1
|
Arana-Chicas E, Prisco LMH, Sharma S, Stauffer F, Dauphin S, Ban-Hoefen M, Navarette J, Zittel J, Cupertino AP, Magnuson A, Mustian KM, Mohile SG. Barriers to participation in clinical trials of rural older adult cancer survivors: A qualitative study. J Rural Health 2024. [PMID: 38847392 DOI: 10.1111/jrh.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Currently, 64% of cancer survivors are aged 65+. Older cancer survivors have unique complications after chemotherapy and are often excluded from cancer clinical trials. Although there is research on barriers to clinical trial participation of older adult cancer survivors, to date no research has explored barriers to clinical trial participation unique to rural older adult cancer survivors. METHODS This study is a secondary qualitative analysis from a study exploring survivorship challenges of rural older adults. Eligible participants were rural residents over age 65 who have completed curative-intent chemotherapy in the past 12 months. Participants (n = 27) completed open-ended semi-structured interviews that included questions on barriers to clinical trial participation. Transcripts were coded independently by two coders using thematic analysis. We have adhered to the standards for reporting qualitative research. FINDINGS Participants reported a variety of barriers that included limited knowledge and fear about clinical trials, transportation challenges, their physicians not informing them of clinical trials, and thinking they are too old to participate in clinical trials. However, participants also reported facilitators to participating in clinical trials, including acknowledging benefits to their own health and society, and understanding the importance of clinical trials. CONCLUSION Rural older cancer survivors face numerous interpersonal, intrapersonal, and organizational barriers to clinical trial participation. Aging- and location-sensitive interventions that focus on patients, their caregivers, and health care providers may lead to improved participation of rural older adult survivors into clinical trials.
Collapse
Affiliation(s)
- Evelyn Arana-Chicas
- Division of Medical Oncology, Rutgers Cancer Institute of NJ, Rutgers University, New Brunswick, New Jersey, USA
| | - Laura M Hincapie Prisco
- Geriatric Oncology Research Group, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Saloni Sharma
- Geriatric Oncology Research Group, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Fiona Stauffer
- Geriatric Oncology Research Group, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Makiko Ban-Hoefen
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Jason Zittel
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ana Paula Cupertino
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Allison Magnuson
- Geriatric Oncology Research Group, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Division of Hematology/Oncology, Rochester, New York, USA
| | - Karen M Mustian
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Division of Hematology/Oncology, Rochester, New York, USA
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|
2
|
Miyata BL, Tafuto B, Jose N. Methods and perceptions of success for patient recruitment in decentralized clinical studies. J Clin Transl Sci 2023; 7:e232. [PMID: 38028356 PMCID: PMC10643920 DOI: 10.1017/cts.2023.643] [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: 03/30/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Patient recruitment, diversity, and retention continue to impede successful and representative clinical studies. This systematic review aims to assess the impact of decentralized methods on recruitment, retention, and diversity in recent clinical studies. A systematic search of literature reporting on recruitment in decentralized clinical studies was performed. Studies were reviewed for those reporting the primary outcome of recruitment in decentralized clinical trials, observational studies, or those covering the topic of clinical trials. Secondary outcomes included retention, participant diversity, and participant satisfaction. This systematic search returned 13 studies highlighting the role of decentralized methods impacting participant recruitment, retention, and diversity in clinical studies. Eleven reported improved recruitment using decentralized methods. Seven of these reported improvements directly compared to traditional methods. Seven studies reported positive retention outcomes, with four directly comparing decentralized methods with traditional methods. Six studies were reported to have trended toward increased diversity in the demographics of the sample population, including race or geographic location. Related reviews have stated a lack of published comparable data to determine if decentralized clinical methods improved recruitment and retention. Results suggest this review addresses such a gap, providing data on how decentralized methods such as virtual visits can positively impact recruitment and retention.
Collapse
Affiliation(s)
- Brian L. Miyata
- New Jersey Alliance for Clinical and Translational Science, Newark, NJ, USA
| | - Barbara Tafuto
- New Jersey Alliance for Clinical and Translational Science, Newark, NJ, USA
- Rutgers School of Health Professions, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Nadina Jose
- New Jersey Alliance for Clinical and Translational Science, Newark, NJ, USA
- Rutgers School of Health Professions, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| |
Collapse
|
3
|
Johnson E, Marsh L. Clinical research nurse utilisation and role in the conduct of decentralised clinical trials: a literature review. J Res Nurs 2023; 28:214-226. [PMID: 37332317 PMCID: PMC10272696 DOI: 10.1177/17449871231162497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background The decentralised clinical trial (DCT) model has been popularised given its remote or virtual design, permitting expanded participant enrolment into community settings. Clinical research nurses (CRNs) are specially trained in the management of clinical trials; however, the utilisation of the research nurse role relating to decentralised trial conduct is not well-established. Aims A literature review was conducted to describe the role of the research nurse in the conduct of DCTs and the current utilisation of this nurse specialty for decentralised trial management. Methods Use of keywords 'DCT' or 'virtual trial' and 'nursing' were used to identify full-text, peer-reviewed literature in the English language and published within the last 10 years that described the clinical research nursing role. Results Of the 102 pre-screened articles identified across five databases, 11 articles were eligible for full-text analysis. Thematic groupings of common discussion elements included Variance in Decentralised Clinical Trial Model Implementation, CRN Involvement in Decentralised Trial Conduct and Reporting and Shared Challenges of Decentralised Trial Implementation Affecting the CRN Role. Conclusions Implications of this literature review include expanded trial sponsor awareness of the support requirements to facilitate research nurse utilisation and optimal decentralised trial conduct.
Collapse
Affiliation(s)
- Elizabeth Johnson
- Assistant Professor, Mark & Robyn Jones College of Nursing, Montana State University, Bozeman, MT, USA
| | - Lisa Marsh
- Adjunct Faculty, Buntain College of Nursing, Northwest University, Kirkland, WA, USA
| |
Collapse
|
5
|
Kron J, Crawford T, Mihalick V, Bogun F, Jordan JH, Koelling T, Syed H, Syed A, Iden T, Polly K, Federmann E, Bray K, Lathkar-Pradhan S, Jasti S, Rosenfeld L, Birnie D, Smallfield M, Kang L, Fowler AB, Ladd A, Ellenbogen K, Van Tassell B, Gregory Hundley W, Abbate A. Interleukin-1 blockade in cardiac sarcoidosis: study design of the multimodality assessment of granulomas in cardiac sarcoidosis: Anakinra Randomized Trial (MAGiC-ART). J Transl Med 2021; 19:460. [PMID: 34749739 PMCID: PMC8575149 DOI: 10.1186/s12967-021-03130-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sarcoidosis is an inflammatory disease characterized by the formation of granulomas, which involve the heart in up to 25% of patients. Cardiac sarcoidosis can lead to life threatening arrhythmias and heart failure. While corticosteroids have been used as a treatment for over 50 years, they are associated with hypertension, diabetes, and weight gain, further increasing cardiovascular risk. Interleukin-1 (IL-1) is the prototypical proinflammatory cytokine that works to activate the nuclear transcription factor NF-kB, one of the targets of glucocorticoids. IL-1 also plays an important role also in the pathophysiology of heart disease including atherosclerosis, myocardial infarction, and myocarditis. METHODS Building on a network of research collaborators developed in the Cardiac Sarcoidosis Consortium, we will investigate the feasibility and tolerability of treatment of CS with anakinra at two National Institute of Health Clinical and Translational Science Award (CTSA) hubs with expertise in cardiac sarcoidosis. In this pilot study, up to 28 patients with cardiac sarcoidosis will be recruited to compare the administration of an IL-1 blocker, anakinra, 100 mg daily on top of standard of care versus standard of care only for 28 days and followed for 180 days. Utilizing surrogate endpoints of changes in systemic inflammatory biomarkers and cardiac imaging, we aim to determine whether IL-1 blockade with anakinra can combat systemic and cardiac inflammation in patients with cardiac sarcoidosis. DISCUSSION The current trial demonstrates an innovative collaborative approach to clinical trial development in a rare, understudied disease that disproportionately affects females and minorities. Trial Registration The trial was registered prospectively with ClinicalTrials.gov on July 12, 2019, identifier NCT04017936.
Collapse
Affiliation(s)
- Jordana Kron
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA.
| | - Thomas Crawford
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Virginia Mihalick
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA
| | - Frank Bogun
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer H Jordan
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA.,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Todd Koelling
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Huzaefah Syed
- Division of Rheumatology, Virginia Commonwealth University, Allergy, and Immunology, Richmond, VA, USA
| | - Aamer Syed
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Iden
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Kelly Polly
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Emily Federmann
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA
| | - Kirsta Bray
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Shilpa Jasti
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA
| | - Lynda Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - David Birnie
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Melissa Smallfield
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Alpha Berry Fowler
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA, USA
| | - Amy Ladd
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA
| | - Kenneth Ellenbogen
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA
| | - Benjamin Van Tassell
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA.,Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - W Gregory Hundley
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, P.O. Box 980053, Richmond, VA, 23298-0053, USA.,Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|