The challenges of conducting clinical research: one research team's experiences

Conducting Digital Health Care Research: Document Analysis of Challenges Experienced During Intervention Development and Feasibility Study Setup of an Internet-Administered Intervention for Parents of Children Treated for Cancer

Background

The design and conduct of research to develop, test, and evaluate complex health care interventions is challenging. Although the existing literature describes key challenges associated with the design and conduct of definitive (evaluation) trials, there is a lack of information concerning specific challenges associated with the intervention development phase and setup of feasibility studies. In particular, the literature is scarce concerning the challenges associated with conducting digital health care research, such as research on internet-administered interventions and research using digital features to support the execution of study procedures (eg, recruitment, consent, retention, and data collection and management). This study is conducted in the context of the intervention development and feasibility study setup phases of an internet-administered, guided, low-intensity cognitive behavioral therapy–based intervention for parents of children previously treated for cancer.

Objective

The aim of this study is to explore the challenges experienced during the development phase of the internet-administered intervention and digital features to support the execution of the study procedures and a feasibility study setup.

Methods

To explore the key challenges experienced, we conducted a document analysis of written records from all study meetings held by the research team (meeting minutes) between June 7, 2018, and January 10, 2020, guided by a thematic analysis approach. Furthermore, discussion groups with members of the research team were held to develop a more detailed understanding of the key challenges experienced. Methods and results are reported in accordance with the relevant items from the Standards for Reporting Qualitative Research checklist.

Results

Six main themes were identified: decision-making and communication, expertise, external constraints, flexibility, planning and scheduling, and technical constraints.

Conclusions

Significant challenges were experienced during the intervention development and setup phases of the feasibility study. Implications are discussed to inform future design, conduct, and planning of internet-administered intervention development and feasibility studies, especially within the context of digital health care research.

Recruiting for caregiver education research: perspectives of caregivers of people with multiple sclerosis

Caregiver education programs can support participants in a role that is often challenging. Research is needed to determine the effectiveness of these programs; however, recruitment for such studies can be difficult. The objectives of this study were to explore 1) how multiple sclerosis (MS) caregivers respond to recruitment materials for a research study evaluating a caregiver education program, including aspects of the materials that encourage or discourage their interest in participation; and 2) what recommendations MS caregivers have for improving study recruitment advertising. Qualitative interviews were conducted with seven MS caregivers. Participants were asked about their reactions to advertisements for a pilot study intended to evaluate an MS caregiver education program. Participants were also asked to reflect on factors that would influence their decision to participate in the program and to provide suggestions to improve recruitment materials. Data were analyzed using a constant-comparative approach. Study findings indicated that the language and visual design of the advertisements influenced the participants' initial responses. Some caregivers first responded to the fact that the program was part of a research study, and these caregivers had overall negative responses to the advertising, such as concern that the program was being "tested." Other caregivers first considered the personal relevance of the program. These caregivers had neutral-to-positive responses to the flyers and weighed the relevance of the program against the research and logistical aspects. Participants provided recommendations to improve the recruitment materials. While recruiting for caregiver education research can be challenging, piloting recruitment materials and using a variety of advertising options may improve response.

Altruism motivates participation in a therapeutic HIV vaccine trial (CTN 173)

This is the first study examining motivation to participate in an HIV therapeutic vaccine trial of Remune and ALVAC. Trial participants (N=49) completed psychological measures at baseline. While 69% reported some personal risk in participating, 100% felt hopeful for societal benefits. Trial participants also reported high levels of existential well-being (e.g., "I believe there is some real purpose for my life"). Results suggest that HIV therapeutic vaccine trial participants are highly motivated by altruism and that participating in research may contribute meaning to living with HIV. Fostering altruism and responsibly promoting the societal benefits of research may facilitate trial participation.

Participant Characteristics Predicting Voluntary Early Withdrawal from a Multidisciplinary Program Providing Home-Delivered Meals and Dietitian/Social Work Case Management to Homebound Elders

We examine whether baseline characteristics of participants enrolled in a multidisciplinary program providing home-delivered meals and dietitian/social work case management to homebound seniors predicted voluntary early withdrawal. Sixty-nine participants voluntarily withdrew early and 111 completed the project. Six hypotheses were based on a conceptual framework incorporating (1) agreement between project elements and needs/preferences of individuals and (2) whether participants would improve and no longer require or desire the intervention. Three of the hypotheses were supported by means of logistic regression analysis. Voluntary early withdrawers at baseline: (1) were more mobile, (2) ate less often, and (3) responded that food tastes good less often. The results suggest that carefully considering the interaction of potential participant characteristics and project interventions will improve nutrition project retention.

The nurse as principal investigator in a pharmaceutically sponsored drug trial: considerations and challenges

PURPOSE/OBJECTIVES

To discuss the process, considerations, benefits, and challenges of the nurse as principal investigator in a cancer care drug trial.

DATA SOURCES

Published articles, anecdotal experience, and completed research studies.

DATA SYNTHESIS

The specific processes that must be considered are funding sources, protocol development, trial implementation, dissemination of results, and ethical implications involved in industry sponsorship. Specific protocols are designed for evaluating adverse events. Working with pharmaceutical companies to receive financial support offers advantages but poses additional issues for consideration.

CONCLUSIONS

Nurses can serve successfully as principal investigators in medication trials for cancer care. Regulatory bodies and specific procedures, as well as general considerations, mandate and guide investigator conduct when embarking on a pharmaceutical trial.

IMPLICATIONS FOR NURSING

Oncology nurse researchers can look to pharmaceutical companies for potential funding in the evaluation of medications used in cancer care.

UNRECOGNIZED Chronic Dehydration in Older Adults: Examining Prevalence Rate and Risk Factors

Dehydration has serious consequences for older adults, including increased risk of illness or death. This retrospective review of medical records describes the prevalence, assessment, and risk factors for chronic dehydration in 185 older adults who visited an emergency department in June 2000. Results showed chronic dehydration was present in 89 (48%) patients. Physicians documented assessment for signs of dehydration in 23 (26%) of the dehydrated older adults, but no independent assessments for dehydration were recorded by nurses. These findings indicate many older adults may suffer from unrecognized dehydration, and nurses should be alert to the possibility that dehydration may be present in community-dwelling older adults as well as those who live in residential facilities.

Research Ethics, Informed Consent, and Participant Recruitment

PURPOSE/OBJECTIVES

This analysis explores ethical issues and challenges in participant recruitment.

BACKGROUND/RATIONALE

The clinical nurse specialist (CNS) as researcher faces many issues and challenges, including ethical issues of informed consent. Balancing participant expectations of care with the research purpose is often challenging. DESCRIPTION OF THE ANALYSIS: This analysis synthesizes literature in key areas related to participant recruitment. Medline, CINAHL, and hand search techniques were used to collect relevant materials for this analysis.

OUTCOMES

Key issues related to ethics and informed consent included readability of consent documents, education level, relationships between participants and health care providers, therapeutic misconception, and illness severity. Related issues include compensation of participants, recruitment of special populations, and the role of clinical research associate.

INTERPRETATION/CONCLUSIONS

The CNS faces considerable ethical and logistical challenges in any research study. Strategies to support the CNS as researcher are available.

IMPLICATIONS FOR NURSING PRACTICE

Increased awareness of ethical issues and challenges in recruitment is important for the CNS to creatively design strategies to enhance recruitment and retention in research studies.