Celio MA, Pérez AE, Monti PM. Using the Internet to access key populations in ecological momentary assessment research: Comparing adherence, reactivity, and erratic responding across those enrolled remotely versus in-person. Psychol Assess 2020; 32:768-779. [PMID: 32437190 DOI: 10.1037/pas0000847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ecological momentary assessment (EMA) is a set of longitudinal methods that researchers can use to understand complex processes (e.g., health, behavior, emotion) in "high resolution." Although technology has made EMA data collection easier, concerns remain about the consistency and quality of data collected from participants who are enrolled and followed online. In this study, we used EMA data from a larger study on HIV-risk behavior among men who have sex with men (MSM) to explore whether several indicators of data consistency/quality differed across those who elected to enroll in-person and those enrolled online. One hundred MSM (age 18-54) completed a 30-day EMA study. Forty-five of these participants chose to enroll online. There were no statistically significant differences in response rates for any survey type (e.g., daily diary [DD], experience sampling [ES], event-contingent [EC]) across participants who enrolled in-person versus online. DD and ES survey response rates were consistent across the study and did not differ between groups. EC response rates fell sharply across the study, but this pattern was also consistent across groups. Participants' responses on the DD were generally consistent with a poststudy follow-up Timeline Followback (TLFB) with some underreporting on the TLFB, but this pattern was consistent across both groups. In this sample of well-educated, mostly White MSM recruited from urban areas, EMA data collected from participants followed online was as consistent, reliable, and valid as data collected from participants followed in-person. These findings yield important insights about best practices for EMA studies with cautions regarding generalizability. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Despotou G, Evans J, Nash W, Eavis A, Robbins T, Arvanitis TN. Evaluation of patient perception towards dynamic health data sharing using blockchain based digital consent with the Dovetail digital consent application: A cross sectional exploratory study. Digit Health 2020; 6:2055207620924949. [PMID: 32435503 PMCID: PMC7223864 DOI: 10.1177/2055207620924949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/16/2020] [Indexed: 11/29/2022] Open
Abstract
Background New patient-centric integrated care models are enabled by the capability to exchange the patient’s data amongst stakeholders, who each specialise in different aspects of the patient’s care. This requires a robust, trusted and flexible mechanism for patients to offer consent to share their data. Furthermore, new IT technologies make it easier to give patients more control over their data, including the right to revoke consent. These characteristics challenge the traditional paper-based, single-organisation-led consent process. The Dovetail digital consent application uses a mobile application and blockchain based infrastructure to offer this capability, as part of a pilot allowing patients to have their data shared amongst digital tools, empowering patients to manage their condition within an integrated care setting. Objective To evaluate patient perceptions towards existing consent processes, and the Dovetail blockchain based digital consent application as a means to manage data sharing in the context of diabetes care. Method Patients with diabetes at a General Practitioner practice were recruited. Data were collected using focus groups and questionnaires. Thematic analysis of the focus group transcripts and descriptive statistics of the questionnaires was performed. Results There was a lack of understanding of existing consent processes in place, and many patients did not have any recollection of having previously given consent. The digital consent application received favourable feedback, with patients recognising the value of the capability offered by the application. Patients overwhelmingly favoured the digital consent application over existing practice. Conclusions Digital consent was received favourably, with patients recognising that it addresses the main limitations of the current process. Feedback on potential improvements was received. Future work includes confirmation of results in a broader demographic sample and across multiple conditions.
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Affiliation(s)
- George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, UK
| | - Jill Evans
- Institute of Digital Healthcare, WMG, University of Warwick, UK
| | | | | | - Tim Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, UK
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Petersen C, Austin RR, Backonja U, Campos H, Chung AE, Hekler EB, Hsueh PYS, Kim KK, Pho A, Salmi L, Solomonides A, Valdez RS. Citizen science to further precision medicine: from vision to implementation. JAMIA Open 2020; 3:2-8. [PMID: 32607481 PMCID: PMC7309265 DOI: 10.1093/jamiaopen/ooz060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/04/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
The active involvement of citizen scientists in setting research agendas, partnering with academic investigators to conduct research, analyzing and disseminating results, and implementing learnings from research can improve both processes and outcomes. Adopting a citizen science approach to the practice of precision medicine in clinical care and research will require healthcare providers, researchers, and institutions to address a number of technical, organizational, and citizen scientist collaboration issues. Some changes can be made with relative ease, while others will necessitate cultural shifts, redistribution of power, recommitment to shared goals, and improved communication. This perspective, based on a workshop held at the 2018 AMIA Annual Symposium, identifies current barriers and needed changes to facilitate broad adoption of a citizen science-based approach in healthcare.
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Affiliation(s)
- Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin R Austin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Uba Backonja
- Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, Washington, USA
- Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hugo Campos
- Kaiser Permanente, Kaiser Permanente Innovation, Oakland, California, USA
| | - Arlene E Chung
- Departments of Internal Medicine and Pediatrics & the Program on Health & Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Eric B Hekler
- Department of Family Medicine & Public Health, Center for Wireless & Population Health Systems, Design Lab, Qualcomm Institute, University of California-San Diego, San Diego, California, USA
| | - Pei-Yun S Hsueh
- Center for Computational Health, IBM TJ Watson Research Center, Yorktown Heights, New York, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, Department of Public Health Sciences-School of Medicine, University of California-Davis, Sacramento, California, USA
| | - Anthony Pho
- School of Nursing, Columbia University, New York, New York, USA
| | - Liz Salmi
- OpenNotes/Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony Solomonides
- Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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45
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Ali Z, Zibert JR, Thomsen SF. Virtual Clinical Trials: Perspectives in Dermatology. Dermatology 2020; 236:375-382. [PMID: 32126560 DOI: 10.1159/000506418] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The cost of developing a new drug is approximately USD 2.6 billion, and over two-thirds of the total cost is embedded in the clinical-testing phase. Patient recruitment is the single biggest cause of clinical trial delays, and these delays can result in up to USD 8 million per day in lost revenue for pharmaceutical companies. Further, clinical trials struggle to keep participants engaged in the study and as many as 40% drop out. To overcome these challenges pharmaceutical companies and research institutions (e.g., universities) increasingly use an emerging concept: virtual clinical trials (VCT) based on a remote approach. SUMMARY VCT (site-less) are a relatively new method of conducting a clinical trial, taking full advantage of technology (apps, monitoring devices, etc.) and inclusion of web platforms (recruitment, informed consent, counselling, measurement of endpoints, and any adverse reactions) to allow the patient to be home-based at every stage of the clinical trial. Studies have shown that VCT are not only operationally feasible, but also successful. They have higher recruitment rates, better compliance, lower drop-out rates, and are conducted faster than traditional clinical trials. The visual nature of dermatological conditions, the relative ease in evaluating skin diseases virtually, and the fact that skin diseases often are not life-threatening and rarely require complex examinations make VCT very attractive for dermatological research. Further, making correct diagnoses based on photographs and patient symptomatology has always been part of the dermatologist's routine. Thus, VCT are in many ways made for dermatology. Herein we describe VCT and their implications in dermatological research.
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Affiliation(s)
- Zarqa Ali
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark,
| | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bunnell BE, Sprague G, Qanungo S, Nichols M, Magruder K, Lauzon S, Obeid JS, Lenert LA, Welch BM. An Exploration of Useful Telemedicine-Based Resources for Clinical Research. Telemed J E Health 2020; 26:51-65. [PMID: 30785853 PMCID: PMC6948002 DOI: 10.1089/tmj.2018.0221] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background: Clinical trials are key to ensuring high-quality, effective, and safe health care interventions, but there are many barriers to their successful and timely implementation. Difficulties with participant recruitment and enrollment are largely affected by difficulties with obtaining informed consent. Teleconsent is a telemedicine- based approach to obtaining informed consent and offers a unique solution to limitations of traditional consent approaches. Methods: We conducted a survey among 134 clinical trial researchers in academic/university-, industry-, and clinically based settings. The survey addressed important aspects of teleconsent, potential teleconsent enhancements, and other telehealth capabilities to support clinical research. Results: The majority of respondents viewed teleconsent as an important approach for obtaining informed consent and indicated that they would likely use teleconsent if available. Consenting participants at remote sites, increasing access to clinical trials, and consenting participants in their homes were viewed as the greatest opportunities for teleconsent. Features for building, validating, and assessing understanding of teleconsent forms, mobile capabilities, three-way teleconsent calls, and direct links to forms via recruitment websites were viewed as important teleconsent enhancements. Other telehealth capabilities to support clinical research, including surveys, file transfer, three-way video, screenshare, and photo capture during telemedicine visits, and proposed telemedicine capabilities such as video call recording, ID information capture, and integration of medical devices, were also viewed as important. Conclusions: Teleconsent and telemedicine are promising solutions to some common challenges to clinical trials. Many barriers to study recruitment and enrollment might be overcome by investing time and resources and further evaluating this technology.
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Affiliation(s)
- Brian E. Bunnell
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Suparna Qanungo
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Michelle Nichols
- Department of Nursing, College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Kathryn Magruder
- Department of Psychiatry, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Lauzon
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jihad S. Obeid
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Leslie A. Lenert
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Brandon M. Welch
- Department of Psychiatry and Behavioral Sciences, Biomedical Informatics Center, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Short NA, Sullivan J, Soward A, Bollen KA, Liberzon I, Martin S, Rauch SAM, Bell K, Rossi C, Lechner M, Novak C, Witkemper K, Kessler RC, McLean SA. Protocol for the first large-scale emergency care-based longitudinal cohort study of recovery after sexual assault: the Women's Health Study. BMJ Open 2019; 9:e031087. [PMID: 31753875 PMCID: PMC6887008 DOI: 10.1136/bmjopen-2019-031087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Worldwide, an estimated 10%-27% of women are sexually assaulted during their lifetime. Despite the enormity of sexual assault as a public health problem, to our knowledge, no large-scale prospective studies of experiences and recovery over time among women presenting for emergency care after sexual assault have been performed. METHODS AND ANALYSIS Women ≥18 years of age who present for emergency care within 72 hours of sexual assault to a network of treatment centres across the USA are approached for study participation. Blood DNA and RNA samples and brief questionnaire and medical record data are obtained from women providing initial consent. Full consent is obtained at initial 1 week follow-up to analyse blood sample data and to perform assessments at 1 week, 6 weeks, 6 months and 1 year. These assessments include evaluation of survivor life history, current health and recovery and experiences with treatment providers, law enforcement and the legal system. ETHICS AND DISSEMINATION This study is approved by the University of North Carolina at Chapel Hill's Institutional Review Board (IRB) and the IRB of each participating study site. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.
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Affiliation(s)
- Nicole A Short
- Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jenyth Sullivan
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - April Soward
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience and Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University System Health Science Center College of Medicine, Bryan, Texas, USA
| | - Sandra Martin
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Kathy Bell
- Tulsa Forensic Nursing, Tulsa Police Department, Tulsa, Oklahoma, USA
| | - Catherine Rossi
- Forensic Nursing, Cone Health, Greensboro, North Carolina, USA
| | - Megan Lechner
- Forensic Nurse Examining Team, University of Colorado Health Colorado Springs, Colorado Springs, Colorado, USA
| | - Carissa Novak
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Witkemper
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel A McLean
- Department of Anesthesiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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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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49
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Khairat S, Tirtanadi K, Ottmar P, Sleath B, Obeid J. Evaluating the Perceptions of Teleconsent in Urban and Rural Communities. EUROPEAN JOURNAL FOR BIOMEDICAL INFORMATICS 2019; 15:https://www.ejbi.org/abstract/evaluating-the-perceptions-of-teleconsent-in-urban-and-rural-communities-5201.html. [PMID: 32802171 PMCID: PMC7427121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Obtaining informed consent from research study participants continues to meet difficulties. New ways to connect with potential participants are necessary to address barriers, expand enrollment and offer more services to underserved populations. OBJECTIVES Electronic consent is designed to complete consenting sessions remotely and may help combat the obstacles inherent in the traditional informed consent process. We investigate the implementation of an electronic consent platform, Teleconsent, to broaden and diversify recruitment for clinical research. METHODS Semi-structured interviews were conducted with community members to assess their perceptions regarding the acceptability and usability of Teleconsent, a form of electronic consent. Interviews were structured to determine the main benefits, challenges and concerns as detailed by each participant. Participants were divided into rural and urban groupings. RESULTS We interviewed 40 participants to gather first-time perceptions of Teleconsent. We found overall positive results. Predominately in urban communities, participants possessed the technological skills and amenities to support smooth implementation of this technology. However, many participants reflect on the challenges regarding logistics, privacy and reliability of utilizing Teleconsent in underserved, rural areas. 5 of 19 participants, more than a quarter for the rural group, experienced Teleconsent software problems. During these sessions, an alternative process with paper templates was employed to complete interviews. CONCLUSION Perceptions regarding Teleconsent demonstrate current challenges along with potential acceptance within different communities. This is despite the fact that on its own it will not be able to overcome the barriers currently found in the informed consent process. Still, investment in electronic consent, including the development of enhanced and interactive content, can potentially revolutionize this process. Our findings offer a preliminary step towards determining the feasibility and acceptance of Teleconsent, a form of electronic consent, in different communities. More research surrounding the logistics of adoption is necessary in order to determine success.
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Affiliation(s)
- Saif Khairat
- The Carolina Health Informatics Program, The University of North Carolina at Chapel Hill, North Carolina, United States
| | - Katie Tirtanadi
- The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, North Carolina, United States
| | - Paige Ottmar
- The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, North Carolina, United States
| | - Betsy Sleath
- The Eshelman School of Pharmacy and The Cecil Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, North Carolina, United States
| | - Jihad Obeid
- The Medical University, South Carolina, United States
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Wagholikar KB, Fischer CM, Goodson AP, Herrick CD, Maclean TE, Smith KV, Fera L, Gaziano TA, Dunning JR, Bosque-Hamilton J, Matta L, Toscano E, Richter B, Ainsworth L, Oates MF, Aronson S, MacRae CA, Scirica BM, Desai AS, Murphy SN. Phenotyping to Facilitate Accrual for a Cardiovascular Intervention. J Clin Med Res 2019; 11:458-463. [PMID: 31143314 PMCID: PMC6522233 DOI: 10.14740/jocmr3830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/30/2019] [Indexed: 01/29/2023] Open
Abstract
Background The conventional approach for clinical studies is to identify a cohort of potentially eligible patients and then screen for enrollment. In an effort to reduce the cost and manual effort involved in the screening process, several studies have leveraged electronic health records (EHR) to refine cohorts to better match the eligibility criteria, which is referred to as phenotyping. We extend this approach to dynamically identify a cohort by repeating phenotyping in alternation with manual screening. Methods Our approach consists of multiple screen cycles. At the start of each cycle, the phenotyping algorithm is used to identify eligible patients from the EHR, creating an ordered list such that patients that are most likely eligible are listed first. This list is then manually screened, and the results are analyzed to improve the phenotyping for the next cycle. We describe the preliminary results and challenges in the implementation of this approach for an intervention study on heart failure. Results A total of 1,022 patients were screened, with 223 (23%) of patients being found eligible for enrollment into the intervention study. The iterative approach improved the phenotyping in each screening cycle. Without an iterative approach, the positive screening rate (PSR) was expected to dip below the 20% measured in the first cycle; however, the cyclical approach increased the PSR to 23%. Conclusions Our study demonstrates that dynamic phenotyping can facilitate recruitment for prospective clinical study. Future directions include improved informatics infrastructure and governance policies to enable real-time updates to research repositories, tooling for EHR annotation, and methodologies to reduce human annotation.
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Affiliation(s)
- Kavishwar B Wagholikar
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | - Lina Matta
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | - Calum A MacRae
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Benjamin M Scirica
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Akshay S Desai
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Shawn N Murphy
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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