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Line EN, Jaramillo S, Goldwater M, Horne Z. Anecdotes impact medical decisions even when presented with statistical information or decision aids. Cogn Res Princ Implic 2024; 9:51. [PMID: 39183199 DOI: 10.1186/s41235-024-00577-3] [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] [Received: 10/09/2023] [Accepted: 07/16/2024] [Indexed: 08/27/2024] Open
Abstract
People are inundated with popular press reports about medical research concerning what is healthy, get advice from doctors, and hear personal anecdotes. How do people integrate conflicting anecdotal and statistical information when making medical decisions? In four experiments (N = 4126), we tested how people use conflicting information to judge the efficacy of artificial and real medical treatments. Participants read an anecdote from someone in a clinical trial, or who had undergone a medical treatment previously, for whom the medical treatment was ineffective. We found that reading anecdotes for either artificial or real medical treatments shifted participants' beliefs about the efficacy of a medical treatment. We observed this result even when the anecdote was uninformative, was paired with an icon array, or when participants were provided with thorough medical decision aids about reproductive health procedures. Our findings highlight the pervasive effect of anecdotes on medical decision making.
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Affiliation(s)
- Emily N Line
- Department of Psychology, University of Illinois, Urbana-Champaign, USA.
| | - Sara Jaramillo
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA
| | - Micah Goldwater
- School of Psychology, The University of Sydney, Camperdown, Australia
| | - Zachary Horne
- Department of Psychology, University of Edinburgh, Edinburgh, UK
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Baba A, Aregbesola A, Caldwell PHY, Elliott SA, Elsman EBM, Fernandes RM, Hartling L, Heath A, Kelly LE, Preston J, Sammy A, Webbe J, Williams K, Woolfall K, Klassen TP, Offringa M. Developments in the Design, Conduct, and Reporting of Child Health Trials. Pediatrics 2024; 154:e2024065799. [PMID: 38832441 DOI: 10.1542/peds.2024-065799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 06/05/2024] Open
Abstract
To identify priority areas to improve the design, conduct, and reporting of pediatric clinical trials, the international expert network, Standards for Research (StaR) in Child Health, was assembled and published the first 6 Standards in Pediatrics in 2012. After a recent review summarizing the 247 publications by StaR Child Health authors that highlight research practices that add value and reduce research "waste," the current review assesses the progress in key child health trial methods areas: consent and recruitment, containing risk of bias, roles of data monitoring committees, appropriate sample size calculations, outcome selection and measurement, and age groups for pediatric trials. Although meaningful change has occurred within the child health research ecosystem, measurable progress is still disappointingly slow. In this context, we identify and review emerging trends that will advance the agenda of increased clinical usefulness of pediatric trials, including patient and public engagement, Bayesian statistical approaches, adaptive designs, and platform trials. We explore how implementation science approaches could be applied to effect measurable improvements in the design, conducted, and reporting of child health research.
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Affiliation(s)
- Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Alex Aregbesola
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Patrina H Y Caldwell
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Sarah A Elliott
- Cochrane Child Health
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen B M Elsman
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ricardo M Fernandes
- Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Lisa Hartling
- Cochrane Child Health
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Science, University College London, London, United Kingdom
| | - Lauren E Kelly
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pharmacology and Therapeutics, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer Preston
- National Institute for Health and Care Research (NIHR) Alder Hey Clinical Research Facility, Liverpool, United Kingdom
| | - Adrian Sammy
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - James Webbe
- Section of Neonatal Medicine, Imperial College London, London, United Kingdom
| | - Katrina Williams
- Department of Paediatrics, Monash University and Developmental Paediatrics, Monash Children's Hospital, Melbourne, Australia
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Hare MM, Walker CS, Sarver DE, Lim CS, Brown DC, Annett RD. Assessing attitudes towards pediatric research participation across diverse populations: Psychometric properties of a novel tool. Contemp Clin Trials 2023; 133:107321. [PMID: 37652358 PMCID: PMC10591922 DOI: 10.1016/j.cct.2023.107321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Clinical trials play a crucial role in advancing medical knowledge and improving health outcomes. However, there is a recognized need for greater representation of marginalized groups to ensure that research findings can be generalized and effectively applied to all individuals. While the Pediatric Research Participation Questionnaire (PRPQ) was developed to assist pediatric clinical trials research by identifying benefits and barriers to research participation among children with chronic medical conditions, there is still limited insight into the structure of the PRPQ when administered in diverse samples, including the general pediatric population. Therefore, the current study examined the factor structure of the PRPQ in a general pediatric population to investigate whether rural-urban differences exist in the PRPQ factor structure. METHODS Caregivers (N = 600) of children under age 18 completed the PRPQ in a population-based survey in Mississippi. Sampling was stratified to ensure equal representation in rural (n = 300) and urban areas (n = 300). Exploratory and confirmatory factor analyses were conducted to determine the factor structure of the PRPQ. RESULTS A five-factor structure was identified, compromising: social pressure, direct benefit, reasons for participation, mistrust in research/researchers, reasons against participation. While results were similar among urban participants, a three-factor structure emerged for rural participants. CONCLUSIONS This study contributes to the broader understanding of research participation among underrepresented groups. The findings suggest that clinical researchers should consider tailoring recruitment strategies to increase clinical trial participation among children in rural areas. Understanding factors that influence pediatric research participation, particularly among marginalized communities, is crucial for developing effective recruitment and retention strategies.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL 33199, USA
| | - Courtney S Walker
- Center for Advancement of Youth, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39110, USA; Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39110, USA
| | - Dustin E Sarver
- Center for Advancement of Youth, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39110, USA; Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39110, USA.
| | - Crystal S Lim
- Department of Health Psychology, University of Missouri, Columbia, MO 65211, USA
| | - Dustin C Brown
- Department of Sociology and Social Science Research Center, Mississippi State University, Mississippi State, MS 39762, USA
| | - Robert D Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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Parker AE, Scull TM, Kennedy KL. Efficacy of DigiKnowItNews: Teen, a multimedia educational website for adolescents about pediatric clinical trials: study protocol for a randomized controlled trial. Trials 2023; 24:436. [PMID: 37391773 DOI: 10.1186/s13063-023-07464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Pediatric research is crucial for the development of new scientific advancements, treatments, and therapies for adolescents. Yet relatively few pediatric clinical trials are conducted due to barriers to successful recruitment and retention, including knowledge and attitudes about clinical trials. Adolescents tend to experience greater autonomy to make decisions and have expressed interest in being part of the decision to participate in clinical trials. Increasing knowledge, positive attitudes, and self-efficacy related to clinical trials could positively impact the decision to participate in a pediatric clinical trial. However, there are currently few interactive, developmentally appropriate, web-based resources available to educate adolescents about clinical trials. DigiKnowItNews: Teen was created as a multimedia educational website to address the relatively low levels of enrollment in pediatric clinical trials and need for information to empower adolescents to make decisions about participating in clinical trials. METHODS This is a parallel group randomized controlled superiority trial to test the effectiveness of DigiKnowItNews: Teen, for improving factors related to clinical trial participation among adolescent and parents. Eligible parent-adolescent (ages 12 to 17 years) pairs will be randomly assigned to one of two conditions: intervention or wait-list control. All participants will complete pre- and post-test questionnaires and participants assigned to the intervention will receive access to review the DigiKnowItNews: Teen content for 1 week. Wait-list control participants will have the option to review DigiKnowItNews: Teen after study completion. The primary outcomes are knowledge about clinical research, attitudes, and beliefs toward pediatric clinical trials, self-efficacy for making decisions related to clinical trial participation, willingness to participate in a future clinical trial, procedural fears, and parent-adolescent communication quality. Overall feedback and satisfaction related to DigiKnowItNews: Teen will also be collected. DISCUSSION The trial will evaluate the effectiveness of DigiKnowIt News: Teen, an educational website about pediatric clinical trials for adolescents. If found effective in promoting factors related to future pediatric clinical trial participation, DigiKnowIt News: Teen could be used by adolescents, along with their parents, as they make the decision to participate in a clinical trial. Clinical trial researchers can also use DigiKnowIt News: Teen to aid their participant recruitment efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT05714943. Registered on 02/03/2023.
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Parker AE, Scull TM, Morrison AM. DigiKnowIt News: Educating youth about pediatric clinical trials using an interactive, multimedia educational website. J Child Health Care 2022; 26:139-153. [PMID: 33836627 DOI: 10.1177/13674935211003774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric clinical trials allow for the testing of appropriate and effective treatments for children. However, some challenges exist with recruitment. This study examined the effectiveness of DigiKnowIt News, an interactive, multimedia website (which includes activities, videos, and comic books) designed to educate children about clinical trials. A randomized controlled trial was conducted in 2018 with 91 participants (M age = 10.92 years; SD = 2.06). Participants were randomly assigned to intervention or wait-list control groups and completed questionnaires at pretest and posttest (1 week later) about their knowledge, attitudes, beliefs about clinical trials, and self-efficacy for participating in clinical trials. Participants in the intervention group received access to DigiKnowIt News between pretest and posttest and completed a satisfaction questionnaire at posttest. At the end of the study, participants in the wait-list control group were offered the option to use the website and complete a satisfaction questionnaire. At posttest, participants in the intervention group, compared to participants in the wait-list control group, had more knowledge about clinical trials and more reported confidence for participating in clinical trials. Participants reported high levels of satisfaction with DigiKnowIt News. The findings suggest that an educational website can improve factors related to increasing rates of participation in clinical trials.
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Watson SE, Smith P, Snowden J, Vaughn V, Cottrell L, Madden CA, Kong AS, McCulloh R, Stack Lim C, Bledsoe M, Kowal K, McNally M, Knight L, Cowan K, Jimenez EY. Facilitators and Barriers to Pediatric Clinical Trial Recruitment and Retention in Rural and Community Settings: A Scoping Review of the Literature. Clin Transl Sci 2022; 15:838-853. [PMID: 35037409 PMCID: PMC9010274 DOI: 10.1111/cts.13220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022] Open
Abstract
Children in rural settings are underrepresented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community-based (non-clinical) settings. Articles identified via PubMed, CINAHL, Embase, and Web of Science were independently double-screened at title/abstract and full-text levels to identify articles meeting eligibility criteria. Included articles reported on recruitment or retention activities for U.S.-based pediatric clinical studies conducted in rural or community-based settings and were published in English through January 2021. Twenty-seven articles describing 31 studies met inclusion criteria. Most articles reported on at least one study conducted in an urban or suburban or unspecified community setting (n=23 articles; 85%); fewer (n=10; 37%) reported on studies that spanned urban and rural settings or were set in rural areas. More studies discussed recruitment facilitators (n=25 studies; 81%) and barriers (n=19; 61%) versus retention facilitators (n=15; 48%) and barriers (n=8; 26%). Descriptions of recruitment and retention barriers and facilitators were primarily experiential or subjective. Recruitment and retention facilitators were similar across settings and included: contacts/reminders, community engagement and relationship-building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited recruitment and retention barriers. Few studies have rigorously examined optimal ways to recruit and retain rural participants in pediatric clinical trials. To expand the evidence base, future studies examining recruitment and retention strategies should systematically assess and report rurality and objectively compare relative impact of different strategies.
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Affiliation(s)
- Sara E Watson
- Department of Pediatrics, University of Louisville, and Norton Children's Hospital, Louisville, KY
| | | | | | | | | | - Christi A Madden
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alberta S Kong
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Russell McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE and Children's Hospital & Medical Center, Omaha, NE
| | - Crystal Stack Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | | | - Karen Kowal
- Nemours Children's Health System, Wilmington, DE
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White AN, Chevette M, Hillerstrom H, Esbensen A. Parental perspectives on research for Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:179-187. [PMID: 34510659 DOI: 10.1111/jar.12937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/18/2021] [Accepted: 08/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Down syndrome is the most common genetic disorder associated with intellectual and developmental disabilities. Research to improve health care outcomes in Down syndrome lags significantly behind other disease categories. Among these reasons are funding, recruitment and availability of research studies being conducted. METHODS We surveyed 228 parents of individuals with Down syndrome to understand their perceptions of research, study design, how they seek out information and topics they would like to see researched. RESULTS Parents with children 18 years and younger responded to our survey. Parents indicated their willingness to participate in research (72%), yet few have (36%). Parents identified barriers to participation, research they feel would help their child, and interests in seeing new therapies and drug studies. CONCLUSION These findings identify recommendations and insights from parents on future research agendas, studies and recruitment strategies that may help researchers improve outcomes for individuals with Down syndrome.
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Affiliation(s)
- Amanda Nicole White
- Graduate School of Leadership and Change, Antioch University, Yellow Springs, Ohio, USA.,Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | - Anna Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Neilan AM, Salvant Valentine S, Knopf AS. Case 27-2021: A 16-Year-Old Boy Seeking Human Immunodeficiency Virus Prophylaxis. N Engl J Med 2021; 385:1034-1041. [PMID: 34496178 DOI: 10.1056/nejmcpc1909626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anne M Neilan
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Sheila Salvant Valentine
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Amelia S Knopf
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
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Landers SE, Francis JKR, Morris MC, Mauro C, Rosenthal SL. Adolescent and Parent Perceptions about Participation in Biomedical Sexual Health Trials. Ethics Hum Res 2020; 42:2-11. [PMID: 32421948 DOI: 10.1002/eahr.500048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Given the burden of HIV and other sexually transmitted infections among adolescents who are legal minors, it is critical that they be included in biomedical sexual health trials to ensure that new prevention and treatment interventions are safe, effective, and acceptable for their use. However, adolescents are often not well represented in clinical trials. We provide an overview of the available evidence regarding adolescent and parent willingness for adolescents to participate in biomedical sexual health trials, parental involvement in the permission-consent process, management of differences and discord among adolescents and parents, and parental involvement throughout the study period. We also outline recommendations for current practice and areas for future research.
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Affiliation(s)
- Sara E Landers
- Research coordinator in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Jenny K R Francis
- Assistant professor in the Department of Pediatrics at the University of Texas Southwestern Medical Center
| | - Marilyn C Morris
- Associate professor in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Christine Mauro
- Assistant professor in the Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center
| | - Susan L Rosenthal
- Professor of medical psychology in the Departments of Pediatrics and Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
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Knopf A, Ott MA, Draucker CB, Fortenberry JD, Reirden DH, Arrington-Sanders R, Schneider J, Straub D, Baker R, Bakoyannis G, Zimet GD. Innovative Approaches to Obtain Minors' Consent for Biomedical HIV Prevention Trials: Multi-Site Quasi-Experimental Study of Adolescent and Parent Perspectives. JMIR Res Protoc 2020; 9:e16509. [PMID: 32224493 PMCID: PMC7154935 DOI: 10.2196/16509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the high burden of new HIV infections in minor adolescents, they are often excluded from biomedical HIV prevention trials, largely owing to the ethical complexities of obtaining consent for enrollment. Researchers and ethics regulators have a duty to protect adolescents-as a special category of human subjects, they must have protection that extends beyond those afforded to all human subjects. Typically, additional protection includes parental consent for enrollment. However, parental consent can present a risk of harm for minor adolescents. Research involving minor adolescents indicate that they are unwilling to join biomedical trials for stigmatized health problems, such as HIV, when parental consent is required. This presents a significant barrier to progress in adolescent HIV prevention by creating delays in research and the translation of new scientific evidence generated in biomedical trials in adult populations. OBJECTIVE This protocol aims to examine how parental involvement in the consent process affects the acceptability of hypothetical participation in biomedical HIV prevention trials from the perspectives of minor adolescents and parents of minor adolescents. METHODS In this protocol, we use a quasi-experimental design that involves a simulated consent process for 2 different HIV prevention trials. The first trial is modeled after an open-label study of the use of tenofovir disoproxil fumarate and emtricitabine as preexposure prophylaxis for HIV. The second trial is modeled after a phase IIa trial of an injectable HIV integrase inhibitor. There are 2 groups in the study-minor adolescents aged 14 to 17 years, inclusive, and parents of minor adolescents in the same age range. The adolescent participants are randomized to 1 of 3 consent conditions with varying degrees of parental involvement. After undergoing a simulated consent process, they rate their willingness to participate (WTP) in each of the 2 trials if offered the opportunity. The primary outcome is WTP, given the consent condition. Parents undergo a similar process but are asked to rate the acceptability of each of the 3 consent conditions. The primary outcome is acceptability of the consent method for enrollment. The secondary outcomes include the following: capacity to consent among both participant groups, the prevalence of medical mistrust, and the effects of the study phase (eg, phase IIa vs the open-label study) and drug administration route (eg, oral vs injection) on WTP (adolescents) and acceptability (parents) of the consent method. RESULTS Enrollment began in April 2018 and ended mid-September 2019. Data are being analyzed and dissemination is expected in April 2020. CONCLUSIONS The study will provide the needed empirical data about minor adolescents' and parents' perspectives on consent methods for minors. The evidence generated can be used to guide investigators and ethics regulators in the design of consent processes for biomedical HIV prevention trials. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16509.
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Affiliation(s)
- Amelia Knopf
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Mary A Ott
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Claire Burke Draucker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - J Dennis Fortenberry
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Daniel H Reirden
- Children's Hospital Colorado, School of Medicine, The University of Colorado, Aurora, CO, United States
| | - Renata Arrington-Sanders
- Division of General Pediatrics & Adolescent Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - John Schneider
- Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Diane Straub
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Rebecca Baker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Giorgos Bakoyannis
- Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
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11
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Savich RD, Tigges BB, Rios LI, McCloskey J, Tollestrup K, Annett RD. Willingness of women to participate in obstetrical and pediatric research involving biobanks. J Community Genet 2019; 11:215-223. [PMID: 31782046 DOI: 10.1007/s12687-019-00446-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/12/2019] [Indexed: 01/06/2023] Open
Abstract
Use of biobanks for future genetic/genomic testing has increased. Biospecimens are increasingly being collected from infants/children; however, little is known about attitudes towards collection of biospecimens from postpartum women and their child. Using a hypothetical consent, this study investigated willingness to participate and attitudes, beliefs, and concerns related to consent materials requesting the biobanking genetic samples. A cross-sectional mixed methods design included women who reviewed a hypothetical consent related to biobanking genetic samples. Women were asked about their willingness to participate, followed by a focus group about biobanks and genetic/genomic testing. Post-focus group questionnaires assessed willingness to participate, the influence of study characteristics, and attitudes about genetic testing. Women (N = 37) were 29.0± 7.3 years of age (range 19-44); 51% had children and 28% were currently pregnant. A total of 46% were Hispanic (H), 38% were White non-Hispanic (WNH), and 16% were Native American (NA). Seventy-six percent (28/37) initially indicated that they would participate in the hypothetical study. Race and ethnicity impacted whether women would participate. Fewer NA women indicated that they would participate compared with H women and with WNH women (p < 0.02). Age, pregnancy status, having children, education level, insurance status, and income had no impact on participation decision and willingness to biobank specimens. NA and H women indicated that they were less likely than WNH women to agree to participate in a long-term biobank study. Given the importance of determining the genetic influence of health and disease, it is critical to attend to the questions and concerns of minority women regarding genetic studies.
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Affiliation(s)
- Renate D Savich
- Pediatrics, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216-4505, USA
| | - Beth B Tigges
- College of Nursing, University of New Mexico, Albuquerque, NM, USA
| | | | - Joanne McCloskey
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Kristine Tollestrup
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Robert D Annett
- Pediatrics, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216-4505, USA.
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Abstract
Individuals approached to participate in human subjects research, irrespective of age, must be completely apprised of the study, and researchers must ensure that the information is understood to the fullest extent possible, prior to decision making. However, evolving regulatory and institutional requirements have led to permission/assent/consent (PAC) forms that are unnecessarily complex, serving only to exacerbate the challenges associated with communicating this important information to prospective participants. At greatest risk are children and other individuals with low literacy, limited English proficiency, and diminished mental capacity, populations all too often neglected in clinical research. This paper examines various strategies that have been evaluated to facilitate informed PAC, drawing on experiences across a broad array of populations whose needs overlap with those of children. These strategies range from simplifying PAC forms for readability and creating multimedia PAC delivery tools to actively engaging participants on their understanding of PAC elements by leveraging testing, rewards, and third-party communications. Notably, the findings from strategies that have been explored in more than one setting are uniformly mixed with respect to their ability to improve comprehension, underscoring the challenges that persist in designing, implementing, and objectively examining strategies intended to facilitate informed PAC. However, these studies do serve to highlight efforts that may reduce anxiety around, and increase the satisfaction of participants with, the PAC process. Ultimately, accommodating a diverse participant pool will require the consideration, and continual refinement, of various PAC strategies along with the engagement of team members who are intimately familiar with these populations.
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Affiliation(s)
- Susan M Abdel-Rahman
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy, 2401 Gillham Rd., POB 2.M02.47, Kansas City, MO, 64108, USA. .,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
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Beasant L, Brigden A, Parslow R, Apperley H, Keep T, Northam A, Wray C, King H, Langdon R, Mills N, Young B, Crawley E. Treatment preference and recruitment to pediatric RCTs: A systematic review. Contemp Clin Trials Commun 2019; 14:100335. [PMID: 30949611 PMCID: PMC6430075 DOI: 10.1016/j.conctc.2019.100335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/25/2019] [Accepted: 02/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recruitment to pediatric randomised controlled trials (RCTs) can be a challenge, with ethical issues surrounding assent and consent. Pediatric RCTs frequently recruit from a smaller pool of patients making adequate recruitment difficult. One factor which influences recruitment and retention in pediatric trials is patient and parent preferences for treatment. PURPOSE To systematically review pediatric RCTs reporting treatment preference. METHODS Database searches included: MEDLINE, CINAHL, EMBASE, and COCHRANE.Qualitative or quantitative papers were eligible if they reported: pediatric population, (0-17 years) recruited to an RCT and reported treatment preference for all or some of the participants/parents in any clinical area. Data extraction included: Number of eligible participants consenting to randomisation arms, number of eligible patients not randomised because of treatment preference, and any further information reported on preferences (e.g., if parent preference was different from child). RESULTS Fifty-two studies were included. The number of eligible families declining participation in an RCT because of preference for treatment varied widely (between 2 and 70%) in feasibility, conventional and preference trial designs. Some families consented to trial involvement despite having preferences for a specific treatment. Data relating to 'participant flow and recruitment' was not always reported consistently, therefore numbers who were lost to follow-up or withdrew due to preference could not be extracted. CONCLUSIONS Families often have treatment preferences which may affect trial recruitment. Whilst children appear to hold treatment preferences, this is rarely reported. Further investigation is needed to understand the reasons for preference and the impact preference has on RCT recruitment, retention and outcome.
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Affiliation(s)
- L. Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - A. Brigden
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - R.M. Parslow
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - H. Apperley
- Department of Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton and Sussex University Hospitals, UK
| | - T. Keep
- NHS Greater Glasgow and Clyde, UK
| | - A. Northam
- Department of Primary Care and Public Health, Royal Sussex County Hospital, Brighton and Sussex Medical School, UK
| | - C. Wray
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - H. King
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Trust, UK
| | - R. Langdon
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - N. Mills
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - B. Young
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - E. Crawley
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
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Francis JKR, de Roche AM, Mauro C, Landers SE, Chang J, Catallozzi M, Breitkopf CR, Rosenthal SL. Adolescent-Parent Dyadic Retention in an Interview Study and Changes in Willingness to Participate in a Hypothetical Microbicide Safety Study. J Pediatr Adolesc Gynecol 2018; 31:592-596. [PMID: 29906513 PMCID: PMC6218291 DOI: 10.1016/j.jpag.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/17/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE In this study we describe adolescent and parent retention and changes in willingness to participate (WTP) in research among adolescents, parents, and adolescent-parent dyads. DESIGN AND SETTING Adolescent-parent dyads were recruited to participate in a longitudinal study to assess research participation attitudes using simultaneous individual interviews of the adolescent and parent with a return visit 1 year later using the same interview. PARTICIPANTS Adolescents (14-17 years old) and their parents. INTERVENTIONS None. MAIN OUTCOME MEASURES The relationship between participant characteristics and dyad retention was assessed. WTP was measured on a Likert scale and dichotomized (willing/unwilling) to assess changes in WTP attitudes over time for adolescents, parents, and dyads. RESULTS Eighty-three percent of the 300 dyads were retained. Dyads in which there was successful contact with the parent before follow-up were more likely to be retained (odds ratio, 4.88; 95% confidence interval, 2.57-9.26). For adolescents at baseline, 59% were willing to participate and 55% were willing to participate at follow-up (McNemar S = 0.91; P = .34). For parents at baseline, 51% were willing to participate and 57% were willing to participate at follow-up (McNemar S = 5.12; P = .02). For dyads at baseline, 57% were concordant (in either direction) and 70% of dyads were concordant at follow-up (McNemar S = 10.56; P = .001). CONCLUSION Over 1 year, parent contact might positively influence successful adolescent retention. Parents become more willing to let their adolescents participate over time, with dyads becoming more concordant about research participation.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Christine Mauro
- Department of Biostatistics, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | - Sara E Landers
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | | | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
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15
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Tsevat RK, Breitkopf CR, Landers SE, de Roche AM, Mauro C, Ipp LS, Catallozzi M, Rosenthal SL. Adolescents' and Parents' Attitudes Toward Adolescent Clinical Trial Participation: Changes Over One Year. J Empir Res Hum Res Ethics 2018; 13:383-390. [PMID: 30103655 PMCID: PMC6146060 DOI: 10.1177/1556264618790889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about how adolescents' and parents' thoughts about participation in clinical trials change over time. In this study, adolescent (14-17 years)-parent dyads were asked about willingness to participate in a hypothetical reproductive health study. A year later, they were asked how their thoughts about the study had changed. Qualitative responses were coded and analyzed using framework analysis. Thirty-two percent of adolescents and 18% of parents reported changes in thoughts; reasons included general changes in perception, clearer understanding, new knowledge or experiences, increased maturity/age of adolescents, and changes in participants independent of the study. Adolescents and parents may benefit from learning about studies multiple times, and investigators should account for development and new experiences to optimize adolescent research enrollment.
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Affiliation(s)
- Rebecca K. Tsevat
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Sara E. Landers
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | - Ariel M. de Roche
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Lisa S. Ipp
- NewYork-Presbyterian Hospital (USA)
- Weill Cornell Medical College (USA)
| | - Marina Catallozzi
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- Columbia University Mailman School of Public Health (USA)
- NewYork-Presbyterian Hospital (USA)
| | - Susan L. Rosenthal
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- NewYork-Presbyterian Hospital (USA)
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Scherer DG. Pediatric Participation in Medical Decision Making: The Devil Is in the Details. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:16-18. [PMID: 29466129 DOI: 10.1080/15265161.2017.1418924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Barned C, Dobson J, Stintzi A, Mack D, O'Doherty KC. Children's perspectives on the benefits and burdens of research participation. AJOB Empir Bioeth 2018; 9:19-28. [PMID: 29369013 DOI: 10.1080/23294515.2018.1430709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Participation in research is associated with benefits and burdens for individual research participants. Children living with a chronic illness are considered particularly vulnerable as they are already burdened with symptoms of their illness. In particular contexts, such as learning health care systems (LHS), where research and clinical care are integrated, children with chronic illnesses may be asked to participate in research related to their illness. A growing body of literature has focused on children's perspectives as research subjects; however, a relatively understudied aspect concerns children's experiences of research in clinics where they are also patients. METHODS We interviewed 25 Canadian children and adolescents living with inflammatory bowel disease (IBD) about their experiences of research participation. RESULTS Our participants described aspects of the research process and particular experiences as benefits and others as burdens. Benefits included helping others, receiving incentives, receiving the results of previous studies, and participating in fun activities. Burdens included the time required for particular types of research, physical and psychological discomfort, and feelings of obligation. CONCLUSIONS Our study describes the experiences of children participating in research at a site that integrates research and clinical care. Our participants described experiences that often go unreported (such as feelings of obligation); we mention these as important considerations to be mindful of when interacting with children as (potential) research participants in an LHS and when thinking about research ethics protocols or the assent/consent process.
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Affiliation(s)
| | | | - Alain Stintzi
- b Ottawa Institute of Systems Biology and Department of Biochemistry, Microbiology and Immunology, University of Ottawa
| | - David Mack
- c Children's Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Centre and CHEO Research Institute
- d Department of Pediatrics , University of Ottawa
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18
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Francis JKR, Dapena Fraiz L, de Roche AM, Catallozzi M, Radecki Breitkopf C, Rosenthal SL. Management of Adolescent-Parent Dyads' Discordance for Willingness to Participate in a Reproductive Health Clinical Trial. J Empir Res Hum Res Ethics 2017; 13:42-49. [PMID: 29226745 DOI: 10.1177/1556264617745409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The objective of this study is to understand the resolution of discordance between adolescent-parent dyads about participation in research. Adolescent (14-17 years) and parent dyads were recruited from NYC pediatric clinics to assess attitudes toward research participation. A subset of dyads participated in videotaped discussions about participation in a hypothetical study. Videos from dyads that held strongly discordant opinions about participation ( n = 30) were content-coded and analyzed using a thematic framework approach. Strategies used to resolve discordance included asserting authority, granting autonomy, or recognizing inaccurate assumptions using a variety of communication behaviors. Missed opportunities to enroll initially discordant dyads may be avoided by allowing time for adolescents and parents to elicit information, clarify a situation, or convince the other.
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Affiliation(s)
| | | | | | - Marina Catallozzi
- 2 Columbia University Medical Center, New York, NY, USA.,3 New York-Presbyterian Hospital, New York City, USA
| | | | - Susan L Rosenthal
- 2 Columbia University Medical Center, New York, NY, USA.,3 New York-Presbyterian Hospital, New York City, USA
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Tejwani R, Wang HHS, Lloyd JC, Kokorowski PJ, Nelson CP, Routh JC. Utility Estimation for Pediatric Vesicoureteral Reflux: Methodological Considerations Using an Online Survey Platform. J Urol 2017; 197:805-810. [PMID: 27746280 PMCID: PMC5315661 DOI: 10.1016/j.juro.2016.09.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE The advent of online task distribution has opened a new avenue for efficiently gathering community perspectives needed for utility estimation. Methodological consensus for estimating pediatric utilities is lacking, with disagreement over whom to sample, what perspective to use (patient vs parent) and whether instrument induced anchoring bias is significant. We evaluated what methodological factors potentially impact utility estimates for vesicoureteral reflux. MATERIALS AND METHODS Cross-sectional surveys using a time trade-off instrument were conducted via the Amazon Mechanical Turk® (https://www.mturk.com) online interface. Respondents were randomized to answer questions from child, parent or dyad perspectives on the utility of a vesicoureteral reflux health state and 1 of 3 "warm-up" scenarios (paralysis, common cold, none) before a vesicoureteral reflux scenario. Utility estimates and potential predictors were fitted to a generalized linear model to determine what factors most impacted utilities. RESULTS A total of 1,627 responses were obtained. Mean respondent age was 34.9 years. Of the respondents 48% were female, 38% were married and 44% had children. Utility values were uninfluenced by child/personal vesicoureteral reflux/urinary tract infection history, income or race. Utilities were affected by perspective and were higher in the child group (34% lower in parent vs child, p <0.001, and 13% lower in dyad vs child, p <0.001). Vesicoureteral reflux utility was not significantly affected by the presence or type of time trade-off warm-up scenario (p = 0.17). CONCLUSIONS Time trade-off perspective affects utilities when estimated via an online interface. However, utilities are unaffected by the presence, type or absence of warm-up scenarios. These findings could have significant methodological implications for future utility elicitations regarding other pediatric conditions.
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Affiliation(s)
- Rohit Tejwani
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Hsin-Hsiao S Wang
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jessica C Lloyd
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Paul J Kokorowski
- Division of Pediatric Urology, Children's Hospital Los Angeles, Los Angeles, California
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
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20
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Catallozzi M, de Roche AM, Hu MC, Breitkopf CR, Chang J, Ipp LS, Francis JKR, Rosenthal SL. Adolescent and Parent Willingness to Participate in Microbicide Safety Studies. J Pediatr Adolesc Gynecol 2017; 30:82-87. [PMID: 27381236 PMCID: PMC5863908 DOI: 10.1016/j.jpag.2016.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE To understand adolescents' and parents' willingness to participate (WTP) in a hypothetical phase I prevention study of sexually transmitted infections, discordance within adolescent-parent dyads, and expectations of each other during decision-making. DESIGN AND SETTING Adolescent-parent dyads were recruited to participate in a longitudinal study about research participation attitudes. PARTICIPANTS Adolescents (14-17 years old) and their parents (n = 301 dyads) participated. INTERVENTIONS None. MAIN OUTCOME MEASURES Individual interviews at baseline assessed WTP on a 6-level Likert scale. WTP was dichotomized (willing/unwilling) to assess discordance. RESULTS WTP was reported by 60% (182 of 301) of adolescents and 52% (156 of 300) of parents. In bivariate analyses, older adolescent age, sexual experience, and less involvement of parents in research processes were associated with higher level of WTP for adolescents; only sexual experience remained in the multivariable analysis. For parents, older adolescent age, perceived adolescent sexual experience, and conversations about sexual health were significant; only conversations remained. Dyadic discordance (44%, 132 of 300) was more likely in dyads in which the parent reported previous research experience, and less likely when parents reported higher family expressiveness. Adolescents (83%, 248 of 299) and parents (88%, 263 of 300) thought that the other would have similar views, influence their decision (adolescents 66%, 199 of 300; parents 75%, 224 of 300), and listen (adolescents 90%, 270 of 300; parents 96%, 287 of 300). There were no relationships between these perceptions and discordance. CONCLUSION Inclusion of adolescents in phase I clinical trials is necessary to ensure that new methods are safe, effective, and acceptable for them. Because these trials currently require parental consent, strategies that manage adolescent-parent discordance and support adolescent independence and parental guidance are critically needed.
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Affiliation(s)
- Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center-Mailman School of Public Health, New York, New York.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
| | | | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Lisa S Ipp
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
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Madden L, Shilling V, Woolfall K, Sowden E, Smyth RL, Williamson PR, Young B. Questioning assent: how are children's views included as families make decisions about clinical trials? Child Care Health Dev 2016; 42:900-908. [PMID: 27136194 PMCID: PMC5082536 DOI: 10.1111/cch.12347] [Citation(s) in RCA: 14] [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] [Received: 03/23/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Assent is used to take children's wishes into account when they are invited into clinical trials, but the concept has attracted considerable criticism. We investigated children's accounts of decision-making with the aim of informing practice in supporting children when invited to join a clinical trial. METHODS We audio-recorded qualitative, semi-structured interviews with 22 children aged 8-16 years about being invited to take part in a clinical trial. Most children were interviewed with their parents. Analysis of the transcribed interviews examined the content of participants' accounts thematically, whilst also drawing on principles of discourse analysis, which examines how individuals use talk to achieve certain effects or social practices. RESULTS It was not possible to separate children's knowledge of the clinical trial, or their decision-making processes from that of their parents, with parents taking a substantial mediating role in producing their children's decisions. Decision-making gradually unfolded across time and events and was interwoven within the family context, rather than happening in one moment or in the clinical setting. Whilst children valued their parents' role, a case study of child-parent disagreement indicated how children can struggle to be heard. CONCLUSIONS Decisions happen within a process of family dynamics, in contrast to ideas of assent that isolate it from this context. Parents have a substantial role in children's decisions, and thus how families come to provide consent. Reflecting this we argue that assent practices need to focus on supporting parents to support their children in learning and deliberating about trials. However, this needs to be accompanied by practitioners being alert to the possibility of divergence in child and parent views and enabling children's perspectives to be heard.
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Affiliation(s)
- L Madden
- c/o Institute of Psychology, Health and Society, Liverpool, UK
| | - V Shilling
- SHORE-C, University of Sussex, Brighton, UK
| | - K Woolfall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - E Sowden
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - R L Smyth
- Institute of Child Health, University College London, London, UK
| | - P R Williamson
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - B Young
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
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Annett RD, Brody JL, Scherer DG, Turner CW, Dalen J, Raissy H. A randomized study of a method for optimizing adolescent assent to biomedical research. AJOB Empir Bioeth 2016; 8:189-197. [PMID: 28949898 DOI: 10.1080/23294515.2016.1251507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Voluntary consent/assent with adolescents invited to participate in research raises challenging problems. No studies to date have attempted to manipulate autonomy in relation to assent/consent processes. This study evaluated the effects of an autonomy-enhanced individualized assent/consent procedure embedded within a randomized pediatric asthma clinical trial. METHODS Families were randomly assigned to remain together or separated during a consent/assent process; the latter we characterize as an autonomy-enhanced assent/consent procedure. We hypothesized that separating adolescents from their parents would improve adolescent assent by increasing knowledge and appreciation of the clinical trial and willingness to participate. RESULTS Sixty-four adolescent-parent dyads completed procedures. The together versus separate randomization made no difference in adolescent or parent willingness to participate. However, significant differences were found in both parent and adolescent knowledge of the asthma clinical trial based on the assent/consent procedure and adolescent age. The separate assent/consent procedure improved knowledge of study risks and benefits for older adolescents and their parents but not for the younger youth or their parents. Regardless of the assent/consent process, younger adolescents had lower comprehension of information associated with the study medication and research risks and benefits, but not study procedures or their research rights and privileges. CONCLUSIONS The use of an autonomy-enhanced assent/consent procedure for adolescents may improve their and their parent's informed assent/consent without impacting research participation decisions. Traditional assent/consent procedures may result in a "diffusion of responsibility" effect between parents and older adolescents, specifically in attending to key information associated with study risks and benefits.
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Affiliation(s)
- Robert D Annett
- a Department of Pediatrics , University of Mississippi Medical Center
| | - Janet L Brody
- b Center for Family and Adolescent Research , Oregon Research Institute
| | - David G Scherer
- c Psychology Department , University of Massachusetts , Amherst
| | - Charles W Turner
- b Center for Family and Adolescent Research , Oregon Research Institute
| | - Jeanne Dalen
- d Center for Family and Adolescent Research, Oregon Research Institute , and Department of Pediatrics, University of New Mexico Health Sciences Center
| | - Hengameh Raissy
- e Department of Pediatrics , University of New Mexico Health Sciences Center
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What Factors Moderate Self-Other Discrepancies in Decision Making? Results from a Vaccination Scenario. THE SPANISH JOURNAL OF PSYCHOLOGY 2016; 19:E52. [PMID: 27646872 DOI: 10.1017/sjp.2016.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
When we make risky decisions for others, we tend to follow social norms about risks. This often results in making different decisions for others than we would make for ourselves in a similar situation (i.e., self-other discrepancies). In an experiment, we investigated self-other discrepancies in young adults' decisions to purchase a vaccine against a sexually-transmitted virus for themselves or for another person (i.e., the target of the decision). When the target's preferences were in line with social norms, surrogates showed large self-other discrepancies in line with these norms. When the target's preferences were contrary to social norms, surrogates did not show self-other discrepancies in line with these preferences; instead they still followed social norms, F(1, 140) = 21.45, p < .001, η p 2 = .13. Surrogates with lower numeracy, F(2, 128) = 3.44, p = .035, η p 2 = .05, and higher empathy, F(2, 128) = 3.72, p = .027, η p 2 = .06, showed self-other discrepancies more in line with the target's preferences, even when these were contrary to the norm. Surrogates whose own risk attitudes were contrary to social norms showed larger self-other discrepancies, F(1, 128) = 5.38, p = .022, η p 2 = .04. These results demonstrate that perceived social norms about risk can predict self-other discrepancies in risky decisions, even when the target's preferences are known and at odds with the social norm. Further, the surrogates' numeracy, empathy, and propensity to take risks influence the extent to which risky decisions for others resemble risky decisions for oneself.
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Parents' and Adolescents' Attitudes about Parental Involvement in Clinical Research. J Pediatr Adolesc Gynecol 2016; 29:372-7. [PMID: 26820441 PMCID: PMC4916057 DOI: 10.1016/j.jpag.2016.01.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To understand parent and adolescent attitudes toward parental involvement during clinical trials and factors related to those attitudes. DESIGN As part of a study on willingness to participate in a hypothetical microbicide study, adolescents and their parents were interviewed separately. SETTING Adolescent medicine clinics in New York City. PARTICIPANTS There were 301 dyads of adolescents (ages 14-17 years; 62% female; 72% Hispanic) and their parents. INTERVENTIONS None. MAIN OUTCOME MEASURES The interview included questions on demographic characteristics, sexual history, and family environment (subscales of the Family Environment Scale) that were associated with attitudes about parental involvement. RESULTS Factor analysis of the parental involvement scale yielded 2 factors: LEARN, reflecting gaining knowledge about study test results and behaviors (4 items) and PROCEDURE, reflecting enrollment and permissions (4 items). Adolescents endorsed significantly fewer items on the LEARN scale and the PROCEDURE scale indicating that adolescents believed in less parental involvement. There was no significant concordance between adolescents and their own parents on the LEARN scale and the PROCEDURE scale. In final multivariate models predicting attitudes, adolescents who were female and had sexual contact beyond kissing, and non-Hispanic parents had lower LEARN scores. Adolescents who were older, had previous research experience, and reported less moral or religious emphasis in their family had lower PROCEDURE scores; there were no significant predictors for parents in the multivariate analyses. CONCLUSION Parents wanted greater involvement in the research process than adolescents. Recruitment and retention might be enhanced by managing these differing expectations.
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Miller VA, Feudtner C. Parent and Child Perceptions of the Benefits of Research Participation. IRB 2016; 38:1-7. [PMID: 29442473 PMCID: PMC5790123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The primary objective of this study was to describe parents' and children's perceptions of the health benefits of research participation. We assessed 180 children ages 8 to 17 years who recently enrolled in medical research and their parents. Of the 136 parents with children on observational protocols, 41% indicated that there would be a health benefit to the child. Their descriptions of benefits revealed that many envisioned a future health benefit to the child arising from improvements in treatment due to the research. There was no difference in ratings of likelihood or importance of benefit between parents of children enrolled in observational protocols versus interventional protocols. Children enrolled in observational protocols were more likely to respond "don't know" to the question about potential health benefit compared to children on interventional protocols. For both observational and interventional protocols, the informed consent process may be enhanced when research personnel explicitly differentiate between different types of potential benefits, including heretofore-unrecognized future direct health benefits.
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Affiliation(s)
- Victoria A Miller
- Assistant Professor of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Feudtner
- Professor of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Francis JKR, Hoffman LF, Hu MC, de Roche AM, Catallozzi M, Breitkopf CR, Rosenthal SL. Adolescents and Their Parents Differ on Descriptions of a Reproductive Health Study. J Pediatr Adolesc Gynecol 2016; 29:240-5. [PMID: 26409154 PMCID: PMC4808475 DOI: 10.1016/j.jpag.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/02/2015] [Accepted: 09/14/2015] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To understand how adolescents and parents describe a sexually transmitted infection prevention study to a friend. DESIGN Adolescents and parents participating in a study about willingness to participate in a hypothetical microbicide clinical trial were interviewed separately and asked to describe the clinical trial to a friend. Qualitative responses were written down verbatim and coded using a thematic framework analysis. SETTING Adolescent medicine clinics in New York City. PARTICIPANTS The participants consisted of adolescents, 14-17 years old, and a parent (n = 301 dyads) who spoke English or Spanish. Most adolescents (72%) identified as Hispanic and 65% reported minimal sexual experience (ie, nothing more than kissing). INTERVENTIONS None. MAIN OUTCOME MEASURES Qualitative responses were content coded for: (1) overall approach; (2) opinion rendered; and (3) details mentioned using thematic framework. The relationship of demographic characteristics, sexual history, and recruitment method to how adolescents and/or parents described the study was evaluated. RESULTS Adolescents (n = 293) differed from parents (n = 298) in their overall approach to describing the study (P < .01) with more adolescents than parents providing a "purpose with detail" (54% adolescents vs 31% parents) and less providing a "commentary" description (6% adolescents vs 28% parents). Fewer adolescents (25% of n = 301) provided an opinion compared with parents (75% of n = 301; P < .01). A greater proportion of adolescents (70% adolescents, n = 206; vs 48% parents, n = 144) provided a detail (P < .01). Adolescents provided a greater number of details than parents (P < .01). CONCLUSION Adolescents in this sample were more focused on the details of the study. Parents were focused on their impression of the study. Adolescents and parents might need to be approached differently about reproductive health studies.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York.
| | - Lily F Hoffman
- Department of Pediatrics, Columbia University Medical Center College of Physicians and Surgeons, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Medical Center College of Physicians and Surgeons, New York, New York
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center College of Physicians and Surgeons, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population and Family Health, Columbia University Medical Center Mailman School of Public Health, New York, New York
| | | | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center College of Physicians and Surgeons, New York, New York
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Abstract
BACKGROUND There are limited data on parental perception of infant participation in minimal risk and minor increase above minimal risk research focusing on the NICU population. The study objective was to assess parental and NICU staff perceptions concerning minimal risk and minor increase above minimal risk in the NICU setting. METHODS Parents of infants and NICU staff were presented with a combination of 4 infant scenarios and 5 hypothetical research procedures. These assessed participants' willingness to allow their infant to participate in research and their attitude towards obligation to assist future children. Linear and hierarchal linear models analyzed the association and interaction effects on the likelihood to consent to research procedures. RESULTS Sixty parents and 30 NICU staff members were surveyed. Parents' acceptability for each of the five research procedures ranged from 31 % to 83 %. Parent gender, age, race/ethnicity, insurance, education and history of previous child in the NICU were not associated with the likelihood to consent to the research procedures. Acceptability for each of the five research procedures among NICU staff ranged from 19 % to 98 %. There were no significant differences between NICU staff's and parents' responses for 4 of 5 research procedures. A minority of parents and nurses (38.3 % and 40 % respectively), compared to a majority of physicians (66.7 %), agreed or strongly agreed that parents have a responsibility to involve their children in low risk medical research in order to help future children, even if this would not help their own child. Lower agreement with obligation to help future children (p < 0.01) and higher education (p = 0.01) were associated with a decreased likelihood to consent to research procedures. CONCLUSION In our study population, common NICU-related research procedures were considered appropriate and acceptable to a diverse group of NICU parents representing a wide range of race/ethnic and socioeconomic strata. Current regulations guiding informed consent for minimal and minor increase over minimal risk research in the NICU environment appear ethically consistent with a diverse group of parents and providers.
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Tromp K, Zwaan CM, van de Vathorst S. Motivations of children and their parents to participate in drug research: a systematic review. Eur J Pediatr 2016; 175:599-612. [PMID: 27041121 PMCID: PMC4839044 DOI: 10.1007/s00431-016-2715-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 03/08/2016] [Accepted: 03/13/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED Information on motivations for research participation, may enable professionals to better tailor the process of recruitment and informed consent to the perspective of parents and children. Therefore, this systematic review assesses motivating and discouraging factors for children and their parents to decide to participate in clinical drug research. Studies were identified from searches in 6 databases. Two independent reviewers screened and selected relevant articles. Results were aggregated and presented by use of qualitative metasummary. 38 studies fulfilled the selection criteria and were of sufficient quality for inclusion in the qualitative metasummary. Most mentioned motivating factors for parents were: health benefit for child, altruism, trust in research, and relation to researcher. Most mentioned motivating factors for children were: personal health benefit, altruism and increasing comfort. Fear of risks, distrust in research, logistical aspects and disruption of daily life were mentioned most by parents as discouraging factors. Burden and disruption of daily life, feeling like a "guinea pig" and fear of risks were most mentioned as discouraging factors by children. CONCLUSION Paying attention to these motivating and discouraging factors of children and their parents during the recruitment and informed consent process in drug research increases the moral and instrumental value of informed consent. WHAT IS KNOWN • This systematic review pools the existing empirical literature on motivations of minors and their parents to consent or dissent to participation in clinical drug research. • The most mentioned motivating and discouraging factors for children and their parents to consent to participation in clinical drug research are identified aggregated and presented by use of qualitative metasummary. What is new: • This information can be used to adapt the research protocol, recruitment, and informed consent/assent process to the needs of children and their parents.
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Affiliation(s)
- Krista Tromp
- />Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, P.O. box 2040, 3000 CA Rotterdam, The Netherlands
| | - C. Michel Zwaan
- />Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, P.O. box 2040, 3000 CA Rotterdam, The Netherlands
| | - Suzanne van de Vathorst
- />Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, P.O. box 2040, 3000 CA Rotterdam, The Netherlands
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Lingler JH, Schmidt KL, Gentry AL, Hu L, Terhorst LA. A New Measure of Research Participant Burden: Brief Report. J Empir Res Hum Res Ethics 2016; 9:46-9. [PMID: 26125079 DOI: 10.1177/1556264614545037] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Effective conceptualizations of research burden should address indirect burdens related to research duration, intensity, and invasiveness. Introducing the concept of perceived research burden, we developed, tested, and validated a new instrument, the Perceived Research Burden Assessment (PeRBA). Initial psychometric evaluation of PeRBA reveals good internal consistency, evidence of face validity, and acceptable convergent and discriminant validity.
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Kim SYH, Miller FG. Waivers and Alterations to Consent in Pragmatic Clinical Trials: Respecting the Principle of Respect for Persons. IRB 2016; 38:1-5. [PMID: 26964403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Coad J, Gibson F, Horstman M, Milnes L, Randall D, Carter B. Be my guest! Challenges and practical solutions of undertaking interviews with children in the home setting. J Child Health Care 2015; 19:432-43. [PMID: 24812062 DOI: 10.1177/1367493514527653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article aims to share critical debate on undertaking interviews with children in the home setting and draws on the authors' extensive research fieldwork. The article focuses on three key processes: planning entry to the child's home, conducting the interviews and exiting the field. In planning entry, we include children's engagement and issues of researcher gender. In conducting the interviews, we consider issues such as the balance of power, the importance of building a rapport, the voluntary nature of consent and the need for a flexible interview structure. Finally, we address exiting from the child's home with sensitivity at the end of the interview and/or research study. Undertaking research in the child's home provides a known and familiar territory for the child, but it means that the researcher faces a number of challenges that require solutions whilst they are a guest in a child's home.
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Affiliation(s)
| | - Faith Gibson
- Great Ormond Street Hospital for Children NHS Trust; London South Bank University, UK
| | | | | | | | - Bernie Carter
- University of Central Lancashire; Alder Hey Children's NHSFT, UK & University of Tasmania, Australia
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Coyne I. Families and health-care professionals' perspectives and expectations of family-centred care: hidden expectations and unclear roles. Health Expect 2015; 18:796-808. [PMID: 23800327 PMCID: PMC5060842 DOI: 10.1111/hex.12104] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Family-centred care (FCC) is viewed as a pivotal concept in the provision of high-quality nursing care for children and their families, yet implementation continues to be problematic worldwide. This research investigated how FCC was enacted from families and nurses' perspectives. DESIGN Descriptive qualitative approach using elements of analysis from grounded theory method. Data were collected though individual interviews with 18 children aged 7-16 years, their parents (n = 18) and 18 nurses from two children's hospital and one children's unit in a large general hospital in Ireland. RESULTS Four key themes were identified: expectations; relying on parents' help; working out roles; and barriers to FCC. Nurses wholeheartedly endorsed FCC because of the benefits for families and their reliance on parents' contribution to the workload. There was minimal evidence of collaboration or negotiation of roles which resulted in parents feeling stressed or abandoned. Nurses cited busy workload, under-staffing and inappropriate documentation as key factors which resulted in over-reliance on parents and hindered their efforts to negotiate and work alongside parents. CONCLUSIONS Families are willing to help in their child's care but they require clear guidance, information and support from nurses. Hidden expectations and unclear roles are stressful for families. Nurses need skills training, adequate resources and managerial support to meet families' needs appropriately, to establish true collaboration and to deliver optimal family-centred care.
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Affiliation(s)
- Imelda Coyne
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
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Brief Report: Adolescents' Reasons for Participating in a Health Care Transition Intervention Study. J Pediatr Nurs 2015; 30:e165-71. [PMID: 26138375 DOI: 10.1016/j.pedn.2015.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE This study investigated the reasons adolescents with spina bifida consented or assented to participate in a randomized controlled prospective health care transition intervention study. METHODS Sixty-five adolescents with spina bifida (SB), ages 14 to 18 years, who had previously participated in the Transition Preparation Training Program (TPT) study were recruited for the current study. A total of 26 consents/assents were obtained; a total of 25 questionnaires were returned (11 treatment; 14 control). Study findings were from a sample of 25 adolescents, aged 14 to 20 years who had participated in a randomized controlled prospective study entitled the Transition Preparation Training Program (TPT). Content analysis was used to code and analyze data. RESULTS Study findings revealed adolescents indicated several reasons for choosing to participate in the research study. Major reasons cited for their participation were related to the desire to learn more about their condition and for altruistic purposes. Numerous reasons were offered by respondents as to why adolescents declined to participate in the research study; feelings of discomfort and issues of privacy were cited. Sixty-four percent of the respondents indicated the offer of a research incentive did not affect their decision to participate in the TPT study. Other findings are reported as to the use of research incentives and future recruitment recommendations. CONCLUSIONS Youth shared a number of reasons and insights about recruitment strategies that may be helpful for future research efforts, especially those studies involving adolescents with special health care needs who participate in health care transition research.
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Staphorst MS, Hunfeld JAM, van de Vathorst S, Passchier J, van Goudoever JB. Children's self reported discomforts as participants in clinical research. Soc Sci Med 2015; 142:154-62. [PMID: 26310591 DOI: 10.1016/j.socscimed.2015.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is little empirical evidence on children's subjective experiences of discomfort during clinical research procedures. Therefore, Institutional Review Boards have limited empirical information to guide their decision-making on discomforts for children in clinical research. To get more insight into what children's discomforts are during clinical research procedures, we interviewed a group of children on this topic and also asked for suggestions to reduce possible discomforts. MATERIALS AND METHODS Forty-six children (aged 6-18) participating in clinical research studies (including needle-related procedures, food provocation tests, MRI scans, pulmonary function tests, questionnaires) were interviewed about their experiences during the research procedures. Thematic analysis was used to analyze the interviews. RESULTS The discomforts of the interviewed children could be divided into two main groups: physical and mental discomforts. The majority experienced physical discomforts during the research procedures: pain, shortness of breath, nausea, itchiness, and feeling hungry, which were often caused by needle procedures, some pulmonary procedures, and food provocation tests. Mental discomforts included anxiousness because of anticipated pain and not knowing what to expect from a research procedure, boredom and tiredness during lengthy research procedures and waiting, and embarrassment during Tanner staging. Children's suggestions to reduce the discomforts of the research procedures were providing distraction (e.g. watching a movie or listening to music), providing age-appropriate information and shortening the duration of lengthy procedures. DISCUSSION Our study shows that children can experience various discomforts during research procedures, and it provides information about how these discomforts can be reduced according to them. Further research is needed with larger samples to study the number of children that experience these mentioned discomforts during research procedures in a quantitative way.
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Affiliation(s)
- Mira S Staphorst
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Joke A M Hunfeld
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Suzanne van de Vathorst
- Department of Medical Ethics and Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jan Passchier
- Department of Clinical Psychology, EMGO+, VU University, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Johannes B van Goudoever
- Department of Pediatrics, VU University Medical Center (VUmc), PO Box 7057, 1007 MB, Amsterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Chávez NR, Williams CY, Ipp LS, Catallozzi M, Rosenthal SL, Breitkopf CR. Altruistic reasoning in adolescent-parent dyads considering participation in a hypothetical sexual health clinical trial for adolescents. RESEARCH ETHICS REVIEW 2015; 12:68-79. [PMID: 27019669 DOI: 10.1177/1747016115587963] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Altruism is a well-established reason underlying research participation. Less is known about altruism in adolescent-parent decision-making about clinical trials enrolling healthy adolescents. This qualitative investigation focused on identifying spontaneous statements of altruism within adolescent-parent (dyadic) discussions of participation in a hypothetical phase I clinical trial related to adolescent sexual health. Content analysis revealed several response patterns to each other's altruistic reasoning. Across 70 adolescent-parent dyads in which adolescents were 14-17 years of age and 91% of their parents were mothers, a majority (61%) of dyadic discussions included a statement reflecting altruism. Parents responded to adolescents' statements of altruism more frequently than adolescents responded to parents' statements. Responses included: expresses concern, reiterates altruistic reasoning, agrees with altruistic reasoning, and adds to/expands altruistic reasoning. Since an altruistic perspective was often balanced with concerns about risk or study procedures, researchers cannot assume that altruism will directly lead to study participation. Optimizing the informed consent process for early phase clinical trials involving healthy adolescents may include supporting parents to have conversations with their adolescents which will enhance their capacity to consider all aspects of trial participation.
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Affiliation(s)
- Noé Rubén Chávez
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, United States
| | - Camille Y Williams
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, United States
| | - Lisa S Ipp
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, United States
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, United States; Heilbrunn Department of Population & Family Health, Columbia University Medical Center - Mailman School of Public Health, New York, New York, United States
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, United States
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Wiener L, Viola A, Wilfond BS, Wendler D, Grady C. Contrasting views of risk perception and influence of financial compensation between adolescent research participants and their parents. J Empir Res Hum Res Ethics 2015; 10:49-58. [PMID: 25742666 PMCID: PMC5533159 DOI: 10.1177/1556264614563249] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
U.S. regulations governing pediatric research do not specify the assent process. To identify best practices, it is important to examine parents' and adolescents' views. The present study focuses on parents' and adolescents' views regarding possible research risks and the influence of financial compensation on their willingness to accept research procedures. Interviews were conducted with 177 adolescents participating in clinical research for a medical or psychiatric illness, or as healthy volunteers, and a parent. Significant discordance was found between how bothered the teen would feel from research-related side effects and procedures compared with parental report. Most teens were willing to accept non-beneficial procedures without compensation. Payment had significantly greater influence on healthy volunteers and their parents compared with those with a medical or psychiatric illness. Discordance between adolescent and parental views about risks recommends obtaining direct input from adolescents during the assent process. Modest payments should not raise concerns of undue inducement, especially in teens with pre-existing conditions.
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Affiliation(s)
- Lori Wiener
- National Cancer Institute, Bethesda, MD, USA
| | - Adrienne Viola
- National Cancer Institute, Bethesda, MD, USA Yale University, New Haven, CT, USA
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Abstract
Pharmacological research in the adolescent population is not meeting adolescents' needs. Medication is still frequently prescribed off label, and studies especially in sensitive areas of adolescent health care are underrepresented. Adolescents did not benefit from the new knowledge gained in cancer research, and their outcome has essentially not improved during the last two decades in comparison to younger children and adults. There are many obstacles that make it challenging to enroll adolescents in pharmacological research. Access can be difficult. Confidentiality plays an essential role for minors and may be a hindrance, notably to studying sexual and mental health matters. Pharmaceutical companies may exclude the adolescent patient because of a lack of profit and in fear of a complex study design. Research concepts should be explained to the adolescent in a comprehensive manner, and assent and consent forms should be clear and understandable. New laws and incentives have been developed to encourage pharmaceutical companies to engage adolescents in their research projects. Centralization and collaboration of all parties involved may make the whole approach to adolescent research more efficient and uniform. The mature minor doctrine has facilitated the enrollment process. Parental consent may be waived for low-risk medical trials to promote recruitment. Ethics committees therefore play a major role in protecting the adolescent from harm from participating in research. In conclusion, pharmacological research in adolescents has to be encouraged. This will increase the safety of current medical treatment regimens and will allow this population to benefit from therapeutic advancements.
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Affiliation(s)
- Eva Welisch
- Department of Pediatric Cardiology, Western University, LHSC, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada,
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Brown DS, Poulos C, Johnson FR, Chamiec-Case L, Messonnier ML. Adolescent Girls’ Preferences for HPV Vaccines: A Discrete Choice Experiment. PREFERENCE MEASUREMENT IN HEALTH 2014. [DOI: 10.1108/s0731-219920140000024002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Grady C, Wiener L, Abdoler E, Trauernicht E, Zadeh S, Diekema DS, Wilfond BS, Wendler D. Assent in research: the voices of adolescents. J Adolesc Health 2014; 54:515-20. [PMID: 24630932 PMCID: PMC4047975 DOI: 10.1016/j.jadohealth.2014.02.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescents join clinical research after investigators obtain their positive agreement or "assent." Although intended to respect adolescents, little is known about the views of adolescents or their parents regarding assent or research enrollment decisions. This study aimed to better understand perspectives of adolescent research participants and their parents about assent and parental permission. METHODS Structured interviews were conducted with 13- through 17-year-old teens, enrolled in clinical research at the National Institutes of Health or Seattle Children's Hospital, and separately with one parent. RESULTS One hundred and seventy-seven adolescent-parent pairs were interviewed. Teens were well distributed by age and gender, represented a wide variety of research and illnesses ranging in severity from mild to life threatening; 20% were healthy volunteers. Teens and parents were generally satisfied with the assent/permission process. Normally, they made the enrollment decision together and teens wanted parents' input and support. About 25% of teens reported pressure to enroll, not only from parents or relatives but also from doctors/nurses/research teams. Only 2% of teens preferred not to sign a consent form. CONCLUSIONS Despite some differing views about how decisions should be made, the current assent/permission process is perceived as satisfactorily respectful by most teens in research. Many teens want to sign consent forms, and teens' signatures should generally be sought. Flexible guidance allows research teams and Institutional Review Boards to customize the assent process for teens in particular studies in order to facilitate an appropriate balance between giving teens a voice reflective of their emerging independence and enabling supportive collaboration with parents.
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Affiliation(s)
- Christine Grady
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland.
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute
| | - Emily Abdoler
- Formerly at the Department of Bioethics, NIH Clinical Center, currently University of California San Francisco
| | - Emily Trauernicht
- Formerly summer student, Department of Bioethics, Currently at University of Virginia Medical School
| | - Sima Zadeh
- Pediatric Oncology Branch, National Cancer Institute
| | - Douglas S. Diekema
- Treuman Katz Center for Pediatric Bioethics, Seattle Childrens Research Institute
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Childrens Research Institute
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Roth-Cline M, Nelson RM. Parental permission and child assent in research on children. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2013; 86:291-301. [PMID: 24058304 PMCID: PMC3767214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Grounded on the ethical principle of respect for persons, parental permission and child assent function together to protect the child and to foster the development of the child's self-determination. Although both parental permission and child assent involve the same components of information sharing, comprehension, and voluntariness, how these three components are understood and operationalized should differ depending on the developmental level of the child. For example, the amount of information that a child must comprehend to provide meaningful and developmentally appropriate child assent (or dissent) should be allowed to vary with the age and maturity of the child. By understanding child assent together with the important protections of parental permission, child assent does not need to be burdened with the same informational and process requirements. As a result, the age (as a proxy for developmental stage) at which a child is deemed capable of assent would be lower (i.e., 5 to 7 years old). By assuming a lack of capacity, the potential arises to dishonor and disregard a child's wishes by failing to solicit meaningful assent or dissent. Further research needs to be done on how best to obtain truly informed and voluntary parental permission and child assent for research participation.
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Affiliation(s)
- Michelle Roth-Cline
- Office of Pediatric Therapeutics, Food and Drug Administration, Silver Spring,
Maryland
| | - Robert M. Nelson
- Office of Pediatric Therapeutics, Food and Drug Administration, Silver Spring,
Maryland
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Ezell JM, Saltzgaber J, Peterson E, Joseph CLM. Reconnecting with urban youth enrolled in a randomized controlled trial and overdue for a 12-month follow-up survey. Clin Trials 2013; 10:775-82. [PMID: 23983157 DOI: 10.1177/1740774513498320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Retention of study participants in randomized controlled trials (RCTs) is crucial to study validity. PURPOSE We analyzed the results of four retention strategies used to reconnect with urban teens enrolled in a school-based RCT and overdue for a 12-month follow-up survey. METHODS Traditional retention strategies used to reconnect with teens categorized as 'unable to contact' were weekly redials of nonworking telephone numbers and mailings to the student's home. Nontraditional retention strategies were obtaining assistance from school administration and performing outreach on Facebook. RESULTS Of the 422 students enrolled, 125 (29.5%) were overdue for a 12-month follow-up survey, but had no working telephone number (unable to contact). We made 196 attempts to contact these 125 students, of which 82 attempts (41.8%) were successful in 'reconnecting' with the student. Using 'mailed reminder letters' as the referent category, odds ratios (95% confidence intervals) for the association between the strategy used and reconnecting were 4.60 (1.8-11.8), 1.94 (1.01-3.73), and 2.91 (0.58-14.50), respectively, for telephone number redials, Facebook outreach, and school administration assistance. Of the 422 students, 380 (90%) ultimately completed the 12-month follow-up survey. LIMITATIONS Retention strategies were not applied hierarchically or systematically. We were unable to determine student preference for a particular strategy. Findings are likely only applicable to similar study populations. CONCLUSION A mix of traditional retention strategies and more contemporary methods was effective in reconnecting with urban teenagers enrolled in a school-based RCT and in controlling attrition during the 12-month follow-up survey period.
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Affiliation(s)
- Jerel M Ezell
- aDepartment of Public Health Sciences, Henry Ford Hospital, Henry Ford Health System, Detroit, MI, USA
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Behrmann J. The paucity of ethical analysis in allergology. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2013; 9:5. [PMID: 23388345 PMCID: PMC3573914 DOI: 10.1186/1710-1492-9-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 01/17/2013] [Indexed: 11/10/2022]
Abstract
While a growing body of research is uncovering the aetiology and effective treatments for allergy, research that assess the broader ethical implications of this disease is lacking significantly. This article will demonstrate both the paucity of academic research concerning ethical implications in allergy and explain why ethical analysis is integral to formulating effective health strategies for allergic disease. An exhaustive literature search of publications in French and English identified less than 35 academic articles focussed on the topic of ethics and allergy; this is a miniscule number when compared to the amount of articles published on ethical issues related to other chronic illnesses, such as obesity. It is important to demonstrate to allergy specialists the need for, and utility of, further incorporating ethical analyses in allergology; the current success of Ethical, Legal, Social Implications (ELSI) research programmes in human genetics and nanotechnology will serve as notable examples. Indeed, future research and innovation in allergy will undoubtedly encounter ethical dilemmas and the allergology community should play a significant role in helping to address these issues. However, incorporating ethical analyses in allergology does not imply that the allergology community must acquire extensive knowledge in bioethics; instead, interdisciplinary research that incorporates expertise from allergology and bioethics would enable allergy specialists to advance critical knowledge development in this largely overlooked domain of study.
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Affiliation(s)
- Jason Behrmann
- Institute for Gender, Sexuality, and Feminist Studies, McGill University, 3487 Peel Street, 2nd floor, Montréal H3A 1W7, Canada.
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Scherer DG, Brody JL, Annett RD, Turner C, Dalen J, Yoon Y. Empirically-derived Knowledge on Adolescent Assent to Pediatric Biomedical Research. AJOB PRIMARY RESEARCH 2013; 4:15-26. [PMID: 23914304 PMCID: PMC3728675 DOI: 10.1080/21507716.2013.806967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There has been a recent growth in empirical research on assent with pediatric populations, due in part, to the demand for increased participation of this population in biomedical research. Despite methodological limitations, studies of adolescent capacities to assent have advanced and identified a number of salient psychological and social variables that are key to understanding assent. METHODS The authors review a subsection of the empirical literature on adolescent assent focusing primarily on asthma and cancer therapeutic research; adolescent competencies to assent to these studies; perceptions of protocol risk and benefit; the affects of various social context variables on adolescent research participation decision making; and the inter-relatedness of these psychological and social factors. RESULTS Contemporary studies of assent, using multivariate methods and updated approaches to statistical modeling, have revealed the importance of studying the intercorrelation between adolescents' psychological capacities and their ability to employ these capacities in family and medical decision-making contexts. Understanding these dynamic relationships will enable researchers and ethicists to develop assent procedures that respect the authority of parents, while at the same time accord adolescents appropriate decision-making autonomy. CONCLUSIONS Reviews of empirical literature on the assent process reveal that adolescents possess varying capacities for biomedical research participation decision making depending on their maturity and the social context in which the decision is made. The relationship between adolescents and physician-investigators can be used to attenuate concerns about research protocols and clarify risk and benefit information so adolescents, in concert with their families, can make the most informed and ethical decisions. Future assent researchers will be better able to navigate the complicated interplay of contextual and developmental factors and develop the empirical bases for research enrollment protocols that will support increased involvement of adolescents in biomedical research.
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Affiliation(s)
- David G. Scherer
- Department of Psychology, University of Massachusetts Amherst, 610 Tobin Hall, 135 Hicks Way, Amherst, MA 01003
| | - Janet L. Brody
- Center for Family and Adolescent Research, Oregon Research Institute
| | - Robert D. Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center
| | - Charles Turner
- Center for Family and Adolescent Research, Oregon Research Institute
| | - Jeanne Dalen
- Center for Family and Adolescent Research, Oregon Research Institute
| | - Yesel Yoon
- Department of Psychology, University of Massachusetts Amherst
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Wendler D, Abdoler E, Wiener L, Grady C. Views of adolescents and parents on pediatric research without the potential for clinical benefit. Pediatrics 2012; 130:692-9. [PMID: 22966027 PMCID: PMC3457618 DOI: 10.1542/peds.2012-0068] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Critics argue that pediatric research without the potential for clinical benefit is unethical because it treats children as mere means, exposing those who cannot consent to risks for the benefit of others. The present survey was designed to assess whether this claim is consistent with the views of adolescents who actually participate in research, or their parents. METHODS Interviews were conducted with adolescents participating in research at the NIH Clinical Center or Seattle Children's Hospital, and their parents, from June 2008 through April 2010. RESULTS Interviews were completed with 177 of 186 adolescent/parent pairs (response rate= 95.2%). Overall, 90% of the adolescents and parents were willing to have the adolescent undergo a few extra blood draws, and 65% were willing to have the adolescent undergo an extra skin biopsy, for research purposes. The vast majority felt that the adolescents were making an important contribution to help others, and 80.8% of the adolescents felt proud to be doing so. Respondents overall were equally willing to have the adolescent face risks to help others in a research study or in a charitable activity. CONCLUSIONS The views and experiences of these respondents do not support the claim that pediatric research without the potential for clinical benefit treats subjects as mere means. Instead, the findings provide proof of principle for the claim that non-beneficial pediatric research involves a type of charitable activity which offers children the opportunity to contribute to a valuable project to help others.
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Affiliation(s)
- David Wendler
- Department of Bioethics, NIH Clinical Center, Building 10, Room 1C118, Bethesda, MD 20892, USA.
| | - Emily Abdoler
- Department of Bioethics, National Institutes of Health Clinical Center, and
| | - Lori Wiener
- Pediatric Branch, National Cancer Institute, Bethesda, Maryland
| | - Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, and
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Halverson CME, Ross LF. Attitudes of African-American parents about biobank participation and return of results for themselves and their children. JOURNAL OF MEDICAL ETHICS 2012; 38:561-566. [PMID: 22573882 PMCID: PMC4260924 DOI: 10.1136/medethics-2012-100600] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Biobank-based research is growing in importance. A major controversy exists about the return of aggregate and individual research results. METHODS The authors used a mixed-method approach in order to study parents' attitudes towards the return of research results regarding themselves and their children. Participants attended four 2-h, deliberative-engagement sessions held on two consecutive Saturdays. Each session consisted of an educational presentation followed by focus-group discussions with structured questions and prompts. This manuscript examines discussions from the second Saturday which focused on the benefits and risks of returning aggregate and individual research results regarding both adults (morning session) and children (afternoon session). Attitudes were assessed in pre-engagement and post-engagement surveys. RESULTS The authors recruited 45 African-American adults whose children received medical care at two healthcare facilities on the South Side of Chicago that serve different socioeconomic communities. Three dominant themes were identified. First, most participants stated that they would enrol themselves and their children in a biobank, although there was a vocal minority opposed to enrolling children, particularly children unable to participate in the consent process. Second, participants did not distinguish between the results they wanted to receive regarding themselves and their children. Supplemental survey data found no attitudinal changes pre-engagement and post-engagement. Third, participants believed that children should be allowed access to their health information, but they wanted to be involved in deciding when and how the information was shared. DISCUSSION Participant attitudes are in tension with current biobank policies. An intensive educational effort had no effect on their attitudes.
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Affiliation(s)
| | - Lainie Friedman Ross
- Departments of Pediatrics, Medicine and Surgery, and MacLean Center for Clinical Medical Ethics
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Brody JL, Turner C, Annett RD, Scherer DG, Dalen J. Predicting adolescent asthma research participation decisions from a structural equations model of protocol factors. J Adolesc Health 2012; 51:252-8. [PMID: 22921135 PMCID: PMC3628807 DOI: 10.1016/j.jadohealth.2011.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 12/08/2011] [Accepted: 12/09/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine similarities and differences in the process that parents and adolescents use to make decisions concerning participation in an asthma clinical trial. We hypothesized that a single conceptual model, tested through structural equations modeling, could explain adolescent assent and parent consent for adolescent research participation. METHODS One hundred nine adolescents enrolled with at least one parent and received an asthma evaluation from a pediatric asthma specialist and then evaluated a hypothetical asthma research protocol. Family members independently evaluated the protocol and made research participation decisions. RESULTS Perceived risk, benefit, and compensation were direct predictors of participation decisions for parents and adolescents. Adolescents perceived direct study benefit from the relationship with the physician, however parents did not. Parent decisions were most strongly associated with perceived risk, and parents associated discomfort with risk more strongly than did adolescents. Protocol procedures contributed to perceptions of benefit and discomfort for parents and adolescents. CONCLUSIONS Parent and adolescent research participation decisions are influenced by protocol variables in similar ways, although there are differences that account for disagreements within families. Findings may help investigators develop protocols that appeal to parents and adolescents and highlight issues of particular importance to address during the process of informed consent.
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Affiliation(s)
- Janet L. Brody
- Center for Family and Adolescent Research, Oregon Research Institute
| | - Charles Turner
- Center for Family and Adolescent Research, Oregon Research Institute
| | | | | | - Jeanne Dalen
- Center for Family and Adolescent Research, Oregon Research Institute
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Milnes L, Kendal S. Ethical challenges of conducting health research in UK school setting. ACTA ACUST UNITED AC 2012; 21:294-8. [DOI: 10.12968/bjon.2012.21.5.294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Linda Milnes
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester
| | - Sarah Kendal
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester
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Wulf F, Krasuska M, Bullinger M. Determinants of decision-making and patient participation in paediatric clinical trials: A literature review. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojped.2012.21001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Arnold DH, Gebretsadik T, Abramo TJ, Hartert TV. Noninvasive testing of lung function and inflammation in pediatric patients with acute asthma exacerbations. J Asthma 2011; 49:29-35. [PMID: 22133263 DOI: 10.3109/02770903.2011.637599] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is limited information on performance rates for tests of lung function and inflammation in pediatric patients with acute asthma exacerbations. We sought to examine how frequently pediatric patients with acute asthma exacerbations could perform noninvasive lung function and exhaled nitric oxide (FE(NO)) testing and participant characteristics associated with successful performance. METHODS We studied a prospective convenience sample aged 5-17 years with acute asthma exacerbations in a pediatric emergency department. Participants attempted spirometry for percent predicted forced expiratory volume in 1 second (%FEV(1)), airway resistance (Rint), and FE(NO) testing before treatment. We examined overall performance rates and the associations of age, gender, race, and baseline acute asthma severity score with successful test performance. RESULTS Among 573 participants, age was (median [interquartile range]) 8.8 [6.8, 11.5] years, 60% were male, 57% were African-American, and 58% had Medicaid insurance. Tests were performed successfully by the following [n (%)]: full American Thoracic Society-European Respiratory Society criteria spirometry, 331 (58%); Rint, 561 (98%); and FE(NO), 354 (70% of 505 attempted test). Sixty percent with mild-moderate exacerbations performed spirometry compared to 17% with severe exacerbations (p = .0001). Participants aged 8-12 years (67%) were more likely to perform spirometry than those aged 5-7 years (48%) (OR = 2.23, 95% CI: 1.45-3.11) or 13-17 years (58%) (OR = 1.61, 95% CI: 1.00-2.59). CONCLUSIONS There is clinically important variability in performance of these tests during acute asthma exacerbations. The proportion of patients with severe exacerbations able to perform spirometry (17%) limits its utility. Almost all children with acute asthma can perform Rint testing, and further development and validation of this technology is warranted.
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Affiliation(s)
- Donald H Arnold
- Department of Pediatrics, Division of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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de Vries MC, Wit JM, Engberts DP, Kaspers GJL, van Leeuwen E. Pediatric oncologists' attitudes towards involving adolescents in decision-making concerning research participation. Pediatr Blood Cancer 2010; 55:123-8. [PMID: 20486177 DOI: 10.1002/pbc.22510] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Various regulations and guidelines stipulate the importance of involving adolescents in decision-making concerning research participation. Several studies have shown that in the context of pediatric oncology this involvement is difficult to achieve due to emotional stress, the complexity of research protocols and limited time. Still, up to 80% of adolescents with cancer enter onto a trial during their illness. The aim of this study was to determine clinicians' views and attitudes towards enrolling adolescents in research, considering the difficulties surrounding their involvement in decision-making. METHODS A qualitative multicenter study was performed, using in-depth semi-structured interviews on the informed consent process with 15 pediatric hemato-oncologists. RESULTS Four central themes emerged that characterize clinicians' attitudes towards involving adolescents in the decision-making process: (1) clinicians regard most adolescents as not capable of participating meaningfully in discussions regarding research; (2) clinicians do not always provide adolescents with all information; (3) proxy consent from parents is obtained and is deemed sufficient; (4) clinician-investigator integrity: clinicians judge research protocols as not being harmful and even in the best interest of the adolescent. CONCLUSIONS Clinicians justify not involving adolescents in research discussions by referring to best interest arguments (adolescents' incompetence, proxy consent, and investigator integrity), although this is not in line with legal regulations and ethical guidelines.
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Affiliation(s)
- Martine C de Vries
- Department of Medical Humanities (Metamedica), VU University Medical Center, Amsterdam, the Netherlands. m.c.de
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