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Santarossa S, Baber M, Hussein J, Oley C, Slangerup K, Murphy D, Kippen KE. Using action research and a community-academic partnership to understand clinical trial participation: a patient-centered perspective. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:61. [PMID: 38872195 DOI: 10.1186/s40900-024-00593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Clinical trials that are patient-centered appear to be more successful (e.g., clinical outcomes, improved communication, mutual empowerment, changed attitudes), thus, action research may be a field of importance. The current study explores the Formation and Execution of Activities phases of a community-academic partnership (CAP). METHODS Members consisted of industry stakeholders, a healthcare/academic institution, and patients/families with lived experiences as cancer survivors and/or caregivers. Retrospectively, CAP members described the facilitating and/or hindering factors present in the partnership development. A document review process was used. Field notes from three CAP meetings, which focused on understanding clinical trial participation, were analyzed using a thematic approach. RESULTS Seven facilitating and three hindering factors were present. Interpersonal (vs. operational) processes were referenced as influential facilitating factors more often. Themes that emerged included 'trials as a treatment option', 'leaving a legacy', and 'timing is critical.' CONCLUSION This study provides a patient-centered perspective on barriers/challenges of clinical trial participation and how to improve future perceptions.
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Affiliation(s)
- Sara Santarossa
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA.
| | - Michele Baber
- AstraZeneca, Inc, 1 MedImmune Way, Gaithersburg, MD, USA
| | - Janine Hussein
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA
| | - Chrystal Oley
- AstraZeneca, Inc, 1 MedImmune Way, Gaithersburg, MD, USA
| | | | - Dana Murphy
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA
| | - Karen E Kippen
- Henry Ford Health System, Department of Public Health Sciences, Patient-Engaged Research Center, Detroit, MI, USA
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Zgierska AE, Gramly T, Prestayko N, Symons Downs D, Murray TM, Yerby LG, Howell B, Stahlman B, Cruz J, Agolli A, Horan H, Hilliard F, Croff JM. Transportation, childcare, lodging, and meals: Key for participant engagement and inclusion of historically underrepresented populations in the healthy brain and child development birth cohort. J Clin Transl Sci 2024; 8:e38. [PMID: 38476249 PMCID: PMC10928703 DOI: 10.1017/cts.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Participant recruitment and retention (R&R) are well-documented challenges in longitudinal studies, especially those involving populations historically underrepresented in research and vulnerable groups (e.g., pregnant people or young children and their families), as is the focus of the HEALthy Brain and Child Development (HBCD) birth cohort study. Subpar access to transportation, overnight lodging, childcare, or meals can compromise R&R; yet, guidance on how to overcome these "logistical barriers" is sparse. This study's goal was to learn about the HBCD sites' plans and develop best practice recommendations for the HBCD consortium for addressing these logistical barriers. Methods The HBCD's workgroups developed a survey asking the HBCD sites about their plans for supporting research-related transportation, lodging, childcare, and meals, and about the presence of institutional policies to guide their approach. Descriptive statistics described the quantitative survey data. Qualitative survey responses were brief, not warranting formal qualitative analysis; their content was summarized. Results Twenty-eight respondents, representing unique recruitment locations across the U.S., completed the survey. The results indicated substantial heterogeneity across the respondents in their approach toward supporting research-related transportation, lodging, childcare, and meals. Three respondents were aware of institutional policies guiding research-related transportation (10.7%) or childcare (10.7%). Conclusions This study highlighted heterogeneity in approaches and scarcity of institutional policies regarding research-related transportation, lodging, childcare, and meals, underscoring the need for guidance in this area to ensure equitable support of participant R&R across different settings and populations, so that participants are representative of the larger community, and increase research result validity and generalizability.
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Affiliation(s)
- Aleksandra E. Zgierska
- Departments of Family and Community Medicine, Anesthesiology and
Perioperative Medicine, and Public Health Sciences, Pennsylvania State
University College of Medicine, Hershey, PA,
USA
| | - Tatum Gramly
- Department of Family and Community Medicine, Pennsylvania
State University College of Medicine, Hershey,
PA, USA
| | - Nicholas Prestayko
- Department of Family and Community Medicine, Pennsylvania
State University College of Medicine, Hershey,
PA, USA
| | - Danielle Symons Downs
- Department of Kinesiology and College of Medicine, Department of
Obstetrics and Gynecology, Pennsylvania State University College of Health and
Human Development, University Park, PA,
USA
| | - Traci M. Murray
- National Institutes of Health, National Institute on Drug
Abuse, Bethesda, MD, USA
| | - Lea G. Yerby
- Department of Community Medicine and Population Health, The
University of Alabama College of Community Health Sciences,
Tuscaloosa, AL, USA
| | - Brittany Howell
- Department of Human Development and Family Science, Virginia Tech,
Fralin Biomedical Research Institute, Roanoke,
VA, USA
| | - Barbara Stahlman
- Department of Family and Community Medicine, Pennsylvania
State University College of Medicine, Hershey,
PA, USA
| | - Jennifer Cruz
- Department of Family and Community Medicine, Pennsylvania
State University College of Medicine, Hershey,
PA, USA
| | - Arjola Agolli
- Department of Family and Community Medicine, Pennsylvania
State University College of Medicine, Hershey,
PA, USA
| | - Holly Horan
- Department of Obstetrics and Gynecology, Global and Rural Women’s Health
Program, Heersink School of Medicine, The University of Alabama at
Birmingham, Birmingham, AL,
USA
| | | | - Julie M. Croff
- Oklahoma State University Center for Health Sciences,
Tulsa, OK, USA
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Bandiera C, Lam L, Locatelli I, Dotta-Celio J, Duarte D, Wuerzner G, Pruijm M, Zanchi A, Schneider MP. Understanding reasons and factors for participation and non-participation to a medication adherence program for patients with diabetic kidney disease in Switzerland: a mixed methods study. Diabetol Metab Syndr 2022; 14:140. [PMID: 36167584 PMCID: PMC9516833 DOI: 10.1186/s13098-022-00898-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An interprofessional medication adherence intervention led by pharmacists, combining motivational interviews and feedback with electronic monitor (EM) drug assessment, was offered to all consecutive patients with diabetic kidney disease (DKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m2) visiting their nephrologist or endocrinologist. Approximately 73% (202/275) of eligible patients declined to participate, and the factors and reasons for refusal were investigated. METHODS Sociodemographic and clinical data of included patients and those who refused were collected retrospectively for those who had previously signed the general consent form. Multivariate logistic regression analysis was performed to identify independent variables associated with non-participation. Patients who refused or accepted the adherence study were invited to participate in semi-structured interviews. Verbatim transcription, thematic analysis, and inductive coding were performed. RESULTS Patients who refused to participate were older (n = 123, mean age 67.7 years, SD:10.4) than those who accepted (n = 57, mean age 64.0 years, SD:10.0, p = 0.027) and the proportion of women was higher among them than among patients who accepted it (30.9% vs 12.3%, p = 0.007). The time from diabetes diagnosis was longer in patients who refused than in those who accepted (median 14.2 years IQR 6.9-22.7 vs. 8.6 years, IQR 4.5-15.9, p = 0.003). Factors associated with an increased risk of non-participation were female sex (OR 3.8, 95% CI 1.4-10.0, p = 0.007) and the time from diabetes diagnosis (OR 1.05, 95% CI 1.01-1.09, p = 0.019). The included patients who were interviewed (n = 14) found the interprofessional intervention useful to improve their medication management, support medication literacy, and motivation. Patients who refused to participate and who were interviewed (n = 16) explained no perceived need, did not agree to use EM, and perceived the study as a burden and shared that the study would have been beneficial if introduced earlier in their therapeutic journey. Other barriers emerged as difficult relationships with healthcare providers, lack of awareness of the pharmacist's role, and negative perception of clinical research. CONCLUSIONS Investigating the factors and reasons for participation and non-participation in a study helps tailor intervention designs to the needs of polypharmacy patients. Patients who refused the adherence intervention may not be aware of the benefits of medication management and medication literacy. There is an urgent need to advocate for interprofessional outpatient collaborations to support medication adherence in patients with DKD. Trial registration Clinicaltrials.gov NCT04190251_PANDIA IRIS.
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Affiliation(s)
- Carole Bandiera
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Liliane Lam
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jennifer Dotta-Celio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Dina Duarte
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne Zanchi
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Service of Endocrinology, Diabetes and Metabolism, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie P. Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Watson SE, Smith P, Snowden J, Vaughn V, Cottrell L, Madden CA, Kong AS, McCulloh R, Stack Lim C, Bledsoe M, Kowal K, McNally M, Knight L, Cowan K, Jimenez EY. Facilitators and Barriers to Pediatric Clinical Trial Recruitment and Retention in Rural and Community Settings: A Scoping Review of the Literature. Clin Transl Sci 2022; 15:838-853. [PMID: 35037409 PMCID: PMC9010274 DOI: 10.1111/cts.13220] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022] Open
Abstract
Children in rural settings are underrepresented in clinical trials, potentially contributing to rural health disparities. We performed a scoping review describing available literature on barriers and facilitators impacting participation in pediatric clinical trials in rural and community-based (non-clinical) settings. Articles identified via PubMed, CINAHL, Embase, and Web of Science were independently double-screened at title/abstract and full-text levels to identify articles meeting eligibility criteria. Included articles reported on recruitment or retention activities for U.S.-based pediatric clinical studies conducted in rural or community-based settings and were published in English through January 2021. Twenty-seven articles describing 31 studies met inclusion criteria. Most articles reported on at least one study conducted in an urban or suburban or unspecified community setting (n=23 articles; 85%); fewer (n=10; 37%) reported on studies that spanned urban and rural settings or were set in rural areas. More studies discussed recruitment facilitators (n=25 studies; 81%) and barriers (n=19; 61%) versus retention facilitators (n=15; 48%) and barriers (n=8; 26%). Descriptions of recruitment and retention barriers and facilitators were primarily experiential or subjective. Recruitment and retention facilitators were similar across settings and included: contacts/reminders, community engagement and relationship-building, consideration of participant logistics, and incentives. Inadequate staff and resources were commonly cited recruitment and retention barriers. Few studies have rigorously examined optimal ways to recruit and retain rural participants in pediatric clinical trials. To expand the evidence base, future studies examining recruitment and retention strategies should systematically assess and report rurality and objectively compare relative impact of different strategies.
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Affiliation(s)
- Sara E Watson
- Department of Pediatrics, University of Louisville, and Norton Children's Hospital, Louisville, KY
| | | | | | | | | | - Christi A Madden
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alberta S Kong
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Russell McCulloh
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE and Children's Hospital & Medical Center, Omaha, NE
| | - Crystal Stack Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | | | - Karen Kowal
- Nemours Children's Health System, Wilmington, DE
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Mohini P, Palaganas M, Elia Y, Motran L, Sochett E, Curtis J, Scholey JW, McArthur L, Mahmud FH. Exploring the Motivational Drivers of Young Adults with Diabetes for Participation in Kidney Research. J Patient Exp 2022; 9:23743735221138236. [PMID: 36388087 PMCID: PMC9663656 DOI: 10.1177/23743735221138236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Understanding motivational drivers and barriers to patient participation in diabetes research are important to ensure research is relevant and valuable. Young adults with type 1 diabetes (T1D) completed a 31-question qualitative survey evaluating participant experience, understanding, and motivators and barriers to research involvement. A total of 35 participants, 19–28 years of age, 60% female, completed the survey. Motivating factors included personal benefit, relationship with the study team, curiosity, financial compensation, altruism, and nostalgia. Older participants (>22 years) reported higher levels of trust in the study team (p = 0.02) and their relationship with the study team positively influenced their decision to participate (p = 0.03). Financial compensation was a strong motivator for participants with higher education (p = 0.02). Age, sex, education level, and trust in the study team influenced participants’ understanding. Barriers included logistics and lack of familial support. Important motivational drivers and barriers to participation in research by young adults with T1D must be considered to increase research engagement and facilitate the discovery of new knowledge.
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Affiliation(s)
- P Mohini
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - M Palaganas
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Y Elia
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - L Motran
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - E Sochett
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - J Curtis
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - JW Scholey
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - L McArthur
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - FH Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
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6
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Jaffe K, Nosova E, DeBeck K, Hayashi K, Milloy MJ, Richardson L. Trust in research physicians as a key dimension of randomized controlled trial participation in clinical addictions research. Subst Abus 2021; 42:927-934. [DOI: 10.1080/08897077.2021.1900987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kaitlyn Jaffe
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada
- Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada
- School of Public Policy, Simon Fraser University, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - M.-J. Milloy
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, University of British Columbia, Vancouver, Canada
- Department of Sociology, University of British Columbia, Vancouver, Canada
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Goldman V, Dushkin A, Wexler DJ, Chang Y, Porneala B, Bissett L, McCarthy J, Rodriguez A, Chase B, LaRocca R, Wheeler A, Delahanty LM. Effective recruitment for practice-based research: Lessons from the REAL HEALTH-Diabetes Study. Contemp Clin Trials Commun 2019; 15:100374. [PMID: 31193095 PMCID: PMC6517530 DOI: 10.1016/j.conctc.2019.100374] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/20/2019] [Accepted: 04/30/2019] [Indexed: 12/21/2022] Open
Abstract
Background Aims: The REAL HEALTH Diabetes Study is a practice-based randomized clinical trial that compares the effectiveness of lifestyle intervention aimed at weight reduction to medical nutrition therapy in primary care patients with type 2 diabetes. This paper describes a tiered approach to recruitment, the resultant enrollment rates of sequentially more intensive recruitment strategies, and identifies barriers to participation. Methods Potential participants were identified using patient health registries and classified by recruitment site. Four recruitment strategies were used to achieve target enrollment: (1) mail/telephone outreach; (2) direct referral from providers; (3) orientation sessions; and (4) media/advertising. Reasons for ineligibility and non-participation were tracked. Results Fifteen thousand two hundred sixty-nine (15,269) potential participants were identified from all sources, with the clear majority coming from patient registries. Mail/telephone outreach alone had the lowest enrollment rate (1.2%). Direct referral and orientation sessions superimposed on mail/telephone outreach was used for fewer participants but had greater enrollment rates (27% and 52%.) Media/advertising was ineffective. The most commonly reported reasons for non-participation were not wanting to be in a research (30%) or a weight loss program (22%); time commitment (20%); and distance/transportation (14%). Conclusions The use of population registries to identify potential participants coupled with successively more intensive recruitment strategies, executed in a tiered approach moving toward personal engagement to establish trust and credibility, maximized recruitment enrollment rates. Our findings regarding facilitators and barriers to recruitment could be used to inform other practice-based research or to engage patients in group interventions in usual care settings. Clinical trial registration NCT02320253.
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Affiliation(s)
- Valerie Goldman
- Massachusetts General Hospital (MGH) Diabetes Research Center, MGH Diabetes Unit, Department of Medicine, Boston, MA, USA
| | - Amy Dushkin
- Massachusetts General Hospital (MGH) Diabetes Research Center, MGH Diabetes Unit, Department of Medicine, Boston, MA, USA
| | - Deborah J Wexler
- Massachusetts General Hospital (MGH) Diabetes Research Center, MGH Diabetes Unit, Department of Medicine, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Laurie Bissett
- Massachusetts General Hospital (MGH) Diabetes Research Center, MGH Diabetes Unit, Department of Medicine, Boston, MA, USA
| | - Jeanna McCarthy
- Massachusetts General Hospital (MGH) Diabetes Research Center, MGH Diabetes Unit, Department of Medicine, Boston, MA, USA
| | - Anthony Rodriguez
- Massachusetts General Hospital (MGH) Diabetes Research Center, MGH Diabetes Unit, Department of Medicine, Boston, MA, USA
| | - Barbara Chase
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,MGH Chelsea Health Center, Boston, MA, USA
| | - Rajani LaRocca
- Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,MGH Charlestown Health Center, Boston, MA, USA
| | - Amy Wheeler
- Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,MGH Revere Health Center, Boston, MA, USA
| | - Linda M Delahanty
- Massachusetts General Hospital (MGH) Diabetes Research Center, MGH Diabetes Unit, Department of Medicine, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Zhao Y, Ding A, Arya R, Patel JP. Factors influencing the recruitment of lactating women in a clinical trial involving direct oral anticoagulants: a qualitative study. Int J Clin Pharm 2018; 40:1511-1518. [PMID: 30306454 PMCID: PMC6280865 DOI: 10.1007/s11096-018-0734-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
Background Robust human data on medication use during lactation is scarce. With increasing medication use in postpartum women, it is important to conduct clinical lactation studies measuring the excretion of drugs in human milk and generate evidence. We plan to conduct a clinical lactation study, involving the direct oral anticoagulants (DOACs). Objective This study aimed to identify factors influencing lactating women's clinical trial participation and to improve the design of a proposed DOACs clinical lactation study. Setting Lactating women in London, UK. Methods Three focus groups were conducted in lactating women with differing experiences of being prescribed anticoagulants during puerperium. Main outcome measures Thematic framework approach was used to analyse and identify key themes, using NVivo version 11. Results Eight breastfeeding mothers participated. Women's decision-making on clinical trial participation was largely influenced by the lactation stage and previous breastfeeding experience. The concern of harm to their infant caused by the test medication or interruption of lactation were the predominant barriers to potential participation. Around 6 months following the birth of their infant and second-time mothers appeared to be more amenable to clinical trial participation. The provision of home visits for the execution of the study was highly recommended. Conclusion Our findings suggest that lactating women would participate in a clinical trial during the breastfeeding period, if the timing is right and if the woman is an experienced mother. Home visits will be provided in our proposed DOACs clinical lactation study.
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Affiliation(s)
- Yating Zhao
- Institute of Pharmaceutical Science, King's College London, 5th Floor Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK.
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.
| | - Amally Ding
- Institute of Pharmaceutical Science, King's College London, 5th Floor Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Roopen Arya
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Jignesh P Patel
- Institute of Pharmaceutical Science, King's College London, 5th Floor Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
- King's Thrombosis Centre, Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
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9
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Paglialunga S, Bond R, Jaycox SH. Evaluation of HbA1c screening during outreach events for prediabetes subject recruitment for clinical research. Trials 2018; 19:60. [PMID: 29357915 PMCID: PMC5778743 DOI: 10.1186/s13063-018-2459-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/08/2018] [Indexed: 11/25/2022] Open
Abstract
Background There are a number of obstacles which may impede the recruitment of underserved populations in clinical research studies; some of these factors include mistrust of medical research, socioeconomic constraints, cultural factors, and language barriers. For chronic metabolic disease indications, these barriers may also include lack of disease awareness. Recently, national organizations such as the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) have highlighted the need for prediabetes recognition. Therefore the aim of the study was twofold: to raise prediabetes awareness in an under-represented Hispanic community and to engage prediabetes participants in clinical research. Methods Hemoglobin A1c (HbA1c) screening was performed at major outreach events catered to the Hispanic community. All participants signed an ethics review board approved waiver which collected basic demographic information and the HbA1c test was performed with a hand-held monitor and finger-stick blood sample. Participants were given their HbA1c results at the event as well as information on prediabetes and upcoming clinic studies. After the event, participants were contacted by a study participant recruiter to assess interest in participating in clinical research. Results The majority of participants screened fell within a prediabetes HbA1c range. Mean HbA1c was similar among men and women, yet higher in individuals aged 45–65 years compared to adults aged < 45 years (p < 0.05). For recruitment purposes, the highest number of leads came from participants attending a faith-based community event. In all, 17% of individuals contacted expressed interest in participating in clinical research and created a profile within our database to be eligible for future studies. Conclusions Providing no-cost HbA1c screening is an excellent recruitment tool for clinical research as well as an opportunity to raise prediabetes awareness in a traditionally underserved population.
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Affiliation(s)
- Sabina Paglialunga
- Celerion, Global Clinical Research, 2420 W Baseline Rd, Tempe, AZ, 85283, USA.
| | - Ryan Bond
- Celerion, Global Clinical Research, 2420 W Baseline Rd, Tempe, AZ, 85283, USA
| | - Sharon H Jaycox
- Celerion, Global Clinical Research, 2420 W Baseline Rd, Tempe, AZ, 85283, USA
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Lee SB, Zak A, Iversen MD, Polletta VL, Shadick NA, Solomon DH. Participation in Clinical Research Registries: A Focus Group Study Examining Views From Patients With Arthritis and Other Chronic Illnesses. Arthritis Care Res (Hoboken) 2017; 68:974-80. [PMID: 26474187 DOI: 10.1002/acr.22767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/16/2015] [Accepted: 10/13/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patient registries have contributed substantially to progress in clinical research in rheumatic diseases. However, not much is known about how to optimize the patient experience in such registries. We assessed patient views, motivations, and potential barriers towards participation in registry research to better understand how registries can be improved to maximize patient engagement. METHODS Focus groups were held with 23 patients (mean ± SD age 59 ± 13 years) from the Boston area and led by a bilingual moderator trained in focus group methodology, using a semistructured moderator guide. Three separate focus groups were conducted to thematic saturation: patients with rheumatoid arthritis (RA) who had registry experience, patients with any chronic illness, and Spanish-speaking patients with RA or osteoarthritis. Patients in the latter 2 groups had no prior registry experience. Focus groups were audiotaped and transcribed. Four researchers independently analyzed transcripts using open data coding to identify themes. A normative group process was used to consolidate and refine themes. RESULTS Seven major themes were identified, including personalization/convenience of data collection, trust and confidentiality, camaraderie, learning about yourself and your disease, altruism, material motivators, and capturing mental health and other elements of the lived experience. We observed distinct differences in the discussion content of the Spanish-speaking patients compared to the English-speaking patients. CONCLUSION This study identified patient attitudes towards registry research among those with and without prior experience in a registry. The results provide insight into strategies for registry design to maximize patient engagement, which can lead to more robust registry data.
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Affiliation(s)
- Sara B Lee
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Agnes Zak
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Maura D Iversen
- Brigham and Women's Hospital, Northeastern University, and Harvard University, Boston, Massachusetts
| | | | - Nancy A Shadick
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
| | - Daniel H Solomon
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
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Development of a Survey to Explore Factors Influencing the Adoption of Best Practices for Diabetic Foot Ulcer Offloading. J Wound Ostomy Continence Nurs 2017; 44:129-137. [DOI: 10.1097/won.0000000000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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DasMahapatra P, Raja P, Gilbert J, Wicks P. Clinical trials from the patient perspective: survey in an online patient community. BMC Health Serv Res 2017; 17:166. [PMID: 28241758 PMCID: PMC5327530 DOI: 10.1186/s12913-017-2090-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/10/2017] [Indexed: 12/03/2022] Open
Abstract
Background Developing new medicines relies on the successful conduct of clinical trials. As trial protocols become more arduous, it becomes harder to recruit and retain patient volunteers, although recent efforts such as OMERACT and I-SPY2 show that partnering with patients can be beneficial. We sought to describe drivers and barriers to trial participation, as well as condition-specific trial preferences. Methods An online survey was fielded via the patient-powered research network PatientsLikeMe to 1,621 members living with nine selected chronic health conditions. Questions included demographics, trial experience, reasons for non-participation, questions relating to aspects of trial design, and an adaptation of the Net Promoter Score (NPS) for trial satisfaction. Results Mean age of respondents was 55 years; most patients were white (93%), female (67%), and living in the United States (72%). Primary conditions were MS (21%), Parkinson’s (20%), fibromyalgia (15%), ALS (10%), type 2 diabetes (10%), rheumatoid arthritis (RA, 8%), epilepsy (8%), major depressive disorder (MDD, 5%) and systemic lupus erythematosus (SLE, 3%). Most patients had not discussed a trial with their physician and only 21% had ever enrolled, with rates highest in ALS (36%), Parkinson’s disease (36%) and MS (20%) and lowest among SLE (9%), MDD (11%) and Fibromyalgia (11%). Common reasons for non-participation were eligibility criteria, inconvenience of travel and concerns about side effects. NPS suggested that many patients were unsatisfied; patients with lupus, epilepsy, RA, and fibromyalgia reported negative scores, i.e. they would dissuade other patients like them from taking part in trials. The most important considerations in trial participation were the opportunity to improve one’s own health and that of others, the reputation of the institution, and having medical bills covered in case of injury. Least important were remuneration and possibility of receiving a placebo. ALS patients were more willing to tolerate undesirable aspects of trials. Conclusions Most patients are willing to enroll yet very few are invited. When they do, trial participation is often burdensome, but patients are willing to help improve their design. Researchers should let patients help design better trials to overcome recruitment and retention issues and hasten the development of new medicines. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2090-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Priya Raja
- PatientsLikeMe Inc, 155 Second Street, Cambridge, MA, 02141, USA
| | - Jeremy Gilbert
- PatientsLikeMe Inc, 155 Second Street, Cambridge, MA, 02141, USA
| | - Paul Wicks
- PatientsLikeMe Inc, 155 Second Street, Cambridge, MA, 02141, USA
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Autobiography of William N. Robiner, Ph.D. J Clin Psychol Med Settings 2016; 24:21-26. [PMID: 27752980 DOI: 10.1007/s10880-016-9468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Farrington C, Allen J, Tauschmann M, Randell T, Trevelyan N, Hovorka R. Factors Affecting Recruitment of Participants for Studies of Diabetes Technology in Newly Diagnosed Youth with Type 1 Diabetes: A Qualitative Focus Group Study with Parents and Children. Diabetes Technol Ther 2016; 18:568-73. [PMID: 27355100 PMCID: PMC5035376 DOI: 10.1089/dia.2016.0157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Relatively little is known about parents' or children's attitudes toward recruitment for, and participation in, studies of new diabetes technologies immediately after diagnosis. This study investigated factors affecting recruitment of participants for studies in newly diagnosed youth with type 1 diabetes. METHODS Qualitative focus group study incorporating four recorded focus groups, conducted in four outpatient pediatric diabetes clinics in large regional hospitals in England. Participants comprised four groups of parents (n = 22) and youth (n = 17) with type 1 diabetes, purposively sampled on the basis of past involvement (either participation or nonparticipation) in an ongoing two-arm randomized trial comparing multiple daily injection with conventional continuous subcutaneous insulin infusion regimens from the onset of type 1 diabetes. RESULTS Stress associated with diagnosis presents significant challenges in terms of study recruitment, with parents demonstrating varied levels of willingness to be approached soon after diagnosis. Additional challenges arise regarding the following: randomization when study arms are perceived as sharply differentiated in terms of therapy effectiveness; burdens arising from study participation; and the need to surrender new technologies following the end of the study. However, these challenges were mostly insufficient to rule out study participation. Participants emphasized the benefits and reassurance arising from support provided by staff and fellow study participants. CONCLUSIONS Recruitment to studies of new diabetes technologies immediately after diagnosis in youth presents significant challenges, but these are not insurmountable. The stress and uncertainty arising from potential participation may be alleviated by personalized discussion with staff and peer support from fellow study participants.
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Affiliation(s)
- Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Janet Allen
- Department of Paediatrics, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Martin Tauschmann
- Department of Paediatrics, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Tabitha Randell
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Nicola Trevelyan
- Department of Paediatric Endocrinology and Diabetes, Southampton Children's Hospital, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Roman Hovorka
- Department of Paediatrics, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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Chechi T, Siyahian S, Thairu L, Hagerman R, Lozano R. Participation of underrepresented minority children in clinical trials for Fragile X syndrome and other neurodevelopmental disorders. Intractable Rare Dis Res 2014; 3:147-52. [PMID: 25606364 PMCID: PMC4298644 DOI: 10.5582/irdr.2014.01025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/28/2014] [Indexed: 01/02/2023] Open
Abstract
The purpose of this study was to identify demographic data, motivational factors and barriers for participation in clinical trials (CTs) at the University of California Davis, MIND Institute. We conducted a cross-sectional survey in 100 participants (81 females and 19 males). The participants had high education levels (only 2% had not completed high school), a mean age of 44 years (SD ± 9.899) and had at least one child with a neurodevelopmental disorder. The diagnosis of Fragile X syndrome (FXS) had a significant association with past participation in CTs (p < 0.001). A statistical significance for age of diagnosis and participation in CTs was also found (z = -2.01, p = 0.045). The motivating factors were to help find cures/treatments for neurodevelopmental disorders and to relieve symptoms related to child's diagnosis. Factors explaining lack of participation, unwillingness to participate or unsure of participation were: lack of information/knowledge about the trials, time commitment to participation (screening, appointments, assessments, laboratory tests, etc.) and low annual household income. These results show that a portion of underrepresented minorities (URM) not participating in CTs are willing to participate and suggests that reducing barriers, particularly lack of knowledge/information and time commitment to trials are needed to improve recruitment.
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Affiliation(s)
- Tasleem Chechi
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
| | - Salpi Siyahian
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
| | - Lucy Thairu
- Touro University, Public Health Program, Vallejo, CA, USA
| | - Randi Hagerman
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
| | - Reymundo Lozano
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
- Address correspondence to: Dr. Reymundo Lozano, MIND Institute 2825 50th Street, Sacramento, CA 95817, USA. E-mail:
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Geppert C, Candilis P, Baker S, Lidz C, Appelbaum P, Fletcher K. Motivations of Patients with Diabetes to Participate in Research. AJOB Empir Bioeth 2014; 5:14-21. [PMID: 25419533 DOI: 10.1080/23294515.2014.910282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Research on the motivations of research participants has focused primarily on vulnerable populations at risk of exploitation, and there is little research on the motivations and reasons of general medical patients participating in research. Given a significant increase in research studies recruiting participants with diabetes, we sought to better understand the motivations of patients with diabetes considering a general medical research protocol. METHODS The analyses presented here compare the reasoning and willingness to participate in a hypothetical research study of medically ill subjects (patients with diabetes, n=51) with non-ill (n=57) subjects. Responses on the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) were correlated with demographic variables and scores on the Mini-Mental State Examination (MMSE) and Short-Form-36 (SF-36). RESULTS Overall, 44% of the group with diabetes and 56% of the comparison group indicated a willingness to participate in the research study. The reasons diabetic and comparison groups offered for willingness or unwillingness to participate in research did not differ significantly. 75% mentioned reasons related to treatment, 63% altruism; none mentioned money. Of those patients with diabetes who would not participate in research, 94% cited risk, and 89% expressed an aversion to research. CONCLUSIONS The present study suggests that when research is not related to their diagnosis, persons with diabetes do not differ significantly from non-ill comparison subjects in their motivations to participate in research. Given the similarity of our subjects' motivations to those of other medically ill populations, it may be that investigators can now focus more closely on the decision-making characteristics of their patients involved in clinical research rather than their diagnoses.
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Affiliation(s)
- Cynthia Geppert
- New Mexico Veterans Affairs Health Care System - Ethics 1501 San Pedro Dr. SE University of New Mexico Albuquerque, New Mexico 87108
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Affiliation(s)
- Arun Bhatt
- President, Clininvent Research Private Limited, Andheri (E), Mumbai, Maharashtra, India
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The Mela Study: exploring barriers to diabetes research in black and minority ethnic groups. Prim Health Care Res Dev 2014; 16:53-60. [PMID: 24513136 DOI: 10.1017/s1463423614000061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Black and minority ethnic (BME) groups are particularly susceptible to diabetes and its vascular complications in the United Kingdom and most western societies. To understand potential predisposition and tailor treatments accordingly, there is a real need to engage these groups in diabetes research. Despite this, BME participation in research studies continues to remain low in most countries and this may be a contributory factor to reduced health outcomes and poorer quality of life in these groups. This study explores the barriers BME groups may have towards participation in diabetes research in one area of East London, and includes local recommendations on how to improve this for the future. METHODS A questionnaire designed from previously reported exploratory work and piloted in several BME localities was distributed at the East London Bangladeshi Mela and similar cultural and religious events in London, UK. People were asked opportunistically to complete the survey themselves if they understood English, or discuss their responses with an advocate. The purpose of the questionnaire was to understand current local awareness with regards to diabetes, identify specific BME barriers and attitudes towards diabetes research by ethnicity, gender and age, and gain insight into how these barriers may be addressed. RESULTS Of 1682 people surveyed (16-90 years; median age 40 years), 36.4% were South Asian, 25.9% White, and 11.1% Black and other ethnicities; 26.6% withheld their ethnicity. Over half cited language problems generally (54%) and lack of research awareness (56%) as main barriers to engaging in research. South Asian groups were more likely to cite research as too time consuming (42%) whereas Black groups were more concerned with potential drug side effects in research (39%). Participants expressed a general mistrust of research, and the need for researchers to be honest in their approach. Recommendations for increased participation in South Asian groups centred round both helping the community (61%) and improving health (55%). With regards to gender influences, females (34.6%) were significantly more likely to fear drug side effects than males (23.8%), P<0.001. Females were also significantly more likely not to participate in research due to fear of experimentation (25.8%) compared with males (18.9%) P=<0.001. CONCLUSION Initial findings from the study demonstrate that in East London research barriers are focused on time, drug side effects, lack of awareness and language. There is a perception that research is time consuming even though the majority of those surveyed had not taken part in a research study. Further potential solutions from the survey have suggested that researchers also need to involve BME community leaders in their study strategy and indicate any individual health benefits to participation in research. Accessible studies with regards to time and advocacy provision need to be included in the design.
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Robiner WN, Strand TD, Mauer M. Adherence and renal biopsy feasibility in the Renin Angiotensin-System Study (RASS) primary prevention diabetes trial. Diabetes Res Clin Pract 2013; 102:25-34. [PMID: 24050942 PMCID: PMC4452734 DOI: 10.1016/j.diabres.2013.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 11/28/2022]
Abstract
AIMS Enhancing adherence in research trials is fundamental to the proper testing of treatment hypotheses. METHODS Regimen and follow-up adherence as well as factors associated with adherence in the Renin Angiotensin-System Study (RASS) diabetic nephropathy primary prevention trial were evaluated. Adherence to medication (i.e., pill count), follow-up visits, and follow-up renal biopsies was evaluated. RESULTS 89.8% of subjects completed the second renal biopsy. 96% of follow-up visits were attended within prescribed time windows. Mean medication adherence was 85.6%. Subgroup analyses revealed greater declines in the least adherent participants over time. Factors associated with greater adherence levels included older age, type 1 diabetes (TIDM) duration, lower HbA1c and blood pressure, GFR, ethnicity, and participants', principal investigators' (PI), and trial coordinators' (TC) baseline predictions of adherence. CONCLUSIONS T1DM patients without nephropathy were willing to take experimental medications and undergo repeat renal biopsies. Although overall adherence was excellent, patterns of adherence varied among participants, suggesting the need to better track adherence and to develop customized and targeted approaches for promoting adherence to clinical research regimens. Staff subjective predictions of adherence were imprecise, supporting need for further development of adherence predictors.
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Affiliation(s)
- William N. Robiner
- Health Psychology, Department of Medicine, University of Minnesota Medical School, USA
- Corresponding author at: Health Psychology, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street S.E., Minneapolis, MN 55455, USA. Tel.: +1 612 624 1479; fax: +1 612 624 3189. (W.N. Robiner)
| | - Trudy D. Strand
- Health Psychology, Department of Medicine, University of Minnesota Medical School, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, 6th Floor East Building, MB681, Minneapolis, MN 55454, USA
| | - Michael Mauer
- Health Psychology, Department of Medicine, University of Minnesota Medical School, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, 6th Floor East Building, MB681, Minneapolis, MN 55454, USA
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Lv J, Perkovic V, Foote CV, Craig ME, Craig JC, Strippoli GFM. Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database Syst Rev 2012; 12:CD004136. [PMID: 23235603 PMCID: PMC11357690 DOI: 10.1002/14651858.cd004136.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Various blood pressure-lowering agents, and particularly inhibitors of the renin-angiotensin system (RAS), are widely used for people with diabetes to prevent the onset of diabetic kidney disease (DKD) and adverse cardiovascular outcomes. This is an update of a Cochrane review first published in 2003 and updated in 2005. OBJECTIVES This systematic review aimed to assess the benefits and harms of blood pressure lowering agents in people with diabetes mellitus and a normal amount of albumin in the urine (normoalbuminuria). SEARCH METHODS In January 2011 we searched the Cochrane Renal Group's Specialised Register through contact with the Trials Search Co-ordinator. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing any antihypertensive agent with placebo or another agent in hypertensive or normotensive patients with diabetes and no kidney disease (albumin excretion rate < 30 mg/d) were included. DATA COLLECTION AND ANALYSIS Two investigators independently extracted data on kidney and other patient-relevant outcomes (all-cause mortality and serious cardiovascular events), and assessed study quality. Analysis was by a random effects model was applied to analyse results which were expressed as risk ratio (RR) and 95% confidence intervals (CI). MAIN RESULTS We identified 26 studies that enrolling 61,264 participants. Angiotensin-converting enzyme inhibitors (ACEi) reduced the risk of new onset of microalbuminuria, macroalbuminuria or both when compared to placebo (8 studies, 11,906 patients: RR 0.71, 95% CI 0.56 to 0.89), with similar benefits in people with and without hypertension (P = 0.74), and when compared to calcium channel blockers (5 studies, 1253 participants: RR 0.60, 95% CI 0.42 to 0.85). ACEi reduced the risk of death when compared to placebo (6 studies, 11,350 participants: RR 0.84, 95% CI 0.73 to 0.97). No effect was observed for angiotensin receptor blockers (ARB) when compared to placebo for new microalbuminuria, macroalbuminuria or both (5 studies, 7653 participants: RR 0.90, 95% CI 0.68 to 1.19) or death (5 studies, 7653 participants: RR 1.12, 95% CI 0.88 to 1.41); however, meta-regression suggested possible benefits from ARB for preventing kidney disease in high risk patients. There was a trend towards benefit from use of combined ACEi and ARB for prevention of DKD compared with ACEi alone (2 studies, 4171 participants: RR 0.88, 95% CI 0.78 to 1.00).The risk of cough was significantly increased with ACEi when compared to placebo (6 studies, 11,791 patients: RR 1.84, 95% CI 1.24 to 2.72), however there was no significant difference in the risk of headache or hyperkalaemia. There was no significant difference in the risk of cough, headache or hyperkalaemia when ARB was to placebo. On average risk of bias was judged to be either low (27% to 69%) or unclear (i.e. no information available) (8% to 73%). Blinding of participants, incomplete outcome data and selective reporting were judged to be high in 23%, 31% and 31% of studies, respectively. AUTHORS' CONCLUSIONS ACEi were found to prevent new onset DKD and death in normoalbuminuric people with diabetes, and could therefore be used in this population. More data are needed to clarify the role of ARB and other drug classes in preventing DKD.
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Affiliation(s)
- Jicheng Lv
- The George Institute for Global HealthRenal and Metabolic DivisionLevel 10, KGV Building, RPAHMissenden RdCamperdownNSWAustralia2050
| | - Vlado Perkovic
- The George Institute for Global HealthRenal and Metabolic DivisionLevel 10, KGV Building, RPAHMissenden RdCamperdownNSWAustralia2050
| | - Celine V Foote
- The George Institute for Global HealthRenal and Metabolic DivisionLevel 10, KGV Building, RPAHMissenden RdCamperdownNSWAustralia2050
| | - Maria E Craig
- University of New South WalesDivison of Women's and Children's HealthSt George HospitalGray StreetKogarahNSWAustralia2025
| | - Jonathan C Craig
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Giovanni FM Strippoli
- The Children's Hospital at WestmeadCochrane Renal Group, Centre for Kidney ResearchWestmeadNSWAustralia2145
- University of BariDepartment of Emergency and Organ TransplantationBariItaly70100
- Mario Negri Sud ConsortiumDepartment of Clinical Pharmacology and EpidemiologySanta Maria ImbaroItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
- DiaverumMedical‐Scientific OfficeLundSweden
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Carroll R, Antigua J, Taichman D, Palevsky H, Forfia P, Kawut S, Halpern SD. Motivations of patients with pulmonary arterial hypertension to participate in randomized clinical trials. Clin Trials 2012; 9:348-57. [PMID: 22388077 DOI: 10.1177/1740774512438981] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is substantial need to rigorously evaluate existing and new therapies for pulmonary arterial hypertension (PAH) and other severe and relatively rare conditions affecting younger patients. However, the ability to conduct meaningful randomized clinical trials (RCTs) in such contexts often is limited by difficulties obtaining adequate patient enrollment. PURPOSE To understand the motivations of patients with PAH for participating in RCTs so as to facilitate enrollment in future trials among patients with similar diseases. METHODS We conducted semistructured interviews of a diverse sample of patients with World Health Organization (WHO) Group I PAH. We purposefully recruited a diverse sample of participants until theoretical saturation was reached. We randomly assigned patients to review hypothetical RCTs that did or did not allow continuation of background PAH therapies and elicited their reasons for or against enrolling. Interviews were transcribed and analyzed using constant comparison techniques to code and sort data into discrete themes. RESULTS The 26 PAH patients enrolled before theoretical saturation was reached identified 24 factors that would influence their RCT enrollment decisions. These factors grouped naturally into four themes: (1) personal medical benefits, (2) personal medical risks/harms, (3) nonmedical benefits, and (4) nonmedical burdens. Personal benefits were cited as commonly as altruistic motives. One third of the patients (9/26) suggested that they would defer enrollment decisions to their treating clinicians. Seventy-nine percent of patients (11/14) assigned to consider trials without background therapies expressed concerns about clinical deterioration (vs. 17% (2/12) among patients assigned to consider trials allowing background therapies). LIMITATIONS The sample was recruited from a single academic center. Furthermore, the use of hypothetical trials may not elicit identical decision-making processes as may be used among patients contemplating actual trial participation. CONCLUSION For PAH patients considering RCT enrollment, the potentials for personal benefit and risk are at least as important as altruistic motives. Minimizing the time demands of participating, financial remuneration, and allowing participants to continue current therapies are factors, which might enhance enrollment to trials in similar disease areas.
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Affiliation(s)
- Ricki Carroll
- Department of Medicine, University of Pennsylvania, Philadelphia, 19104-6021, USA
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