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Shiely F, O Shea N, Murphy E, Eustace J. Registry-based randomised controlled trials: conduct, advantages and challenges-a systematic review. Trials 2024; 25:375. [PMID: 38863017 PMCID: PMC11165819 DOI: 10.1186/s13063-024-08209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Registry-based randomised controlled trials (rRCTs) have been described as pragmatic studies utilising patient data embedded in large-scale registries to facilitate key clinical trial procedures including recruitment, randomisation and the collection of outcome data. Whilst the practice of utilising registries to support the conduct of randomised trials is increasing, the use of the registries within rRCTs is inconsistent. The purpose of this systematic review is to explore the conduct of rRCTs using a patient registry to facilitate trial recruitment and the collection of outcome data, and to discuss the advantages and challenges of rRCTs. METHODS A systematic search of the literature was conducted using five databases from inception to June 2020: PubMed, Embase (through Ovid), CINAHL, Scopus and the Cochrane Controlled Register of Trials (CENTRAL). The search strategy comprised of MESH terms and key words related to rRCTs. Study selection was performed independently by two reviewers. A risk of bias for each study was completed. A narrative synthesis was conducted. RESULTS A total 47,862 titles were screened and 24 rRCTs were included. Eleven rRCTs (45.8%) used more than one registry to facilitate trial conduct. Six rRCTs (25%) randomised participants via a specific randomisation module embedded within a registry. Recruitment ranged between 209 to 106,000 participants. Advantages of rRCTs are recruitment efficiency, shorter trial times, cost effectiveness, outcome data completeness, smaller carbon footprint, lower participant burden and the ability to conduct multiple trials from the same registry. Challenges are data collection/management, quality assurance issues and the timing of informed consent. CONCLUSIONS Optimising the design of rRCTs is dependent on the capabilities of the registry. New registries should be designed and existing registries reviewed to enable the conduct of rRCTs. At all times, data management and quality assurance of all registry data should be given key consideration. We suggest the inclusion of the term 'registry-based' in the title of all rRCT manuscripts and a clear simple breakdown of the registry-based conduct of the trial in the abstract to facilitate indexing in the major databases.
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Affiliation(s)
- Frances Shiely
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland.
- School of Public Health, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland.
| | - Niamh O Shea
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland
- Health Research Board, Trials Methodology Research Network, University College Cork, Cork, Ireland
| | - Ellen Murphy
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, 4th Floor Western Gateway Building, Western Road, Cork, Ireland
- Health Research Board, Trials Methodology Research Network, University College Cork, Cork, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland
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Edwards PJ, Roberts I, Clarke MJ, DiGuiseppi C, Woolf B, Perkins C. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2023; 11:MR000008. [PMID: 38032037 PMCID: PMC10687884 DOI: 10.1002/14651858.mr000008.pub5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Self-administered questionnaires are widely used to collect data in epidemiological research, but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of epidemiological research. OBJECTIVES To identify effective strategies to increase response to postal and electronic questionnaires. SEARCH METHODS We searched 14 electronic databases up to December 2021 and manually searched the reference lists of relevant trials and reviews. We contacted the authors of all trials or reviews to ask about unpublished trials; where necessary, we also contacted authors to confirm the methods of allocation used and to clarify results presented. SELECTION CRITERIA Randomised trials of methods to increase response to postal or electronic questionnaires. We assessed the eligibility of each trial using pre-defined criteria. DATA COLLECTION AND ANALYSIS We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity amongst trial odds ratios using a Chi2 test and quantified the degree of inconsistency between trial results using the I2 statistic. MAIN RESULTS Postal We found 670 eligible trials that evaluated over 100 different strategies of increasing response to postal questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response almost doubled when: using monetary incentives (odds ratio (OR) 1.86; 95% confidence interval (CI) 1.73 to 1.99; heterogeneity I2 = 85%); using a telephone reminder (OR 1.96; 95% CI 1.03 to 3.74); and when clinical outcome questions were placed last (OR 2.05; 95% CI 1.00 to 4.24). The odds of response increased by about half when: using a shorter questionnaire (OR 1.58; 95% CI 1.40 to 1.78); contacting participants before sending questionnaires (OR 1.36; 95% CI 1.23 to 1.51; I2 = 87%); incentives were given with questionnaires (i.e. unconditional) rather than when given only after participants had returned their questionnaire (i.e. conditional on response) (OR 1.53; 95% CI 1.35 to 1.74); using personalised SMS reminders (OR 1.53; 95% CI 0.97 to 2.42); using a special (recorded) delivery service (OR 1.68; 95% CI 1.36 to 2.08; I2 = 87%); using electronic reminders (OR 1.60; 95% CI 1.10 to 2.33); using intensive follow-up (OR 1.69; 95% CI 0.93 to 3.06); using a more interesting/salient questionnaire (OR 1.73; 95% CI 1.12 to 2.66); and when mentioning an obligation to respond (OR 1.61; 95% CI 1.16 to 2.22). The odds of response also increased with: non-monetary incentives (OR 1.16; 95% CI 1.11 to 1.21; I2 = 80%); a larger monetary incentive (OR 1.24; 95% CI 1.15 to 1.33); a larger non-monetary incentive (OR 1.15; 95% CI 1.00 to 1.33); when a pen was included (OR 1.44; 95% CI 1.38 to 1.50); using personalised materials (OR 1.15; 95% CI 1.09 to 1.21; I2 = 57%); using a single-sided rather than a double-sided questionnaire (OR 1.13; 95% CI 1.02 to 1.25); using stamped return envelopes rather than franked return envelopes (OR 1.23; 95% CI 1.13 to 1.33; I2 = 69%), assuring confidentiality (OR 1.33; 95% CI 1.24 to 1.42); using first-class outward mailing (OR 1.11; 95% CI 1.02 to 1.21); and when questionnaires originated from a university (OR 1.32; 95% CI 1.13 to 1.54). The odds of response were reduced when the questionnaire included questions of a sensitive nature (OR 0.94; 95% CI 0.88 to 1.00). Electronic We found 88 eligible trials that evaluated over 30 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response tripled when: using a brief letter rather than a detailed letter (OR 3.26; 95% CI 1.79 to 5.94); and when a picture was included in an email (OR 3.05; 95% CI 1.84 to 5.06; I2 = 19%). The odds of response almost doubled when: using monetary incentives (OR 1.88; 95% CI 1.31 to 2.71; I2 = 79%); and using a more interesting topic (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by half when: using non-monetary incentives (OR 1.60; 95% CI 1.25 to 2.05); using shorter e-questionnaires (OR 1.51; 95% CI 1.06 to 2.16; I2 = 94%); and using a more interesting e-questionnaire (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third when: offering survey results as an incentive (OR 1.36; 95% CI 1.16 to 1.59); using a white background (OR 1.31; 95% CI 1.10 to 1.56); and when stressing the benefits to society of response (OR 1.38; 95% CI 1.07 to 1.78; I2 = 41%). The odds of response also increased with: personalised e-questionnaires (OR 1.24; 95% CI 1.17 to 1.32; I2 = 41%); using a simple header (OR 1.23; 95% CI 1.03 to 1.48); giving a deadline (OR 1.18; 95% CI 1.03 to 1.34); and by giving a longer time estimate for completion (OR 1.25; 95% CI 0.96 to 1.64). The odds of response were reduced when: "Survey" was mentioned in the e-mail subject (OR 0.81; 95% CI 0.67 to 0.97); when the email or the e-questionnaire was from a male investigator, or it included a male signature (OR 0.55; 95% CI 0.38 to 0.80); and by using university sponsorship (OR 0.84; 95%CI 0.69 to 1.01). The odds of response using a postal questionnaire were over twice those using an e-questionnaire (OR 2.33; 95% CI 2.25 to 2.42; I2 = 98%). Response also increased when: providing a choice of response mode (electronic or postal) rather than electronic only (OR 1.76 95% CI 1.67 to 1.85; I2 = 97%); and when administering the e-questionnaire by computer rather than by smartphone (OR 1.62 95% CI 1.36 to 1.94). AUTHORS' CONCLUSIONS Researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this Cochrane review.
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Affiliation(s)
- Philip James Edwards
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mike J Clarke
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin Woolf
- School of Psychological Science, University of Bristol, Bristol, UK
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Shi W, Vasishta S, Dow L, Cavellini D, Palmer C, McKinstry B, Sullivan F. Early experience with an opt-in research register - Scottish Health Research Register (SHARE): a multi-method evaluation of participant recruitment performance. BMC Med Res Methodol 2021; 21:286. [PMID: 34930144 PMCID: PMC8686271 DOI: 10.1186/s12874-021-01479-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/28/2021] [Indexed: 01/01/2023] Open
Abstract
Background Recruiting participants to a clinical study is a resource-intensive process with a high failure rate. The Scottish Health Research Register (SHARE) provides recruitment support service which helps researchers recruit participants by searching patients’ Electronic Health Records (EHRs). The current study aims to evaluate the performance of SHARE in participant recruitment. Methods Recruitment projects eligible for evaluation were those that were conducted for clinical trials or observational studies and finished before 2020. For analysis of recruitment data, projects with incomplete data were excluded. For each project we calculated, from SHARE records, 1) the fraction of the participants recruited through SHARE as a percentage of the number requested by researchers (percentage fulfilled), 2) the percentage of the potential candidates provided by SHARE to researchers that were actually recruited (percentage provided and recruited), 3) the percentage of the participants recruited through SHARE of all the potentially eligible candidates identified by searching registrants’ EHRs (percentage identified and recruited). Research teams of the eligible projects were invited to participate in an anonymised online survey. Two metrics were derived from research teams’ responses, including a) the fraction of the recruited over the study target number of participants (percentage fulfilled), and b) the percentage of the participants recruited through SHARE among the candidates received from SHARE (percentage provided and recruited). Results Forty-four projects were eligible for inclusion. Recruitment data for 24 projects were available (20 excluded because of missingness or incompleteness). Survey invites were sent to all the eligible research teams and received 12 responses. Analysis of recruitment data shows the overall percentage fulfilled was 34.2% (interquartile 13.3–45.1%), the percentage provided and recruited 29.3% (interquartile 20.6–52.4%) and percentage identified and recruited 4.9% (interquartile 2.6–10.2%). Based on the data reported by researchers, percentage fulfilled was 31.7% (interquartile 5.8–59.6%) and percentage provided and recruited was 20.2% (interquartile 8.2–31.0%). Conclusions SHARE may be a valuable resource for recruiting participants for some clinical studies. Potential improvements are to expand the registrant base and to incorporate more data generated during patients’ different health care encounters into the candidate-searching step. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01479-4.
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Affiliation(s)
- Wen Shi
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, North Haugh, Fife, St Andrews, KY16 9TF, UK.
| | - Shobna Vasishta
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Louise Dow
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Daniella Cavellini
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Colin Palmer
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | | | - Frank Sullivan
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, North Haugh, Fife, St Andrews, KY16 9TF, UK
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Haynes A, Sherrington C, Wallbank G, Wickham J, Tong A, Kirkham C, Manning S, Ramsay E, Tiedemann A. Using self-determination theory to understand and improve recruitment for the Coaching for Healthy Ageing (CHAnGE) trial. PLoS One 2021; 16:e0259873. [PMID: 34797820 PMCID: PMC8604286 DOI: 10.1371/journal.pone.0259873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches. METHODS We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory-autonomy, competence and relatedness-was used to explore if and how this theory fit with and helped to explain our data. RESULTS Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention's demonstrated potential to support self-determination needs could be conveyed more effectively. CONCLUSIONS Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs.
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Affiliation(s)
- Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Geraldine Wallbank
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James Wickham
- School of Biomedical Sciences, Charles Sturt University, Orange, NSW, Australia
| | - Allison Tong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Shona Manning
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Christian Homes Tasmania Inc, Kingston, TAS, Australia
| | - Elisabeth Ramsay
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Liu J, Butow P, Bui KT, Serafimovska A, Costa DSJ, Kiely BE, Hui MN, Goodwin A, McNeil CM, Beith JM. Novel Clinician-Lead Intervention to Address Fear of Cancer Recurrence in Breast Cancer Survivors. JCO Oncol Pract 2021; 17:e774-e784. [PMID: 33571035 DOI: 10.1200/op.20.00799] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Fear of cancer recurrence (FCR) affects 50%-70% of cancer survivors. This multicenter, single-arm study sought to determine the participant-rated usefulness of an oncologist-delivered FCR intervention. METHODS Women who completed treatment for early breast cancer (could be receiving endocrine therapy) with baseline FCR > 0 were invited to participate. FCR was measured using a validated 42-item FCR Inventory. The brief oncologist-delivered intervention entailed (1) FCR normalization; (2) provision of personalized prognostic information; (3) recurrence symptoms education, (4) advice on managing worry, and (5) referral to psycho-oncologist if FCR was high. FCR, depression, and anxiety were assessed preintervention (T0), at 1 week (T1), and 3 months (T2) postintervention. The primary outcome was participant-rated usefulness. Secondary outcomes included feasibility and efficacy. RESULTS Five oncologists delivered the intervention to 61/255 women invited. Mean age was 58 ± 12 years. Mean time since breast cancer diagnosis was 2.5 ± 1.3 years. Forty-three women (71%) were on adjuvant endocrine therapy. Of 58 women who completed T1 assessment, 56 (97%) found the intervention to be useful. FCR severity decreased significantly at T1 (F = 18.5, effect size = 0.39, P < .0001) and T2 (F = 24, effect size = 0.68, P < .0001) compared with baseline. There were no changes in unmet need or depression or anxiety. Mean consultation length was 22 minutes (range, 7-47 minutes), and mean intervention length was 8 minutes (range, 2-20 minutes). The intervention was perceived as useful and feasible by oncologists. CONCLUSION A brief oncologist-delivered intervention to address FCR is useful and feasible, and has preliminary efficacy in reducing FCR. Plans for a cluster randomized trial are underway.
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Affiliation(s)
- Jia Liu
- Crown Princess Mary Cancer Centre, Westmead, Australia.,Psycho-Oncology Co-operative Research Group, University of Sydney, Camperdown, Australia.,The Chris O'Brien Lifehouse, Camperdown, Australia.,Blacktown Cancer Centre, Blacktown, Australia.,Western Sydney University, Campbelltown, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, University of Sydney, Camperdown, Australia.,The Chris O'Brien Lifehouse, Camperdown, Australia
| | - Kim T Bui
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia
| | - Anastasia Serafimovska
- Psycho-Oncology Co-operative Research Group, University of Sydney, Camperdown, Australia
| | - Daniel S J Costa
- Pain Management Research Institute, St Leonards, Australia.,School of Psychology, University of Sydney, Camperdown, Australia
| | | | - Mun N Hui
- The Chris O'Brien Lifehouse, Camperdown, Australia
| | | | | | - Jane M Beith
- Psycho-Oncology Co-operative Research Group, University of Sydney, Camperdown, Australia.,The Chris O'Brien Lifehouse, Camperdown, Australia
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Herrmann A, Mansfield E, Tzelepis F, Lynagh M, Hall A. Use of the supportive care framework to explore haematological cancer survivors' unmet needs: a qualitative study. BMC Health Serv Res 2020; 20:1062. [PMID: 33228652 PMCID: PMC7686725 DOI: 10.1186/s12913-020-05927-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/15/2020] [Indexed: 12/30/2022] Open
Abstract
Background Some sub-types of haematological cancers are acute and require intensive treatment soon after diagnosis. Other sub-types are chronic, relapse over many years and require life-long cycles of monitoring interspersed with bouts of treatment. This often results in significant uncertainty about the future, high levels of depression and anxiety, and reduced quality of life. Little is known about how to improve care for haematological cancer survivors. This study explored qualitatively, in a sample of haematological cancer survivors, (i) their unmet needs experienced as a result of their disease and treatment; and (ii) strategies that may help address these needs. Methods Semi-structured interviews were conducted with 17 adult haematological cancer survivors. Data was analysed using qualitative content analysis. The Supportive Care Framework guided data collection and analysis. Results Participants had a mean age of 57 years (SD 13). Most were male (n = 10, 59%). Five themes emerged from the data: (i) changes in unmet needs across the care trajectory (with greatest unmet needs experienced soon after diagnosis, at discharge from hospital and with cancer recurrence); (ii) informational unmet needs requiring improved patient-centred communication; (iii) uncertainty about treatment and the future; (iv) coordinated, tailored and documented post-treatment care planning as a strategy for optimal care delivery; and (v) ongoing support services to meet psychosocial and practical unmet needs by involving peer support, less bureaucratic transport services and flexible work arrangements. Conclusions To our knowledge, this is the first qualitative investigation using the Supportive Care Framework to explore unmet needs of haematological cancer survivors. Our findings offer fresh insights into this important area of study. Written, take-home care plans which provide simple but tailored guidance on where to seek additional support may help decrease uncertainty and feelings of vulnerability post-treatment for adult haematological cancer survivors. Future research should further develop and test strategies aimed at addressing unmet needs of haematological cancer survivors identified in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05927-7.
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Affiliation(s)
- Anne Herrmann
- Department for Epidemiology and Preventive Medicine, Professorship for Medical Sociology, University of Regensburg, Regensburg, Germany. .,Department of Haematology and Internal Oncology, University Hospital Regensburg, Regensburg, Germany. .,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. .,Hunter Medical Research Institute, Newcastle, Australia.
| | - Elise Mansfield
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Marita Lynagh
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Alix Hall
- Hunter Medical Research Institute, Newcastle, Australia.,Clinical Research, Design and Statistics, Hunter Medical Research Institute, Newcastle, Australia
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7
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Karanatsios B, Prang KH, Verbunt E, Yeung JM, Kelaher M, Gibbs P. Defining key design elements of registry-based randomised controlled trials: a scoping review. Trials 2020; 21:552. [PMID: 32571382 PMCID: PMC7310018 DOI: 10.1186/s13063-020-04459-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/26/2020] [Indexed: 01/09/2023] Open
Abstract
Background Traditional randomised controlled trials remain the gold standard for improving clinical care but they do have their limitations, including their associated high costs, high failure rate and limited external validity. An alternative methodology is the newly defined, prospective, registry-based randomised controlled trial (RRCT), where treatment and outcome data is collected in an existing registry. This scoping review explores the current literature regarding RRCTs to help identify the key design elements of RRCTs and the characteristics of clinical registries on which they are reliant on. Methods A scoping review methodology conducted in accordance with the Joanna Briggs Institute guidelines was performed. Four databases were searched for articles published from inception to June 2018: Medline; Embase; the Cumulative Index to Nursing and Allied Health Literature and; Scopus. The search strategy included MeSH and text words related to RRCT. Results We identified 2369 articles of which 75 were selected for full-text screening. Of these, only 17 articles satisfied our inclusion criteria. All studies were published between 1996 and 2017 and all were investigator-initiated. Study designs were mainly multi-site comparative/effectiveness studies incorporating the use of disease registries (n = 8), procedure registries (n = 8) and a health services registry (n = 1). The low cost, reduced administrative burden and enhanced external validity of RRCTs make them an attractive research methodology which can be used to address questions of public health importance. We identified that that there are variable definitions of what constituted a RRCT and that issues related to ethical conduct and data integrity, completeness, timeliness, validation and endpoint adjudication need to be carefully addressed. Conclusion RRCTs potentially have an important role to play in informing best clinical practice and health policy. There are a number of issues that need to be addressed to optimise the utility of this approach, including establishing universally accepted criteria for the definition of a RRCT.
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Affiliation(s)
- Bill Karanatsios
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia. .,Western Health Chronic Disease Alliance, Western Health, St Albans, VIC, Australia.
| | - Khic-Houy Prang
- Centre for Health Policy, The University of Melbourne, Parkville, VIC, Australia
| | - Ebony Verbunt
- Centre for Health Policy, The University of Melbourne, Parkville, VIC, Australia
| | - Justin M Yeung
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.,Western Health Chronic Disease Alliance, Western Health, St Albans, VIC, Australia
| | - Margaret Kelaher
- Centre for Health Policy, The University of Melbourne, Parkville, VIC, Australia
| | - Peter Gibbs
- Systems Biology and Personalised Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Center, Parkville, VIC, Australia
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8
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Carey M, Boyes AW, Bryant J, Turon H, Clinton-McHarg T, Sanson-Fisher R. The Patient Perspective on Errors in Cancer Care: Results of a Cross-Sectional Survey. J Patient Saf 2019; 15:322-327. [PMID: 28230580 PMCID: PMC6903340 DOI: 10.1097/pts.0000000000000368] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to explore medical oncology outpatients' perceived experiences of errors in their cancer care. METHODS A cross-sectional survey was conducted. English-speaking medical oncology outpatients aged 18 years or older were recruited from 9 Australian cancer treatment centers. Participants completed 2 paper-and-pencil questionnaires: an initial survey on demographic, disease and treatment characteristics upon recruitment; and a second survey on their experiences of errors in cancer care 1 month later. RESULTS A total of 1818 patients (80%) consented to participate, and of these, 1136 (62%) completed both surveys. One hundred forty-eight participants (13%) perceived that an error had been made in their care, of which one third (n = 46) reported that the error was associated with severe harm. Of those who perceived an error had been made, less than half reported that they had received an explanation for the error (n = 65, 45%) and only one third reported receiving an apology (n = 50, 35%) or being told that steps had been taken to prevent the error from reoccurring (n = 52, 36%). Patients with university or vocational level education (odds ratio [OR] = 1.6 [1.09-2.45], P = 0.0174) and those who received radiotherapy (OR = 1.72 [1.16-2.57]; P = 0.0076) or "other" treatments (OR = 3.23 [1.08-9.63]; P = 0.0356) were significantly more likely to report an error in care. CONCLUSIONS There is significant scope to improve communication with patients and appropriate responses by the healthcare system after a perceived error in cancer care.
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Affiliation(s)
- Mariko Carey
- From the Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Allison W. Boyes
- From the Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jamie Bryant
- From the Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Heidi Turon
- From the Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Tara Clinton-McHarg
- From the Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Robert Sanson-Fisher
- From the Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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9
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Millar MM, Elena JW, Gallicchio L, Edwards SL, Carter ME, Herget KA, Sweeney C. The feasibility of web surveys for obtaining patient-reported outcomes from cancer survivors: a randomized experiment comparing survey modes and brochure enclosures. BMC Med Res Methodol 2019; 19:208. [PMID: 31730474 PMCID: PMC6858678 DOI: 10.1186/s12874-019-0859-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
Background Central cancer registries are often used to survey population-based samples of cancer survivors. These surveys are typically administered via paper or telephone. In most populations, web surveys obtain much lower response rates than paper surveys. This study assessed the feasibility of web surveys for collecting patient-reported outcomes via a central cancer registry. Methods Potential participants were sampled from Utah Cancer Registry records. Sample members were randomly assigned to receive a web or paper survey, and then randomized to either receive or not receive an informative brochure describing the cancer registry. We calculated adjusted risk ratios with 95% confidence intervals to compare response likelihood and the demographic profile of respondents across study arms. Results The web survey response rate (43.2%) was lower than the paper survey (50.4%), but this difference was not statistically significant (adjusted risk ratio = 0.88, 95% confidence interval = 0.72, 1.07). The brochure also did not significantly influence the proportion responding (adjusted risk ratio = 1.03, 95% confidence interval = 0.85, 1.25). There were few differences in the demographic profiles of respondents across the survey modes. Older age increased likelihood of response to a paper questionnaire but not a web questionnaire. Conclusions Web surveys of cancer survivors are feasible without significantly influencing response rates, but providing a paper response option may be advisable particularly when surveying older individuals. Further examination of the varying effects of brochure enclosures across different survey modes is warranted.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA. .,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Kimberly A Herget
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Carol Sweeney
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA.,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr. Salt, Lake City, UT, 84112, USA
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10
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Millar MM, Elena JW, Gallicchio L, Edwards SL, Carter ME, Herget KA, Sweeney C. The feasibility of web surveys for obtaining patient-reported outcomes from cancer survivors: a randomized experiment comparing survey modes and brochure enclosures. BMC Med Res Methodol 2019. [PMID: 31730474 DOI: 10.1186/s12874-019-0859-9:10.1186/s12874-019-0859-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Central cancer registries are often used to survey population-based samples of cancer survivors. These surveys are typically administered via paper or telephone. In most populations, web surveys obtain much lower response rates than paper surveys. This study assessed the feasibility of web surveys for collecting patient-reported outcomes via a central cancer registry. METHODS Potential participants were sampled from Utah Cancer Registry records. Sample members were randomly assigned to receive a web or paper survey, and then randomized to either receive or not receive an informative brochure describing the cancer registry. We calculated adjusted risk ratios with 95% confidence intervals to compare response likelihood and the demographic profile of respondents across study arms. RESULTS The web survey response rate (43.2%) was lower than the paper survey (50.4%), but this difference was not statistically significant (adjusted risk ratio = 0.88, 95% confidence interval = 0.72, 1.07). The brochure also did not significantly influence the proportion responding (adjusted risk ratio = 1.03, 95% confidence interval = 0.85, 1.25). There were few differences in the demographic profiles of respondents across the survey modes. Older age increased likelihood of response to a paper questionnaire but not a web questionnaire. CONCLUSIONS Web surveys of cancer survivors are feasible without significantly influencing response rates, but providing a paper response option may be advisable particularly when surveying older individuals. Further examination of the varying effects of brochure enclosures across different survey modes is warranted.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA. .,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Kimberly A Herget
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Carol Sweeney
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA.,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr. Salt, Lake City, UT, 84112, USA
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11
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Murugesu L, Hopman ME, Van Voorst SF, Rosman AN, Fransen MP. Systematic Development of Materials for Inviting Low Health-Literate Individuals to Participate in Preconception Counseling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214223. [PMID: 31683516 PMCID: PMC6862136 DOI: 10.3390/ijerph16214223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 12/30/2022]
Abstract
In this study we aimed to systematically analyze problems in the recruitment of women with low health literacy for preconception counseling and to adapt and evaluate written invitations for this group. In a problem analysis (stage 1) we used structured interviews (n = 72) to assess comprehension of the initial invitations, perception of perinatal risks, attitude and intention to participate in preconception counseling. These outcomes were used to adapt the invitation. The adapted flyer was pretested in interviews (n = 16) (stage 2) and evaluated in structured interviews among a new group of women (n = 67) (stage 3). Differences between women in stages 1 and 3 regarding comprehension, risk perception, attitude and intention to participate in counseling were analyzed by linear regression analysis and chi-square tests. Women in stage 3 (who read the adapted flyer) had a more positive attitude towards participation in preconception counselling and a better understanding of how to apply for a consultation than women in stage 1 (who read the initial invitations). No differences were found in intention to participate in preconception counseling and risk perception. Systematic adaptation of written invitations can improve the recruitment of low health-literate women for preconception counselling. Further research should gain insight into additional strategies to reach and inform this group.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam Public Health Research Institute, Department of Public Health, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands.
| | - Miriam E Hopman
- Amsterdam Public Health Research Institute, Department of Public Health, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands.
| | - Sabine F Van Voorst
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
- Department of Health Care Studies, Rotterdam University of Applied Sciences, 3015 EK Rotterdam, The Netherlands.
| | - Mirjam P Fransen
- Amsterdam Public Health Research Institute, Department of Public Health, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands.
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12
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Godinho A, Schell C, Cunningham JA. How one small text change in a study document can impact recruitment rates and follow-up completions. Internet Interv 2019; 18:100284. [PMID: 31890631 PMCID: PMC6926325 DOI: 10.1016/j.invent.2019.100284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The validity and reliability of longitudinal research is highly dependent on the recruitment and retention of representative samples. Various strategies have been developed and tested for improving recruitment and follow-up rates into health-behavioural research, but few have examined the role of linguistic choices and study document readability on participation rates. This study examined the impact of one small text change, assigning an inappropriate or grade-8 reading level password for intervention access, on participation rates and attrition in an online alcohol intervention trial. METHODS Participants were recruited into an online alcohol intervention study using Amazon's Mechanical Turk via a multi-step recruitment process which required participants to log into a study portal using a pre-assigned password. Passwords were qualitatively coded as grade-8 and/or inappropriate for use within a professional setting. Separate logistic regressions examined which demographic, clinical characteristics, and password categorizations were most strongly associated with recruitment rates and follow-up completions. RESULTS Inappropriate passwords were a barrier for recruitment among participants with post-secondary education as compared to those with less education (p = 0.044), while grade-8 passwords appeared to significantly facilitate the completion of 6-month follow-ups (p = 0.005). CONCLUSIONS Altogether, these findings suggest that some linguistic choices may play an important role in recruitment, while others, such as readability, may have longer-term effects on follow-up rates and attrition. Possible explanations for the findings, as well as, sample selection biases during recruitment and follow-up are discussed. Limitations of the study are stated and recommendations for researchers are provided. TRIAL REGISTRATION ClinicalTrials.gov NCT02977026. Registered 27 Nov 2016.
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Affiliation(s)
- Alexandra Godinho
- Institute of Mental Health and Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Christina Schell
- Institute of Mental Health and Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - John A. Cunningham
- Institute of Mental Health and Policy Research, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Australian National University, Canberra, Australia,Corresponding author at: Centre for Addiction and Mental Health, 33 Russell St., Toronto, Ontario M5S 2S1, Canada.
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13
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Millar MM, Kinney AY, Camp NJ, Cannon-Albright LA, Hashibe M, Penson DF, Kirchhoff AC, Neklason DW, Gilsenan AW, Dieck GS, Stroup AM, Edwards SL, Bateman C, Carter ME, Sweeney C. Predictors of Response Outcomes for Research Recruitment Through a Central Cancer Registry: Evidence From 17 Recruitment Efforts for Population-Based Studies. Am J Epidemiol 2019; 188:928-939. [PMID: 30689685 DOI: 10.1093/aje/kwz011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/24/2022] Open
Abstract
When recruiting research participants through central cancer registries, high response fractions help ensure population-based representation. We conducted multivariable mixed-effects logistic regression to identify case and study characteristics associated with making contact with and obtaining cooperation of Utah cancer cases using data from 17 unique recruitment efforts undertaken by the Utah Cancer Registry (2007-2016) on behalf of the following studies: A Population-Based Childhood Cancer Survivors Cohort Study in Utah, Comparative Effectiveness Analysis of Surgery and Radiation for Prostate Cancer (CEASAR Study), Costs and Benefits of Follow-up Care for Adolescent and Young Adult Cancers, Study of Exome Sequencing for Head and Neck Cancer Susceptibility Genes, Genetic Epidemiology of Chronic Lymphocytic Leukemia, Impact of Remote Familial Colorectal Cancer Risk Assessment and Counseling (Family CARE Project), Massively Parallel Sequencing for Familial Colon Cancer Genes, Medullary Thyroid Carcinoma (MTC) Surveillance Study, Osteosarcoma Surveillance Study, Prostate Cancer Outcomes Study, Risk Education and Assessment for Cancer Heredity Project (REACH Project), Study of Shared Genomic Segment Analysis and Tumor Subtyping in High-Risk Breast-Cancer Gene Pedigrees, Study of Shared Genomic Segment Analysis for Localizing Multiple Myeloma Genes. Characteristics associated with lower odds of contact included Hispanic ethnicity (odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.27, 0.41), nonwhite race (OR = 0.46, 95% CI: 0.35, 0.60), and younger age at contact. Years since diagnosis was inversely associated with making contact. Nonwhite race and age ≥60 years had lower odds of cooperation. Study features with lower odds of cooperation included longitudinal design (OR = 0.50, 95% CI: 0.41, 0.61) and study brochures (OR = 0.70, 95% CI: 0.54, 0.90). Increased odds of cooperation were associated with including a questionnaire (OR = 3.19, 95% CI: 1.54, 6.59), postage stamps (OR = 1.60, 95% CI: 1.21, 2.12), and incentives (OR = 1.62, 95% CI: 1.02, 2.57). Among cases not responding after the first contact, odds of eventual response were lower when >10 days elapsed before subsequent contact (OR = 0.71, 95% CI: 0.59, 0.85). Obtaining high response is challenging, but study features identified in this analysis support better results when recruiting through central cancer registries.
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Affiliation(s)
- Morgan M Millar
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey
| | - Nicola J Camp
- Division of Hematology and Hematological Malignancies, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Lisa A Cannon-Albright
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Mia Hashibe
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - David F Penson
- Urologic Surgery, Department of Urology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
- Center for Surgical Quality and Outcomes Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Deborah W Neklason
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Alicia W Gilsenan
- Department of Epidemiology, RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
| | - Gretchen S Dieck
- Safety, Epidemiology, and Risk Management, United BioSource Corporation, Blue Bell, Pennsylvania
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey
- Division of Cancer Epidemiology, Rutgers School of Public Health, Rutgers University, New Brunswick, New Jersey
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carrie Bateman
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carol Sweeney
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
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14
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van Gelder MMHJ, Vlenterie R, IntHout J, Engelen LJLPG, Vrieling A, van de Belt TH. Most response-inducing strategies do not increase participation in observational studies: a systematic review and meta-analysis. J Clin Epidemiol 2018. [PMID: 29518475 DOI: 10.1016/j.jclinepi.2018.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate response-inducing strategies for observational studies using health-related questionnaires or interviews. STUDY DESIGN AND SETTING We searched PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science up to December 28, 2017. Studies evaluating the effect of a response-inducing strategy on participation rates of observational studies were included. For each strategy, we estimated pooled response ratios with 95% confidence intervals (CIs) in a Hartung-Knapp/Sidik-Jonkman random effects model with the final participation rate as outcome, stratified for type of participants and method of data collection. RESULTS The search yielded 168 eligible studies involving 367,616 potential participants and 33 strategies. Among patients, response-inducing strategies for paper-based questionnaires included unconditional monetary incentives (response ratio 1.15; 95% CI 1.09-1.21) and shorter questionnaires (1.04; 1.02-1.06). Among nonpatients, a personalized mode of delivery (1.47; 1.24-1.74), more expensive mailing type (1.25; 1.00-1.56), unconditional monetary incentives (1.24; 1.12-1.38), prenotification (1.12; 1.03-1.22), unconditional scratch lottery tickets (1.09; 1.01-1.18), and shorter questionnaires (1.06; 1.02-1.11) increased response rates to paper-based questionnaires. For Web-based questionnaires and interviews among nonpatients, response rates were increased by conditional lottery tickets (1.17; 1.02-1.34) and conditional monetary incentives (1.39; 1.01-1.91), respectively. CONCLUSION Although the majority of strategies evaluated were unsuccessful, some may increase response rates to observational studies, particularly among nonpatients.
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Affiliation(s)
- Marleen M H J van Gelder
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101 6500 HB, Nijmegen, The Netherlands; Radboud REshape Innovation Center, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Richelle Vlenterie
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101 6500 HB, Nijmegen, The Netherlands
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101 6500 HB, Nijmegen, The Netherlands
| | - Lucien J L P G Engelen
- Radboud REshape Innovation Center, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Alina Vrieling
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, P.O. Box 9101 6500 HB, Nijmegen, The Netherlands
| | - Tom H van de Belt
- Radboud REshape Innovation Center, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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15
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Oral E, Simonsen N, Brennan C, Berken J, Su LJ, Mohler JL, Bensen JT, Fontham ETH. Unit Nonresponse in a Population-Based Study of Prostate Cancer. PLoS One 2016; 11:e0168364. [PMID: 27992587 PMCID: PMC5161356 DOI: 10.1371/journal.pone.0168364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
Low unit response rates can increase bias and compromise study validity. Response rates have continued to fall over the past decade despite all efforts to increase participation. Many factors have been linked to reduced response, yet relatively few studies have employed multivariate approaches to identify characteristics that differentiate respondents from nonrespondents since it is hard to collect information on the latter. We aimed to assess factors contributing to enrollment of prostate cancer (PCa) patients. We combined data from the North Carolina-Louisiana (LA) PCa Project's LA cohort, with additional sources such as US census tract and LA tumor registry data. We included specific analyses focusing on blacks, a group often identified as hard to enroll in health-related research. The ability to study the effect of Hurricane Katrina, which occurred amidst enrollment, as a potential determinant of nonresponse makes our study unique. Older age (≥ 70) for blacks (OR 0.65) and study phase with respect to Hurricane Katrina for both races (OR 0.59 for blacks, OR 0.48 for whites) were significant predictors of participation with lower odds. Neighborhood poverty for whites (OR 1.53) also was a significant predictor of participation, but with higher odds. Among blacks, residence in Orleans parish was associated with lower odds of participation (OR 0.33) before Katrina. The opposite occurred in whites, with lower odds (OR 0.43) after Katrina. Our results overall underscore the importance of tailoring enrollment approaches to specific target population characteristics to confront the challenges posed by nonresponse. Our results also show that recruitment-related factors may change when outside forces bring major alterations to a population's environment and demographics.
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Affiliation(s)
- Evrim Oral
- Biostatistics Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Neal Simonsen
- Consultant Epidemiologist, New Orleans, Louisiana, United States of America
| | - Christine Brennan
- Health Policy and Systems Management Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
| | - Jennifer Berken
- Department of Mathematical Sciences, McNeese State University, Lake Charles, Louisiana, United States of America
| | - L. Joseph Su
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - James L. Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jeannette T. Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Elizabeth T. H. Fontham
- Epidemiology Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
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16
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Hall A, Lynagh M, Tzelepis F, Paul C, Bryant J. How can we help haematological cancer survivors cope with the changes they experience as a result of their cancer? Ann Hematol 2016; 95:2065-2076. [PMID: 27623627 DOI: 10.1007/s00277-016-2806-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
Haematological cancer often necessitates that individuals make significant lifestyle and behaviour changes to protect themselves against infections. It is essential that haematological cancer survivors receive the support and information they require to adjust to such changes. This cross-sectional survey of 259 haematological cancer survivors found that over two thirds of haematological cancer survivors would like to receive more detailed information or help with: diet and nutrition that takes into account their diagnosis and treatment, how to manage the symptoms from the cancer and/or treatment, signs and symptoms to be aware of that may indicate a possible infection and appropriate exercise. Over a third of survivors reported that they had to make changes to reduce their chance of infection, with social restriction the most commonly reported area of change survivors made. Improving communication and access to care and providing additional emotional support may assist survivors in making these additional changes. Healthcare providers should use this information to better support haematological cancer survivors in dealing with the effects haematological cancer has on their life.
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Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Marita Lynagh
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Flora Tzelepis
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Chris Paul
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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17
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Peek K, Carey M, Sanson-Fisher R, Mackenzie L. Physiotherapists’ perceptions of patient adherence to prescribed self-management strategies: a cross-sectional survey of Australian physiotherapists. Disabil Rehabil 2016; 39:1932-1938. [DOI: 10.1080/09638288.2016.1212281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Kerry Peek
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Mariko Carey
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Lisa Mackenzie
- Health Behaviour Research Group, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, Australia
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18
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Hall AE, Sanson-Fisher RW, Carey ML, Paul C, Williamson A, Bradstock K, Campbell HS. Prevalence and associates of psychological distress in haematological cancer survivors. Support Care Cancer 2016; 24:4413-22. [DOI: 10.1007/s00520-016-3282-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
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Glenn BA, Lin T, Chang LC, Okada A, Wong WK, Glanz K, Bastani R. Sun protection practices and sun exposure among children with a parental history of melanoma. Cancer Epidemiol Biomarkers Prev 2015; 24:169-77. [PMID: 25587110 DOI: 10.1158/1055-9965.epi-14-0650] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND First-degree relatives of melanoma survivors have a substantially higher lifetime risk for melanoma than individuals with no family history. Exposure to ultraviolet radiation (UVR) is the primary modifiable risk factor for the disease. Reducing UV exposure through sun protection may be particularly important for children with a parental history of melanoma. Nonetheless, limited prior research has investigated sun protection practices and sun exposure among these children. METHODS The California Cancer Registry was used to identify melanoma survivors eligible to participate in a survey to assess their children's sun protection practices and sun exposure. The survey was administered by mail, telephone, or web to Latino and non-Latino white melanoma survivors with at least one child (0-17 years; N = 324). RESULTS Sun exposure was high and the rate of sunburn was equivalent to or higher than estimates from average-risk populations. Use of sun protection was suboptimal. Latino children were less likely to wear sunscreen and hats and more likely to wear sunglasses, although these differences disappeared in adjusted analyses. Increasing age of the child was associated with lower sun protection and higher risk for sunburn, whereas higher objective risk for melanoma predicted improved sun protection and a higher risk for sunburns. Perception of high barriers to sun protection was the strongest modifiable correlate of sun protection. CONCLUSIONS Interventions to improve sun protection and reduce sun exposure and sunburns in high-risk children are needed. IMPACT Intervening in high-risk populations may help reduce the burden of melanoma in the United States.
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Affiliation(s)
- Beth A Glenn
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California.
| | - Tiffany Lin
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - L Cindy Chang
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Ashley Okada
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Weng Kee Wong
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roshan Bastani
- UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California
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Hall AE, Sanson-Fisher RW, Lynagh MC, Tzelepis F, D'Este C. What do haematological cancer survivors want help with? A cross-sectional investigation of unmet supportive care needs. BMC Res Notes 2015; 8:221. [PMID: 26047620 PMCID: PMC4456764 DOI: 10.1186/s13104-015-1188-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to identify the most prevalent unmet needs of haematological cancer survivors. METHODS Haematological cancer survivors aged 18-80 years at time of recruitment were selected from four Australian state cancer registries. Survivors completed the Survivor Unmet Needs Survey. The most frequently reported "high/very high" unmet needs items were identified, as well as characteristics associated with the three most prevalent "high/very high" unmet needs reported by haematological cancer survivors. RESULTS A total of 715 eligible survivors returned a completed survey. "Dealing with feeling tired" (17%), was the most frequently endorsed "high/very high" unmet need. Seven out of the ten most frequently endorsed unmet needs related to emotional health. Higher levels of psychological distress (e.g., anxiety, depression and stress) and indicators of financial burden as a result of cancer (e.g., having used up savings and trouble meeting day-to-day expenses due to cancer) were consistently identified as characteristics associated with the three most prevalent "high/very high" unmet needs. CONCLUSIONS A minority of haematological cancer survivors endorsed a "high/very high" unmet need on individual items. Additional emotional support may be needed by a minority of survivors. Survivors reporting high levels of psychological distress or those who experience increased financial burden as a result of their cancer diagnosis may be at risk of experiencing the most prevalent "high/very high" unmet needs identified by this study.
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Affiliation(s)
- Alix E Hall
- Priority Research Centre for Health Behaviour, Faculty of Health, Wing 4 HMRI Building, The University of Newcastle and Hunter Medical Research Institute, University Drive, Callaghan, NSW, 2308, Australia.
| | - Rob W Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health, Wing 4 HMRI Building, The University of Newcastle and Hunter Medical Research Institute, University Drive, Callaghan, NSW, 2308, Australia.
| | - Marita C Lynagh
- Priority Research Centre for Health Behaviour, Faculty of Health, Wing 4 HMRI Building, The University of Newcastle and Hunter Medical Research Institute, University Drive, Callaghan, NSW, 2308, Australia.
| | - Flora Tzelepis
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle and Hunter Medical Research Institute, University Drive, Callaghan, NSW, 2308, Australia.
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, 0200, Australia.
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Tan MH, Thomas M, MacEachern MP. Using registries to recruit subjects for clinical trials. Contemp Clin Trials 2014; 41:31-8. [PMID: 25545027 DOI: 10.1016/j.cct.2014.12.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Abstract
AIM We studied the use of patient/disease registries to recruit potential subjects for prospective clinical trials - describing the number, types and major benefits of using this approach. METHODS In December 2013, we conducted a focused database search in PubMed, EMBASE, and Web of Science for studies (English language only) that used registries to recruit subjects for clinical trials published in 2004-2013. Of the 233 unique citations identified, 21 used registries to recruit subjects - 10 papers and 11 abstracts. Pearling and search for subsequent full papers of the abstracts identified 4 more papers. RESULTS Our analysis, based on these 25 citations, showed that 14 are related to cancer, 3 to diabetes mellitus, 1 each to stroke, asthma, and celiac disease and 5 are disease neutral. Many types of registries (population-based cancer, quality improvement, disease-specific, web-based disease-neutral registries, local general practice registers, and national health database) are used to recruit subjects for clinical trials and uncover new knowledge. Overall, 16 registries are in the US, 4 in UK, 1 each in Canada, Spain, and Australia and 1 involved in many countries. Registries can identify very large number of subjects for screening for eligibility for clinical trials, especially in very large trials, rare disease trials, and trials involving minority patients. CONCLUSIONS Registries can retrospectively identify very large numbers of potential subjects for screening for eligibility and enrollment in prospective clinical trials. This matching can lead to more timely recruitment and help solve a major problem in conducting clinical trials.
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Affiliation(s)
- Meng H Tan
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA.
| | - Matthew Thomas
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Mark P MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
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Smoking, alcohol, diabetes, obesity, socioeconomic status, and the risk of colorectal cancer in a population-based case-control study. Cancer Causes Control 2014; 25:1659-68. [PMID: 25301194 DOI: 10.1007/s10552-014-0470-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Although previous research has identified factors that may determine willingness to participate in research, relatively few studies have attempted to quantify the impact non-participation may have on exposure-disease associations. The aims of this study were to (a) investigate the associations between smoking, alcohol, diabetes, obesity, and socioeconomic status and the risk of colorectal cancer in a case-control study (59.7 and 47.2 % response fractions among cases and controls, respectively); and (b) perform sensitivity analyses to examine the possible influence of non-participation. METHODS Logistic regression was used to estimate the exposure-disease associations. We then investigated the associations between various demographic and health factors and the likelihood that an individual would participate in the case-control study and then performed two sensitivity analyses (sampling weights and multiple imputation) to examine whether non-participation bias may have influenced the exposure-disease associations. RESULTS The exposures alcohol, smoking, and diabetes were associated with an increased risk of colorectal cancer. We found some differences between cases and controls when examining the factors associated with the participation in the study, and in the sensitivity analyses, the exposure-disease associations were slightly attenuated when compared with those from the original analysis. CONCLUSION Non-participation may have biased the risk estimates away from the null, but generally not enough to change the conclusions of the study.
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How are we communicating about clinical trials? Contemp Clin Trials 2014; 38:275-83. [DOI: 10.1016/j.cct.2014.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 11/22/2022]
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Factors associated with haematological cancer survivors experiencing a high level of unmet need across multiple items of supportive care: a cross-sectional survey study. Support Care Cancer 2014; 22:2899-909. [PMID: 24828759 DOI: 10.1007/s00520-014-2264-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/22/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE This study aimed to identify subgroups of haematological cancer survivors who report a "high/very high" level of unmet need on multiple (≥7) items of supportive care. METHODS Haematological cancer survivors, aged 18 to 80 years at recruitment were selected from four Australian state-based cancer registries. Eligible survivors were sent a survey containing the Survivor Unmet Needs Survey (SUNS). Logistic regression analysis was used to identify characteristics associated with haematological cancer survivors reporting a "high/very high" level of unmet need on ≥7 items of the SUNS. RESULTS Of the 696 survivors included in this study, 175 (n = 25 %) reported a "high/very high" level of unmet need on seven or more items of the SUNS. Survivors who: had relocated due to their cancer (OR: 2.04; 95 % CI: 1.18, 3.52), had difficulty paying bills (OR: 2.42; 95 % CI: 1.34, 4.38), had used up their savings as a result of cancer (OR: 1.90; 95 % CI: 1.06, 3.40), and were classified as having above normal symptoms of depression (OR: 3.65; 95 % CI: 2.17, 6.15) and stress (OR: 5.94; 95 % CI: 3.22, 10.95) on the Depression Anxiety and Stress Scale-21 (DASS-21) had statistically significantly higher odds of reporting seven or more "high/very high" unmet needs. CONCLUSIONS Additional and intensive supportive care may be needed for this subgroup of haematological cancer survivors experiencing multiple "high/very high" unmet needs. Assistance with accessing relevant financial support and highly accessible services that provide emotional and information support, such as online and telephone peer support programs may prove beneficial in addressing the needs of this subgroup of haematological cancer survivors. It is suggested that future, methodologically rigorous intervention studies assess such strategies.
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Hall A, D’Este C, Tzelepis F, Sanson-Fisher R, Lynagh M. The Survivor Unmet Needs Survey (SUNS) for haematological cancer survivors: a cross-sectional study assessing the relevance and psychometric properties. BMC Health Serv Res 2014; 14:211. [PMID: 24886475 PMCID: PMC4026596 DOI: 10.1186/1472-6963-14-211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 04/30/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Relevant and psychometrically sound needs assessment tools are necessary for accurate assessment of haematological cancer survivors unmet needs. No previous study has developed nor psychometrically evaluated a comprehensive needs assessment tool for use with population-based samples of haematological cancer survivors. This study aimed to assess the validity and reliability of the Survivor Unmet Needs Survey (SUNS) with haematological cancer survivors. METHODS The relevance, content and face validity of the SUNS to haematological cancer survivors was assessed using qualitative interviews. Psychometric evaluation was conducted using data collected from haematological cancer survivors, aged 18-80 years at recruitment and recruited from four Australian cancer registries. Construct, convergent and discriminant validity; internal reliability and floor and ceiling effects were assessed. A second survey was completed by a sub-sample of survivors recruited from two of the four registries to assess test-retest reliability. RESULTS Results from 17 qualitative interviews confirmed the relevance, face and content validity of the original items of the SUNS for use with haematological cancer survivors. Overall, 1,957 eligible haematological cancer survivors were contacted by the cancer registries. Of these 1,280 were sent a survey, and 715 returned a survey (37% of eligible survivors contacted and 56% of survivors sent a survey). A total of 529 survivors completed all 89 items of the SUNS and were included in the exploratory factor analysis. Exploratory factor analysis supported the original five-factor structure of the SUNS. Evidence for convergent validity was established, with all five domains of the SUNS illustrating a moderate positive correlation with all three subscales of the Depression Anxiety and Stress Scale (DASS-21). All Cronbach's alpha values were above 0.9 and all corrected item-total correlations were acceptable (>0.2). Criteria for discriminant validity was not met, with only 10 of the 15 (67%) a-priori hypotheses supported. Test-retest reliability was acceptable for 40 of the 89 items (45%) and for three of the five domains. Significant floor effects were evident for all five domains. CONCLUSIONS The SUNS demonstrates evidence for multiple features of validity and reliability as a measure of unmet needs for haematological cancer survivors. However, evidence supporting some psychometric properties was limited.
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Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology & Environment, Australian National University, Acton, Canberra, ACT, Australia
| | - Flora Tzelepis
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Marita Lynagh
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia
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Development and validation of the Short-Form Survivor Unmet Needs Survey (SF-SUNS). Support Care Cancer 2013; 22:1071-9. [DOI: 10.1007/s00520-013-2061-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
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Paul CL, Hall AE, Carey ML, Cameron EC, Clinton-McHarg T. Access to care and impacts of cancer on daily life: do they differ for metropolitan versus regional hematological cancer survivors? J Rural Health 2013; 29 Suppl 1:s43-50. [PMID: 23944279 DOI: 10.1111/jrh.12020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known about access to care for hematological cancer patients. This study explored patient experiences of barriers to accessing care and associated financial and social impacts of the disease. Metropolitan versus nonmetropolitan experiences were compared. METHODS A state-based Australian cancer registry identified adult survivors of hematological cancers (including lymphoma, leukemia and myeloma) diagnosed in the previous 3 years. Survivors were mailed a self-report pen and paper survey. FINDINGS Of the 732 eligible survivors, 268 (37%) completed a survey. Forty percent of participants reported at least one locational barrier which limited access to care. Only 2% reported cancer-related expenses had restricted their treatment choices. Almost two-thirds (64%) reported at least one financial or social impact on their daily lives related to cancer. The most frequently reported impacts were the need to take time off work (44%) and difficulty paying bills (21%). Survivors living in a nonmetropolitan location had 17 times the odds of reporting locational or financial barriers compared with those in metropolitan areas. Preferred potential solutions to alleviate the financial and social impacts of the disease were: free parking for tests or treatment (37%), free medications or treatments (29%), and being able to get treatment in their local region (20%). CONCLUSIONS Providing more equitable access to care for hematological cancer patients in Australia requires addressing distances traveled to attend treatment and their associated financial and social impacts on nonmetropolitan patients. Greater flexibility in service delivery is also needed for patients still in the workforce.
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Affiliation(s)
- Christine L Paul
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
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Hall A, Campbell HS, Sanson-Fisher R, Lynagh M, D'Este C, Burkhalter R, Carey M. Unmet needs of Australian and Canadian haematological cancer survivors: a cross-sectional international comparative study. Psychooncology 2013; 22:2032-8. [PMID: 23436539 DOI: 10.1002/pon.3247] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 12/18/2012] [Accepted: 12/21/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Few population-based studies have assessed the needs of haematological cancer survivors or conducted international comparisons. We aimed to assess and compare the unmet needs of Australian and Canadian haematological cancer survivors. METHODS Two cross-sectional datasets were analysed. Survivors were recruited from population-based cancer registries and sent a self-report survey containing the Survivors Unmet Needs Survey. Australians were aged 18-80 years at the time of study and diagnosed in the last 3 years. Canadians were diagnosed 1-5 years prior and aged 19 years and over at diagnosis. RESULTS A total of 268 Australian and 169 Canadian survivors returned a completed survey. 'Dealing with feeling tired' was identified as the highest concern by survivors. Country (LRχ(2)=4.0(1), p=0.045) was associated with survivors reporting a 'high/very high' unmet need with 'worry about earning money,' with Australians reporting marginally nonsignificantly higher odds than Canadians (OR 2.1; 95% CI; 0.99, 4.3). Country was not significantly associated with any other outcome. Having a personal expense in the last month as a result of having cancer, younger age at diagnosis, female sex, vocational or other level education, and consulting a health care professional for cancer treatment or concerns about cancer in the last month were associated with multiple areas of need. CONCLUSIONS Australian and Canadian haematological cancer survivors were found to experience similar levels of unmet needs. Overall, haematological cancer survivors may require additional assistance in dealing with feeling tired.
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Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia.
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