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Ison JM, Jackson JD, Hemley H, Willis A, Siddiqi B, Macklin EA, Ulysse C, Fitts MS, Pham TTH, Afshari M, Agarwal P, Aminoff M, Bissonnette S, Fullard M, Khan TS, Larson DN, Wielinski C, Sanchez AV. Fostering Inclusivity in Research Engagement for Underrepresented Populations in Parkinson's Disease: The FIRE-UP PD study. Contemp Clin Trials 2024; 144:107619. [PMID: 38971301 DOI: 10.1016/j.cct.2024.107619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Members of vulnerable populations are underrepresented in Parkinson's disease (PD) research. A complex web of research barriers perpetuates this gap. Community-based research methods are one approach to addressing this issue. The present PD study was designed to examine the effectiveness of community-based interventions to overcome barriers and increase research participation among underrepresented groups (URGs). METHODS Eight study sites across the US were selected and paired based on proposed interventions with specific URGs. Surveys assessed knowledge and attitudes toward PD research. Finally, researchers examined whether the present study affected recruitment to Fox Insight, an online PD research study also recruiting at each site. RESULTS In total, 474 participants were recruited. At post-intervention for the FIRE-UP PD Study, recruitment increased significantly in intervention compared to control sites among Black and African American non-Hispanic/Latino populations (p = 0.003), White Hispanic/Latino (p = 0.003) populations, and Not Listed Hispanic/Latino populations (p < 0.001) as well as those with an educational attainment of a high school diploma/General Education Diploma (GED) (p = 0.009), and an income <$20,000 (p = 0.005) or between $20,000-$34,999 (p < 0.001). Study surveys measuring changes in awareness and attitudes toward PD research had mixed results. In Fox Insight, 181 participants were passively recruited with a shift toward more diverse participant demographics. CONCLUSION Research participation demographics reflective of the general population are critical to PD investigation and treatment. The FIRE-UP PD Study showed the effectiveness of localized community engagement strategies in increasing URG recruitment to PD research. Therefore, further PD research employing community-based methods to improve diverse participant recruitment is needed.
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Affiliation(s)
- Juliana M Ison
- University of California, Gevirtz Graduate School of Education, Isla Vista, Santa Barbara, CA 93106, USA
| | - Jonathan D Jackson
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Helen Hemley
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Allison Willis
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Bernadette Siddiqi
- The Michael J. Fox Foundation, 111 W. 33rd St, New York City, NY 10120, USA
| | - Eric A Macklin
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Christine Ulysse
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Michael S Fitts
- University of Alabama at Birmingham (UAB Libraries), 1700 University Blvd, Birmingham, AL 35233, USA
| | - Tiffany T-H Pham
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Mitra Afshari
- Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA
| | - Pinky Agarwal
- Evergreen Health Care, 12040 NE 128th St, Kirkland, WA 98034, USA
| | - Michael Aminoff
- University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA
| | - Stephanie Bissonnette
- Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100, Richmond, VA 23298, USA
| | - Michelle Fullard
- University of Colorado Denver, 1201 Larimer St, Denver, CO 80204, USA
| | - Tarannum S Khan
- Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA
| | | | - Catherine Wielinski
- Park Nicollet Struthers Parkinson's Center, 6701 Country Club Dr, Minneapolis, MN 55427, USA
| | - Angie V Sanchez
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; University of Louisiana at Lafayette, 104 E University Ave, Lafayette, LA 70504, USA.
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Binoy S, Lithwick Algon A, Ben Adiva Y, Montaser-Kouhsari L, Saban W. Online cognitive testing in Parkinson's disease: advantages and challenges. Front Neurol 2024; 15:1363513. [PMID: 38651103 PMCID: PMC11034553 DOI: 10.3389/fneur.2024.1363513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Parkinson's disease (PD) is primarily characterized by motor symptoms. Yet, many people with PD experience cognitive decline, which is often unnoticed by clinicians, although it may have a significant impact on quality of life. For over half a century, traditional in-person PD cognitive assessment lacked accessibility, scalability, and specificity due to its inherent limitations. In this review, we propose that novel methods of online cognitive assessment could potentially address these limitations. We first outline the challenges of traditional in-person cognitive testing in PD. We then summarize the existing literature on online cognitive testing in PD. Finally, we explore the advantages, but also the limitations, of three major processes involved in online PD cognitive testing: recruitment and sampling methods, measurement and participation, and disease monitoring and management. Taking the limitations into account, we aim to highlight the potential of online cognitive testing as a more accessible and efficient approach to cognitive testing in PD.
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Affiliation(s)
- Sharon Binoy
- Loyola Stritch School of Medicine, Maywood, IL, United States
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Occupational Therapy, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Avigail Lithwick Algon
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Occupational Therapy, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yoad Ben Adiva
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Occupational Therapy, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Leila Montaser-Kouhsari
- Department of Neurology, Brigham and Women Hospital, Harvard University, Boston, MA, United States
| | - William Saban
- Center for Accessible Neuropsychology and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Occupational Therapy, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
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3
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Perez MA, Reyes-Esteves S, Mendizabal A. Racial and Ethnic Disparities in Neurological Care in the United States. Semin Neurol 2024; 44:178-192. [PMID: 38485124 DOI: 10.1055/s-0043-1778639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The burden of neurological disease is increasing globally. In the United States, this burden is disproportionally greater for Black and Latino communities who have limited access to neurological care. Health services researchers have attempted to identify racial and ethnic disparities in neurological care and possible solutions. This article reviews the most current literature on racial and ethnic disparities in commonly encountered neurological conditions, including Stroke, Alzheimer's Disease, Multiple Sclerosis, Epilepsy, Parkinson's Disease, and Migraine. Disparities exist in disease incidence, diagnosis, access to care, treatment, outcomes, and representation in epidemiologic studies and clinical trials. Many of the disparities observed in neurological care in the United States are a consequence of longstanding racist and discriminatory policies and legislation that increase risk factors for the development of neurological disease or lead to disparities in accessing quality neurological care. Therefore, additional efforts on the legislative, community health, and healthcare system levels are necessary to prevent the onset of neurological disease and achieve equity in neurological care.
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Affiliation(s)
- Michael A Perez
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Adys Mendizabal
- Department of Neurology, University of California, Los Angeles, California
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Sanchez AV, Ison JM, Hemley H, Jackson JD. Diversifying the research landscape: Assessing barriers to research for underrepresented populations in an online study of Parkinson's disease. J Clin Transl Sci 2024; 8:e34. [PMID: 38384928 PMCID: PMC10879993 DOI: 10.1017/cts.2024.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/26/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
Despite federal regulations mandating the inclusion of underrepresented groups in research, recruiting diverse participants remains challenging. Identifying and implementing solutions to recruitment barriers in real time might increase the participation of underrepresented groups. Hence, the present study created a comprehensive dashboard of barriers to research participation. Barriers to participation were recorded in real time for prospective participants. Overall, 230 prospective participants expressed interest in the study but were unable to join due to one or more barriers. Awareness of the most common obstacles to research in real time will give researchers valuable data to meaningfully modify recruitment methods.
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Affiliation(s)
- Angie V. Sanchez
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Jonathan D. Jackson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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5
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Roper A, Brooks D, Mitchell LK, Pachana NA, Au TR, Byrne GJ, O'Sullivan JD, Dissanayaka NN. Feasibility and Acceptability of a Videoconferencing CBT Intervention for Anxiety in People with Parkinson's Disease. Clin Gerontol 2024:1-16. [PMID: 38277135 DOI: 10.1080/07317115.2024.2306861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVES In people with Parkinson's disease (PwPD), non-motor symptoms such as anxiety are common and have negative impacts on their quality of life. There are currently few interventions that address anxiety in PwPD, and access to diagnosis and treatment is often limited for those living in rural areas. The aim of this study was to evaluate the feasibility and acceptability of a telehealth videoconferencing CBT intervention for anxiety in PwPD. METHODS A pre- and post-test feasibility study (N = 10) was conducted and evaluated utilizing the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). RESULTS Lack of access to the internet and videoconferencing technology were identified as barriers to participation. Physical health issues also impacted recruitment and retention. Non-completers were significantly older and less likely to have a carer involved in the intervention. Clinician adoption of the intervention was low while participant acceptability of videoconferencing technology varied and required carer support. CONCLUSIONS Providing access to technology and support to overcome technological issues, as well as telehealth training for clinicians, are recommended in future studies to improve recruitment, retention, and implementation. CLINICAL IMPLICATIONS Identification of barriers and facilitators provides future studies with the knowledge to tailorize their program to better suit PwPD.
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Affiliation(s)
- Amy Roper
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Deborah Brooks
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - John D O'Sullivan
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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Chapman R, Zeissler ML, Meinert E, Mullin S, Whipps S, Whipps J, Hockey K, Hockey P, Carroll CB. Incorporating usability evaluation into iterative development of an online platform to support research participation in Parkinson's disease: a mixed methods protocol. BMJ Open 2023; 13:e078638. [PMID: 38114283 DOI: 10.1136/bmjopen-2023-078638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Many people with Parkinson's (PwP) are not given the opportunity or do not have adequate access to participate in clinical research. To address this, we have codeveloped with users an online platform that connects PwP to clinical studies in their local area. It enables site staff to communicate with potential participants and aims to increase the participation of the Parkinson's community in research. This protocol outlines the mixed methods study protocol for the usability testing of the platform. METHODS AND ANALYSIS We will seek user input to finalise the platform's design, which will then be deployed in a limited launch for beta testing. The beta version will be used as a recruitment tool for up to three studies with multiple UK sites. Usability data will be collected from the three intended user groups: PwP, care partners acting on their behalf and site study coordinators. Usability questionnaires and website analytics will be used to capture user experience quantitatively, and a purposive sample of users will be invited to provide further feedback via semistructured interviews. Quantitative data will be analysed using descriptive statistics, and a thematic analysis undertaken for interview data. Data from this study will inform future platform iterations. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Plymouth (3291; 3 May 2022). We will share our findings via a 'Latest News' section within the platform, presentations, conference meetings and national PwP networks.
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Affiliation(s)
- Rebecca Chapman
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Marie-Louise Zeissler
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Edward Meinert
- Centre for Health Technology, Faculty of Health, University of Plymouth, Plymouth, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Mullin
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sue Whipps
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - John Whipps
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - Kate Hockey
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - Philip Hockey
- Patient and Public Involvement (PPI) Representative, University of Plymouth, Plymouth, UK
| | - Camille B Carroll
- Applied Parkinson's Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Moraga Alapont P, Prieto P, Urroz M, Jiménez M, Carcas AJ, Borobia AM. Evaluation of factors associated with recruitment rates in early phase clinical trials based on the European Clinical Trials Register data. Clin Transl Sci 2023; 16:2654-2664. [PMID: 37890866 PMCID: PMC10719455 DOI: 10.1111/cts.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Effective participant recruitment is a critical challenge in clinical trials. Inadequate enrollment of participants can precipitate delays, escalated costs, and compromise scientific integrity. Despite its relevance, particularly during the early phases, it persists as an obstacle in the field of clinical research. The primary aim of this study was to analyze the recruitment rates of early-phase clinical trials and evaluate their potential associations with key trial characteristics. Using a descriptive and statistical analysis, a research study was conducted based on the early-phase trials registered at the European Clinical Trials Register (EU-CTR), spanning the timeframe from January 2017 to December 2021. Among the 194 trials examined, we found median recruitment rates of 68%. A more detailed exploration revealed a greater level of success in terms of recruitment achievement in pediatric trials when compared to trials involving adults, non-oncologic trials, or those also developed in non-European countries. It is important to underscore that only 69 trials out of the total managed to conclude recruitment, with the most prevalent reason for premature cessation being the presence of efficacy and safety issues or sponsor's strategy. This number can be greatly improved. Despite certain disparities observed in the information within EU-CTR, we have successfully determined the recruitment rates of the studies and established associations with some of the clinical trial characteristics analyzed. Owing to the inherent constraints of this study, further research is warranted to gain a comprehensive understanding of the intricate interplay between trial characteristics and their impact on recruitment rates in early-phase studies.
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Affiliation(s)
| | - Paula Prieto
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
| | - Mikel Urroz
- Pharmacology and Therapeutics Department, School of MedicineUniversidad Autónoma de MadridMadridSpain
| | - María Jiménez
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
| | - Antonio J. Carcas
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
- Pharmacology and Therapeutics Department, School of MedicineUniversidad Autónoma de MadridMadridSpain
| | - Alberto M. Borobia
- Clinical Pharmacology DepartmentLa Paz University Hospital, IdiPAZMadridSpain
- Pharmacology and Therapeutics Department, School of MedicineUniversidad Autónoma de MadridMadridSpain
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Aamodt WW, Willis AW, Dahodwala N. Racial and Ethnic Disparities in Parkinson Disease: A Call to Action. Neurol Clin Pract 2023; 13:e200138. [PMID: 37064587 PMCID: PMC10101714 DOI: 10.1212/cpj.0000000000200138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/01/2022] [Indexed: 03/18/2023]
Abstract
Health disparities are pervasive in the United States. In the field of Parkinson disease (PD), profound racial and ethnic disparities exist in diagnosis, treatment, and research participation, leading to differential health outcomes and lack of generalizable research data. Racial and ethnic disparities not only limit our understanding of this complex heterogeneous disorder but also hamper our ability to provide new evidence-based care for America's most vulnerable populations. In this report, we summarize findings from our comprehensive white paper for the Michael J. Fox Foundation that reviews the current state of knowledge on racial and ethnic disparities in PD care in the following areas: epidemiology, etiology, phenotype and diagnosis, treatment, and research. We also identify knowledge gaps and necessary policy changes to ensure equitable, high-value care for all persons with PD. These strategies are designed to help identify and reduce health disparities among persons with PD and may serve as a model for other neurologic diseases.
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Affiliation(s)
- Whitley W Aamodt
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
| | - Allison W Willis
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
| | - Nabila Dahodwala
- Department of Neurology (WWA, AWW, ND); and Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (WWA, AWW), University of Pennsylvania, Philadelphia, PA
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Di Luca DG, Macklin EA, Hodgeman K, Lopez G, Pothier L, Callahan KF, Lowell J, Chan J, Videnovic A, Lungu C, Lang AE, Litvan I, Schwarzschild MA, Simuni T. Enrollment of Participants From Marginalized Racial and Ethnic Groups: A Comparative Assessment of the STEADY-PD III and SURE-PD3 Trials. Neurol Clin Pract 2023; 13:e200113. [PMID: 36865634 PMCID: PMC9973288 DOI: 10.1212/cpj.0000000000200113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/11/2022] [Indexed: 01/19/2023]
Abstract
Background and Objectives Representation of persons from marginalized racial and ethnic groups in Parkinson disease (PD) trials has been low, limiting the generalizability of therapeutic options for individuals with PD. Two large phase 3 randomized clinical trials sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), STEADY-PD III and SURE-PD3, screened participants from overlapping Parkinson Study Group clinical sites under similar eligibility criteria but differed in participation by underrepresented minorities. The goal of this research is to compare recruitment strategies of PD participants belonging to marginalized racial and ethnic groups. Methods A total of 998 participants with identified race and ethnicity consented to STEADY-PD III and SURE-PD3 from 86 clinical sites. Demographics, clinical trial characteristics, and recruitment strategies were compared. NINDS imposed a minority recruitment mandate on STEADY-PD III but not SURE-PD3. Results Ten percent of participants who consented to STEADY-PD III self-identified as belonging to marginalized racial and ethnic groups compared to 6.5% in SURE-PD3 (difference = 3.9%, 95% confidence interval [CI] 0.4%-7.5%, p value = 0.034). This difference persisted after screening (10.1% of patients in STEADY-PD III vs 5.4% in SURE-PD 3, difference = 4.7%, 95% CI 0.6%-8.8%, p value = 0.038). Discussion Although both trials targeted similar participants, STEADY-PD III was able to consent and recruit a higher percentage of patients from racial and ethnic marginalized groups. Possible reasons include differential incentives for achieving minority recruitment goals. Trial Registration Information This study used data from The Safety, Tolerability, and Efficacy Assessment of Isradipine for Parkinson Disease (STEADY-PD III; NCT02168842) and the Study of Urate Elevation in Parkinson's Disease (SURE-PD3; NCT02642393).
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Affiliation(s)
- Daniel G Di Luca
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Eric A Macklin
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Karen Hodgeman
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Gisel Lopez
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Lindsay Pothier
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Katherine F Callahan
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Jill Lowell
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - James Chan
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Aleksandar Videnovic
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Codrin Lungu
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Irene Litvan
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Michael A Schwarzschild
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
| | - Tatyana Simuni
- Edmond J. Safra Program in Parkinson's Disease (DGDL, AEL), Movement Disorders Clinic, Krembil Brain Institute, Toronto Western Hospital; Institute of Health Policy (DGDL), Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Biostatistics Center (EAM, JC), Massachusetts General Hospital; Harvard Medical School (EAM, AV, MAS), Boston, MA; University of Rochester Medical Center (KH, JL), NY; Department of Neurology (GL, LP, KFC, AV, MAS), Massachusetts General Hospital, Boston; Division of Clinical Research (CL), National Institute of Neurological Disorders and Stroke, Bethesda, MD; University of California San Diego (IL), CA; and Northwestern University Feinberg School of Medicine (TS), Chicago, IL
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10
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Kehagia AA, North TK, Grose J, Jeffery AN, Cocking L, Chapman R, Carroll C. Enhancing Trial Delivery in Parkinson’s Disease: Qualitative Insights from PD STAT. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1591-1604. [PMID: 35466952 PMCID: PMC9398073 DOI: 10.3233/jpd-212987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Recruitment and retention of participants in clinical trials for Parkinson’s disease (PD) is challenging. A qualitative study embedded in the PD STAT multi-centre randomised controlled trial of simvastatin for neuroprotection in PD explored the motivators, barriers and challenges of participants, care partners and research staff. Objective: To outline a set of considerations informing a patient-centred approach to trial recruitment, retention, and delivery. Method: We performed semi-structured interviews and focus groups with a subset of trial participants and their care partners. Quantitative and qualitative data were obtained through surveys circulated among the 235 participants across 23 UK sites at the beginning, middle and end of the 2-year trial. We also interviewed and surveyed research staff at trial closure. Results: Twenty-seven people with PD, 6 care partners and 9 researchers participated in interviews and focus groups. A total of 463 trial participant survey datasets were obtained across three timepoints, and 53 staff survey datasets at trial closure. Trial participants discussed the physical and psychological challenges they faced, especially in the context of OFF state assessments, relationships, and communication with research staff. Care partners shared their insights into OFF state challenges, and the value of being heard by research teams. Research staff echoed many concerns with suggestions on flexible, person-centred approaches to maximising convenience, comfort, and privacy. Conclusion: These considerations, in favour of person-centred research protocols informed by the variable needs of participants, care partners and staff, could be developed into a set of recommendations for future trials.
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Affiliation(s)
- Angie A. Kehagia
- University College Hospital, University London Hospitals NHS Trust, London, UK
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Tracie K. North
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Jane Grose
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | | | - Laura Cocking
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Rebecca Chapman
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Camille Carroll
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
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11
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Moving the Dial Toward Equity in Parkinson's Disease Clinical Research: a Review of Current Literature and Future Directions in Diversifying PD Clinical Trial Participation. Curr Neurol Neurosci Rep 2022; 22:475-483. [PMID: 35713775 DOI: 10.1007/s11910-022-01212-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Parkinson's disease (PD), the second most common neurodegenerative disease, has a worldwide prevalence projected at 12 million by 2040. While PD has been extensively researched, our understanding of the disease is based on research studies that include mostly participants of European descent. The lack of diversity in clinical trial enrollment has limited the generalizability of scientific discoveries in the field. Here, we discuss contributors to racial and ethnic disparities in PD clinical research enrollment, summarize recently proposed and tested interventions, and propose next steps to increase equity and representation in PD research. RECENT FINDINGS Enrollment in PD clinical research is vulnerable to upstream disparities and inequities from PD awareness to access to specialized PD centers. While additional research is still needed, recent studies have identified some potential strategies for increasing underrepresented minority (URM) recruitment including increasing the availability of linguistically and culturally diverse research materials and team members, partnering with community organizations, and forming relationships with URM-serving community physicians. To move the dial toward equity in PD research, it will be necessary to implement known successful strategies and further investigate additional contributors to the underrepresentation of URMs in PD clinical research while developing and testing interventions to address these factors.
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12
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Afshari M, Hernandez AV, Nonnekes J, Bloem BR, Goetz CG. Are virtual objective assessments of fall‐risk feasible and safe for people with Parkinson's disease? Mov Disord Clin Pract 2022; 9:799-804. [DOI: 10.1002/mdc3.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/04/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mitra Afshari
- Rush University Medical Center, Department of Neurology Chicago Illinois USA
| | | | - Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Department of Rehabilitation Nijmegen The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology Nijmegen The Netherlands
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13
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Sanchez AV, Ison JM, Hemley H, Willis A, Siddiqi B, Macklin EA, Ulysse C, Reynolds M, Schwarzschild MA, Jackson JD. Designing the fostering inclusivity in research engagement for underrepresented populations in Parkinson's disease study. Contemp Clin Trials 2022; 115:106713. [PMID: 35202842 DOI: 10.1016/j.cct.2022.106713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/20/2022] [Accepted: 02/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Population reflective research enrollment improves study generalizability and disease knowledge. Nevertheless, the proportion of underrepresented groups (URGs) in Parkinson's disease (PD) research remains low. Hence, the current manuscript describes the process of designing a study to analyze the effectiveness of strategies to overcome barriers to URG recruitment in PD research. METHODS The Fostering Inclusivity in Research Engagement for Underrepresented Populations in Parkinson's Disease (FIRE-UP PD) study asked participating sites to identify a URG or geographical region to target to assess knowledge and attitudes toward PD research as well as increase Fox Insight (an online study with The Michael J. Fox Foundation) participation across eight months. URGs were defined as racial and ethnic minorities, women, rural populations, and low socioeconomic status groups. Participating sites were paired based on their proposed interventions and were randomly assigned to either the intervention or control condition. RESULTS The FIRE-UP PD study was divided into pre-intervention, intervention, and post-intervention periods to measure changes in awareness and trust in PD research along with engagement and interest in PD protocols through the use of several surveys. Interventions included developing educational tools to engage local communities, building partnerships within local PD communities, and recruiting stakeholders to reimagine medical and research information for the community. CONCLUSION Improving representation in research is a crucial step toward improving access to PD diagnoses and treatments. This is one of the first multi-site PD research studies to include community engagement to address barriers to research participation and improve research recruitment of URGs.
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Affiliation(s)
- Angie V Sanchez
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America.
| | - Juliana M Ison
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America
| | - Helen Hemley
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America
| | - Allison Willis
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States of America
| | - Bernadette Siddiqi
- The Michael J. Fox Foundation, 111 W. 33rd St, New York City, NY, United States of America
| | - Eric A Macklin
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America
| | - Christine Ulysse
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America
| | - Marissa Reynolds
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America
| | - Michael A Schwarzschild
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America
| | - Jonathan D Jackson
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States of America; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States of America
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14
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Dobkin RD, Amondikar N, Kopil C, Caspell-Garcia C, Brown E, Chahine LM, Marras C, Dahodwala N, Mantri S, Standaert DG, Dean M, Shoulson I, Marek K, Katz A, Korell M, Riley L, Tanner CM. Innovative Recruitment Strategies to Increase Diversity of Participation in Parkinson's Disease Research: The Fox Insight Cohort Experience. JOURNAL OF PARKINSONS DISEASE 2021; 10:665-675. [PMID: 32250321 PMCID: PMC7242847 DOI: 10.3233/jpd-191901] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Clinical research in Parkinson’s disease (PD) faces practical and ethical challenges due to two interrelated problems: participant under-recruitment and lack of diversity. Fox Insight (FI) is a web-based longitudinal study collecting patient-reported outcomes and genetic data worldwide to inform therapeutic studies. FI’s online platform provides an opportunity to evaluate online strategies for recruiting large, diverse research cohorts. Objective: This project aimed to determine 1) whether FI’s digital marketing was associated with increased enrollment overall and from under-represented patient groups, compared to traditional recruitment methods; 2) the clinical and demographic characteristics of samples recruited online, and 3) the cost of this online recruitment. Method: FI recruitment during a 6-week baseline period without digital promotion was compared to recruitment during several periods of digital outreach. Separate online recruiting intervals included general online study promotion and unique Facebook and Google ad campaigns targeting under-represented subgroups: early PD, late/advanced PD, and residents of underrepresented/rural geographic areas. Results: Early PD, late PD, and geotargeting campaigns enrolled more individuals in their respective cohorts compared to baseline. All online campaigns also yielded greater total FI enrollment, attracting more participants who were non-White, Hispanic, older, female, and had lower educational attainment and income, and more medical comorbidities. Cost per new participant ranged from $21 (Facebook) to $108 (Google). Conclusion: Digital marketing may allow researchers to increase, accelerate, and diversify recruitment for PD clinical studies, by tailoring digital ads to target PD cohort characteristics.
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Affiliation(s)
| | - Ninad Amondikar
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Catherine Kopil
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | | | - Ethan Brown
- University of California, & San Francisco Veterans Affairs Medical Care Plan, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | - Marissa Dean
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Andrea Katz
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Monica Korell
- University of California, & San Francisco Veterans Affairs Medical Care Plan, San Francisco, San Francisco, CA, USA
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Caroline M Tanner
- University of California, & San Francisco Veterans Affairs Medical Care Plan, San Francisco, San Francisco, CA, USA
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15
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Cardenas-Rojas A, Pacheco-Barrios K, Castelo-Branco L, Giannoni-Luza S, Balbuena-Pareja A, Luna-Cuadros MA, Vasconcelos Felippe L, Uygur-Kucukseymen E, Gonzalez-Mego P, Gunduz ME, Shaikh ES, Gianlorenco ACL, Fregni F. Barriers and facilitators for clinical trial participation of underrepresented and non-underrepresented fibromyalgia patients: A cross-sectional internet survey. Heliyon 2021; 7:e07475. [PMID: 34286136 PMCID: PMC8278426 DOI: 10.1016/j.heliyon.2021.e07475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/27/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a need of well-powered randomized clinical trials in fibromyalgia. However, challenges for recruitment are presented. This study aims to describe and assess the perception of barriers and facilitators and the associated factors for the participation of underrepresented and non-underrepresented fibromyalgia patients. METHODS We performed an online survey through REDCap (Research Electronic Data Capture) targeting fibromyalgia patients from April 7 to July 3, 2020 during the COVID-19 stay home mandate and it was restricted to the United States of America. We described and compared the survey characteristics between underrepresented and non-underrepresented participants, and we performed logistic regression models to assess the associated factors with clinical trial participation. RESULTS In total, 481 completed the survey including 168 underrepresented fibromyalgia patients. Only (1) 11.09 % reported previous participation in clinical trials and the significant perceived barriers were investigator-related (lack of friendliness of research staff and the opportunity to receive the results) and center-related (privacy and confidentiality policies, and the institution's reputation); (2) the participation rate and perceived barriers and facilitators were similar between underrepresented and non-underrepresented patients; and was positively associated with low income, higher age, and clinical trial awareness from their physician; and negatively associated with the perception of investigator-related barriers; and (4) for the underrepresented population, the presence of emotional support. CONCLUSION Our findings suggest low rates of participation, regardless of underrepresented population status. Strategies as involving their physician as liaison to increase the awareness of clinical trials, as well as improving patient-researcher communication should be considered in this population.
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Affiliation(s)
- Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stefano Giannoni-Luza
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Balbuena-Pareja
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Alejandra Luna-Cuadros
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luna Vasconcelos Felippe
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Uygur-Kucukseymen
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammed Enes Gunduz
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emad Salman Shaikh
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Carolyna Lepesteur Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Therapy, Federal University of Sao Carlos, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Lavorgna L, Brigo F, Esposito S, Abbadessa G, Sparaco M, Lanzillo R, Moccia M, Inglese M, Bonfanti L, Trojsi F, Spina E, Russo A, De Micco P, Clerico M, Tedeschi G, Bonavita S. Public Engagement and Neurology: An Update. Brain Sci 2021; 11:429. [PMID: 33800571 PMCID: PMC8065487 DOI: 10.3390/brainsci11040429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Public engagement (PE) is defined as the involvement of "specialists who listen, develop their understanding, and interact with non-specialists in non-profit activities of educational, cultural, and social nature to engage the public in science-related matters". The public health relevance of PE consists in building up a scientifically literate society, able to participate in and support scientific and technological developments and their implications for educational settings. Neurological disorders account for 35% of all diseases. PE could have a positive impact on the lives of people affected by neurological diseases. METHOD This review evaluates the role of PE in dementia, stroke, epilepsy, multiple sclerosis, Parkinson's disease, migraine, neurogenetics, and amyotrophic lateral sclerosis. RESULTS AND CONCLUSIONS PE can provide accessible information, support research activities and prevention through appropriate lifestyles, and increase knowledge and awareness of neurological disorders, improving their diagnosis and treatment.
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Affiliation(s)
- Luigi Lavorgna
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), 39012 Merano, Italy;
| | - Sabrina Esposito
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Gianmarco Abbadessa
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Maddalena Sparaco
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Matilde Inglese
- Italy—OSPEDALE San Martino, IRCCS, University of Genova, 16132 Genoa, Italy;
| | - Luca Bonfanti
- Neuroscience Institute Cavalieri Ottolenghi (NICO), 10043 Orbassano, Italy;
- Department of Veterinary Sciences, University of Turin, 10095 Torino, Italy
| | - Francesca Trojsi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Emanuele Spina
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, 80138 Naples, Italy; (R.L.); (M.M.); (E.S.)
| | - Antonio Russo
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | | | - Marinella Clerico
- Clinical and Biological Sciences Department, University of Torino, 10124 Turin, Italy;
| | - Gioacchino Tedeschi
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
| | - Simona Bonavita
- Division of Neurology, Department of Advanced Medical and Surgical Sciences, AOU—University of Campania “Luigi Vanvitelli”, P.zza Miraglia 2, 80138 Naples, Italy; (L.L.); (S.E.); (G.A.); (M.S.); (A.R.); (G.T.); (S.B.)
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17
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de Melo-Martín I, Holtzman M, Hacker KS. "I Want to Do It, But I Want to Make Sure That I Do It Right." Views of Patients with Parkinson's Disease Regarding Early Stem Cell Clinical Trial Participation. AJOB Empir Bioeth 2020; 11:160-171. [PMID: 32516056 PMCID: PMC8212889 DOI: 10.1080/23294515.2020.1775721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: First-in-human clinical trials with stem cells for Parkinson's disease (PD) are on the horizon. Their epistemic success depends on ensuring the participation of a sufficient number and appropriately diverse group of patients with PD. Their ethical soundness requires that the research community ensures that subjects' decisions about whether to participate or not are consistent with participants' values, motivations, and goals. We sought to identify PD patients' knowledge, concerns, and expectations regarding early-phase stem cell research in PD. Methods: We conducted five semi-structured focus groups with patients with PD. Group discussions were recorded, transcribed, and coded to identify participants' knowledge, concerns, and expectations regarding participation in early stem cell clinical research in PD. Results: Four themes were generated from our data analysis: (1) participants' skepticism about the potential benefits of these trials; (2) their desire to obtain information about various aspects related to this research; (3) a recognition that accessing available knowledge was often difficult; and (4) the relevance of trusting relationships with various stakeholders. Conclusions: Participants expressed skepticism about the immediate impact of stem cell research. Nonetheless, such skepticism often reflected an appropriate consideration of the risks and potential benefits of participating in high-risk clinical trials. Despite their skepticism, participants were eager to learn more about stem cell research and clinical trials processes. They identified consistently trusted avenues of knowledge on these topics, but they often found it difficult to access relevant information or to determine its value.
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Affiliation(s)
- Inmaculada de Melo-Martín
- Weill Cornell Medical College, Division of Medical Ethics, 407 E.61st St., RR-212, New York, NY 10065
| | - Michael Holtzman
- The New School for Social Research, Psychology Department, 80 Fifth Avenue, 6 Floor, New York, NY 10011
| | - Katrina S. Hacker
- The New School for Social Research, Psychology Department, 80 Fifth Avenue, 6 Floor, New York, NY 10011
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18
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Frank S, Berk S, Hernandez L, Hogarth P, Shill HA, Siddiqi B, Simon DK. Transportation innovation to aid Parkinson disease trial recruitment. Contemp Clin Trials Commun 2019; 16:100449. [PMID: 31650070 PMCID: PMC6804741 DOI: 10.1016/j.conctc.2019.100449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/23/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022] Open
Abstract
Among the barriers to participation in clinical trials, transportation to and from study sites may be a prominent issue. Patients with Parkinson's disease have unique circumstances that add to the barriers including dementia, loss of driving ability, timing of medications, impact of reduced mobility, and bowel and bladder concerns. We sought to alleviate some of the burden of transportation by setting up pre-arranged rides through a third-party ride sharing service. This pilot project was established to assess feasibility and to explore the possibility that reducing the transportation burden may enhance participation in studies. One out of three academic sites was successful in setting up this service, and surveyed participants on the impact of this service. In general, study participants who opted into the ride-sharing service felt it made the process easier and less stressful. Most participants agreed that they are more likely to participate in another study if transportation was provided. This short-term pilot intervention suggests that participants were satisfied with a ride sharing service to help with their medical transportation needs, but larger studies that include data collection about retention are needed.
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Affiliation(s)
- Samuel Frank
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sarah Berk
- Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | | | | | | | | | - David K Simon
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Hall DA, Moore C, Comella C. Recruitment of patients with de novo Parkinson disease: successful strategies in a randomized exercise clinical trial. Trials 2018; 19:630. [PMID: 30428907 PMCID: PMC6237042 DOI: 10.1186/s13063-018-2958-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction Recruitment of sufficient patients with Parkinson disease into clinical trials is a barrier to successful, timely study completion. Non-pharmacologic studies have shown to be even more challenging for recruitment, despite some studies focusing on de novo Parkinson disease populations. This paper describes successful recruitment techniques from a randomized exercise clinical trial in Parkinson disease. Methods Several recruitment strategies were used to enroll de novo patients with Parkinson disease into a year-long clinical trial. Strategies focused on infrastructure included fast-track clinic scheduling, weekly research meetings, an established clinical repository, real-time clinic recruitment, and outreach to the community. The nature of the study facilitated recruitment by offering a wait-listed control group, exercise at a local fitness center with a paid membership, and collection of data by shipping equipment foregoing some visits. An experienced nurse study coordinator involved in recruitment and training of the principal investigator in recruitment of minorities enhanced overall recruitment. Finally, the patient population chosen for this study, patients with de novo Parkinson disease, may be more likely to enroll in an exercise study than patients with later stage disease. Results Seventy-six patients with de novo Parkinson disease were successfully enrolled into the exercise clinical trial from a single site. Conclusion Targeted recruitment strategies were successful in this study. Additional modifications to the study protocol, such as eliminating treadmill stress tests before randomization, travel to an urban downtown location for study visits, and a relatively healthy Parkinson disease population, may also have impacted this study. These strategies could all be adopted for other studies in Parkinson disease, neurodegenerative diseases, or other chronic disorders. Trial registration Clinicaltrials.gov, NCT01506479. Registered on 10 January 2012. Electronic supplementary material The online version of this article (10.1186/s13063-018-2958-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deborah A Hall
- Department of Neurological Sciences, Rush University, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Charity Moore
- Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Cynthia Comella
- Department of Neurological Sciences, Rush University, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
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Reijula E, Halkoaho A, Pietilä AM, Selander T, Martikainen K, Kälviäinen R, Keränen T. Comparable indicators of therapeutic misconception between epilepsy or Parkinson's disease patients between those with clinical trial experience and trial non-participants. Seizure 2018; 60:61-67. [PMID: 29908425 DOI: 10.1016/j.seizure.2018.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022] Open
Abstract
PURPOSE Study design, personal persuasions, and experiences can influence willingness to participate in clinical trials (CTs). A study assessed differences between Parkinson's disease (PD) or epilepsy patients having participated in CTs and non-participants in knowledge of and attitudes toward CTs. Also considered were factors in willingness to take part and how CT participants experienced the informed consent process. METHOD Random samples of members of Finland's PD (n = 2000) and epilepsy (n = 1875) patient organisations were posted a questionnaire on their views about CTs. Of the 1050 questionnaires returned, 845 met inclusion criteria. In total, 126 had participated in CTs. RESULTS While over 90% of respondents knew that participation is always voluntary, CT participants were more often aware that one can withdraw (p<0.001). In both groups, most did not recognise the possibility of randomisation, and 57% in both CT participants and non-participants indicated that CTs are aimed primarily at seeking the best medication for the participant. Nevertheless, 83% of CT participants indicated ability to understand the information provided. CONCLUSIONS While most in our study agreed that patients should be asked to participate in CTs, only 15% of subjects had done so. The discrepancy between willingness to participate and recruitment figures could be minimised by improving knowledge of CTs and communication between patients and researchers. Additionally, the groups displayed comparable false CT-related assumptions, raising questions about whether these subjects fully understood the clinical research's ultimate goal and CT participants had given true informed consent. These issues have practical and ethics implications for clinical investigators.
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Affiliation(s)
- Emmi Reijula
- The University of Eastern Finland, Faculty of Health Sciences, Kuopio University Hospital's Science Service Center, Kuopio, Finland.
| | - Arja Halkoaho
- Kuopio University Hospital's Science Service Center, Kuopio, Finland.
| | - Anna-Maija Pietilä
- The University of Eastern Finland, Faculty of Health Sciences, Kuopio Social and Health Care Services, Kuopio, Finland.
| | - Tuomas Selander
- Kuopio University Hospital's Science Service Center, Kuopio, Finland.
| | | | - Reetta Kälviäinen
- NeuroCenter at Kuopio University Hospital, Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Tapani Keränen
- Kuopio University Hospital's Science Service Center, Kuopio, Finland; Department of Neurology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
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Prizer LP, Gay JL, Wilson MG, Emerson KG, Glass AP, Miyasaki JM, Perkins MM. A Mixed-Methods Approach to Understanding the Palliative Needs of Parkinson’s Patients. J Appl Gerontol 2018; 39:834-845. [DOI: 10.1177/0733464818776794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parkinson’s disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.
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Zolkipli-Cunningham Z, Xiao R, Stoddart A, McCormick EM, Holberts A, Burrill N, McCormack S, Williams L, Wang X, Thompson JLP, Falk MJ. Mitochondrial disease patient motivations and barriers to participate in clinical trials. PLoS One 2018; 13:e0197513. [PMID: 29771953 PMCID: PMC5957366 DOI: 10.1371/journal.pone.0197513] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/03/2018] [Indexed: 01/21/2023] Open
Abstract
Background Clinical treatment trials are increasingly being designed in primary mitochondrial disease (PMD), a phenotypically and genetically heterogeneous collection of inherited multi- system energy deficiency disorders that lack effective therapy. We sought to identify motivating factors and barriers to clinical trial participation in PMD. Methods A survey study was conducted in two independent mitochondrial disease subject cohorts. A discovery cohort invited subjects with well-defined biochemical or molecularly- confirmed PMD followed at a single medical center (CHOP, n = 30/67 (45%) respondents). A replication cohort included self-identified PMD subjects in the Rare Disease Clinical Research Network (RDCRN) national contact registry (n = 290/1119 (26%) respondents). Five-point Likert scale responses were analyzed using descriptive and quantitative statistics. Experienced and prioritized symptoms for trial participation, and patient attitudes toward detailed aspects of clinical trial drug features and study design. Results PMD subjects experienced an average of 16 symptoms. Muscle weakness, chronic fatigue, and exercise intolerance were the lead symptoms encouraging trial participation. Motivating trial design factors included a self-administered study drug; vitamin, antioxidant, natural or plant-derivative; pills; daily treatment; guaranteed treatment access during and after study; short travel distances; and late-stage (phase 3) participation. Relative trial participation barriers included a new study drug; discontinuation of current medications; disease progression; daily phlebotomy; and requiring participant payment. Treatment trial type or design preferences were not influenced by population age (pediatric versus adult), prior research trial experience, or disease severity. Conclusions These data are the first to convey clear PMD subject preferences and priorities to enable improved clinical treatment trial design that cuts across the complex diversity of disease. Partnering with rare disease patient communities is essential to effectively design robust clinical trials that engage patients and enable meaningful evaluation of emerging treatment interventions.
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Affiliation(s)
- Zarazuela Zolkipli-Cunningham
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Mitochondrial Medicine Frontier Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Amy Stoddart
- Mitochondrial Medicine Frontier Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Arcadia University, Glenside, Pennsylvania, United States of America
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth M. McCormick
- Mitochondrial Medicine Frontier Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Amy Holberts
- Rare Diseases Clinical Research Network, Health Informatics Institute, University of South Florida, Tampa, Florida, United States of America
| | - Natalie Burrill
- Mitochondrial Medicine Frontier Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Shana McCormack
- Mitochondrial Medicine Frontier Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Lauren Williams
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York, United States of America
| | - Xiaoyan Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York, United States of America
| | - John L. P. Thompson
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York, United States of America
| | - Marni J. Falk
- Mitochondrial Medicine Frontier Program, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, New York, United States of America
- * E-mail:
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Abstract
Nowadays, the Internet is the major source to obtain information about diseases and their treatments. The Internet is gaining relevance in the neurological setting, considering the possibility of timely social interaction, contributing to general public awareness on otherwise less-well-known neurological conditions, promoting health equity and improving the health-related coping. Neurological patients can easily find several online opportunities for peer interactions and learning. On the other hand, neurologist can analyze user-generated data to better understand patient needs and to run epidemiological studies. Indeed, analyses of queries from Internet search engines on certain neurological diseases have shown a strict temporal and spatial correlation with the "real world." In this narrative review, we will discuss how the Internet is radically affecting the healthcare of people with neurological disorders and, most importantly, is shifting the paradigm of care from the hands of those who deliver care, into the hands of those who receive it. Besides, we will review possible limitations, such as safety concerns, financial issues, and the need for easy-to-access platforms.
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Soh SE, Morris ME, Watts JJ, McGinley JL, Iansek R. Health-related quality of life in people with Parkinson's disease receiving comprehensive care. AUST HEALTH REV 2018; 40:613-618. [PMID: 26910356 DOI: 10.1071/ah15113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/08/2016] [Indexed: 12/26/2022]
Abstract
Objectives The aim of the present study was to quantify the baseline variation in health-related quality of life (HRQOL) between individuals with Parkinson's disease (PD) referred to a comprehensive care program and those attending standard neurological services. Methods Participants included individuals with PD receiving conventional care from neurologists in private practice and individuals referred to a comprehensive inter-professional team hospital out-patient service. The Parkinson's Disease Questionnaire-39 (PDQ-39) and the EuroQoL (EQ-5D-3L) were used to quantify HRQOL. Results Participants referred to an inter-professional service were more likely to have poorer indices on PD-specific measures but not for generic HRQOL compared with individuals receiving standard neurological services. After adjusting for age, gender, disease severity and duration, people referred to a comprehensive care program were more likely to have a higher score for the PDQ-39 summary index (PDQ-39 SI; mean±s.d. 27.2±11.0; 95% confidence interval (CI) 25.5, 28.9) compared with individuals receiving standard neurological services (PDQ-39 SI mean 0.2±12.8; 95% CI 18.0, 22.4). Conclusions Compared with those attending standard neurological out-patient clinics, individuals referred to an inter-professional PD program are more likely to have advanced disease and poorer HRQOL. This observation has implications for the way in which people with PD are recruited for future clinical trials, because uneven recruitment from different sources may be a potential source of bias. What is known about the topic? Given that PD is associated with a complex array of motor and non-motor symptoms, an inter-professional team approach to service provision is argued to be optimal for individuals living with this debilitating condition. What does this paper add? This paper has shown that individuals referred to an inter-professional service are more likely to have advanced disease and complex care needs. Compared with those referred to neurologist private clinics, those referred to an inter-professional clinic had less functional independence and lower PD-specific HRQOL when first assessed, even after controlling for disease severity. What are the implications for practitioners? When recruiting for future trials to examine the efficacy of multidisciplinary care programs in people with PD, it is important to take into account whether these individuals have been referred to an inter-professional service. There may be a potential source of bias if participants were recruited predominantly from such services.
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Affiliation(s)
- Sze-Ee Soh
- Department of Epidemiology and Preventative Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Meg E Morris
- Physiotherapy, School of Allied Health, La Trobe University, Melbourne Campus, Plenty Road, Bundoora, Vic. 3083, Australia. Email
| | - Jennifer J Watts
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email
| | - Jennifer L McGinley
- Physiotherapy Department, The University of Melbourne, Level 7, Alan Gilbert Building, Parkville, Vic. 3052, Australia. Email
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, Kingston Centre, NPF Centre of Excellence, 400 Warrigal Road, Cheltenham, Vic. 3192, Australia. Email
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Adebamowo SN, Francis V, Tambo E, Diallo SH, Landouré G, Nembaware V, Dareng E, Muhamed B, Odutola M, Akeredolu T, Nerima B, Ozumba PJ, Mbhele S, Ghanash A, Wachinou AP, Ngomi N. Implementation of genomics research in Africa: challenges and recommendations. Glob Health Action 2018; 11:1419033. [PMID: 29336236 PMCID: PMC5769805 DOI: 10.1080/16549716.2017.1419033] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/08/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. OBJECTIVE The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. METHODS The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. RESULTS Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. CONCLUSIONS The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for Bioethics and Research, Ibadan, Nigeria
| | - Veronica Francis
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ernest Tambo
- Sydney Brenner Institute of Molecular Bioscience, University of Witwatersrand, Johannesburg, South Africa
| | - Seybou H. Diallo
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Guida Landouré
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Victoria Nembaware
- Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Eileen Dareng
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Primary Care and Public Health, University of Cambridge, Cambridge, UK
| | - Babu Muhamed
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Cardiovascular Genetics, Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Odutola
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Teniola Akeredolu
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Barbara Nerima
- National Livestock Resources Research Institute, Tororo, Uganda
| | - Petronilla J. Ozumba
- Clinical Lab Molecular Virology Unit, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Slee Mbhele
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Anita Ghanash
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ablo P. Wachinou
- National Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin Republic
| | - Nicholas Ngomi
- Health Challenges and Systems program, African Population and Health Research Center, Nairobi, Kenya
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Berger S, Chen T, Eldridge J, Thomas CA, Habermann B, Tickle-Degnen L. The self-management balancing act of spousal care partners in the case of Parkinson's disease. Disabil Rehabil 2017; 41:887-895. [PMID: 29228835 DOI: 10.1080/09638288.2017.1413427] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Living with and caring for someone with chronic illness can lead to limitations in activity and social participation for the care partner. Past research emphasizes the importance of care partners taking care of themselves physically and emotionally so they can stay healthy to support the care recipient. There is little information regarding how the care partner takes care of their own social lives. The purpose of this study was to explore the concept of social self-management from the perspective of spousal care partners of people with Parkinson's disease. METHOD Twenty spousal care partners of people with Parkinson's disease were interviewed three times. A grounded theory approach informed data analysis. RESULTS Findings that emerged from the data focused on balance in activities, support, and emotions and were summarized into three main themes: (1) Activities: Caregiving and beyond; (2) Strategies to support self and spouse; and (3) Emotional impact: Burden and compassion. CONCLUSION This research shows that care partners want to retain social participation and provides support for the importance of addressing the socio-emotional needs of care partners of people with a chronic disease. Interventions that guide care partners to take care of their spectrum of needs may lead to healthier, positive relationships. Implications for rehabilitation The focus of rehabilitation is often on the person diagnosed with the chronic condition. Living with and caring for someone with a chronic illness, such as Parkinson's disease, can lead to limitations in activity and social participation for the care partner. Including care partners in the rehabilitation process is key to helping maintain their health and well-being. Learning caregiving and self-management strategies may help care partners support their loved ones while staying socially engaged.
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Affiliation(s)
- Sue Berger
- a Department of Occupational Therapy , Boston University , Boston , MA , USA
| | - Tiffany Chen
- b Department of Occupational Therapy , Whittier Rehabilitation Hospital , Westborough , MA , USA
| | - Jenna Eldridge
- c Department of Occupational Therapy , Tufts University , Medford , MA , USA
| | - Cathi A Thomas
- d Department of Neurology , Boston University Medical Center , Boston , MA , USA
| | | | - Linda Tickle-Degnen
- c Department of Occupational Therapy , Tufts University , Medford , MA , USA
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27
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Pinto CB, Vélez FGS, French MN, Zeng D, Crandell D, Bolognini N, Merabet LB, Fregni F. STRATEGIES TO ENHANCE RECRUITMENT METHODS IN PHANTOM LIMB PAIN CLINICAL TRIALS. ACTA ACUST UNITED AC 2017; 4:72-79. [PMID: 29683138 DOI: 10.18203/2349-3259.ijct20171917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Phantom Limp Pain (PLP) was first described in 1551. To date, its mechanisms and novel interventions remain mostly untested. Only limited conclusions can be drawn from few and small randomized clinical trials (RCTs) on PLP. In this scenario, recruitment strategies are crucial in order to overcome inherent challenges to recruit PLP subjects for clinical trials. Although there are many methods to enhance recruitment and also retention, in this article we discuss these methods based on a common topic: dissemination. We summarize and discuss 10 strategies of recruitment related to the dissemination of information based on the notion that an increase in trial awareness may lead to both increased recruitment and also increased external generalizability. In addition, in our discussion we included insights based on our experience recruiting PLP patients for our large NIH-sponsored clinical trial. Although specific regulatory considerations need to be considered when choosing the methods of recruitment, which may vary across different countries and Institutional Review Boards (IRBs), these strategies may be applicable to most of research settings.
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Affiliation(s)
- Camila Bonin Pinto
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA.,Department of Neuroscience and Behavior, Psychology Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Faddi Ghassan Saleh Vélez
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Melanie N French
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Dian Zeng
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - David Crandell
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Nadia Bolognini
- Department of Psychology, Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milano, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Lotfi B Merabet
- The Laboratory for Visual Neuroplasticity, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
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Frish Y, Greenbaum D. Is Social Media a Cesspool of Misinformation? Clearing a Path for Patient-Friendly Safe Spaces Online. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:19-21. [PMID: 28207361 DOI: 10.1080/15265161.2016.1274795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Yael Frish
- a Zvi Meitar Institute for Legal Implications of Emerging Technologies
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Condit CM, Shen L, Edwards KL, Bowen DJ, Korngiebel DM, Johnson CO. Participants' Role Expectations in Genetics Research and Re-consent: Revising the Theory and Methods of Mental Models Research Relating to Roles. JOURNAL OF HEALTH COMMUNICATION 2016; 21:16-24. [PMID: 27653592 PMCID: PMC7868084 DOI: 10.1080/10810730.2016.1193914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The rise of large cohort-based health research that includes genetic components has increased the communication challenges for researchers. Controversies have been amplified over requirements for re-consent, return of results, and privacy protections, among other issues. This study extended research on the impact that the perceived role of "research participant" might have on communication expectations to illuminate research participants' preferences for re-consent. The study employed an online survey of participants in a long-standing cancer genetics registry. Results confirmed previous exploratory findings that research participants endorse multiple mental models of participant roles in research (doctor-patient, collaborator, donor, legal contract, etc.). Regression analyses indicated that high and low salience of different models of the role of research participant are related to different communication expectations. However, the pattern of relationships among roles is relevant. The results of the regression analysis also indicated that preference for mandatory re-consent and its relationship to mental models of roles are related to attitudes of trust, benefits, and informational risks. The discussion identifies implications as including the use of explicit approaches to address role relationships in communication with research participants. It also points to implications for methodological approaches in mental model research.
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Affiliation(s)
- Celeste M Condit
- a Department of Communication Studies , University of Georgia , Athens , Georgia , USA
| | - Lijiang Shen
- b Department of Communication Arts and Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Karen L Edwards
- c Department of Epidemiology, School of Medicine , University of California, Irvine , Irvine , California , USA
| | - Deborah J Bowen
- d Department of Bioethics and Humanities , University of Washington , Seattle , Washington , USA
| | - Diane M Korngiebel
- e Biomedical Informatics and Medical Education , University of Washington , Seattle , Washington , USA
| | - Catherine O Johnson
- c Department of Epidemiology, School of Medicine , University of California, Irvine , Irvine , California , USA
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