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Napier MP, Selvan K, Hayeems RZ, Shuman C, Chitayat D, Sutherland JE, Day MA, Héon E. Gene therapy: perspectives from young adults with Leber's congenital amaurosis. Eye (Lond) 2022; 36:2088-2093. [PMID: 34531550 PMCID: PMC9581997 DOI: 10.1038/s41433-021-01763-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 11/08/2022] Open
Abstract
AIMS/PURPOSE To investigate Leber congenital amaurosis (LCA) patients' expectations, decision-making processes and gene therapy-related concerns. METHODS Using a qualitative approach, we explored perceptions of gene therapy and clinical trials among individuals with LCA. Young adults with a clinical diagnosis of LCA were recruited through the Ocular Genetics Programme at the Hospital for Sick Children. Semi-structured interviews were conducted with ten patients and analysed following the principles of qualitative description. RESULTS Study participants were aware of ongoing gene therapy research trials and actively sought information regarding advances in ophthalmology and vision restoration. The majority of participants would enrol or were enrolled in a gene-replacement therapy trial, while a minority was ambivalent or would not enrol if provided an opportunity. Participants attributed different values to clinical trials, which influenced their willingness to participate. Intrinsic factors related to coping, adaptation to vision loss and resilience also influenced decision-making. DISCUSSION This study highlights the complex factors involved in gene-therapy-related decision-making and acts as a proponent for adopting patient-centred care strategies when counselling individuals considering gene therapy or clinical trial participation.
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Affiliation(s)
- Melanie P Napier
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, ON, Canada
| | - Kavin Selvan
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robin Z Hayeems
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Child Health Evaluative Sciences (CHES) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cheryl Shuman
- Department of Pediatrics, Division of Clinical Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - David Chitayat
- Department of Pediatrics, Division of Clinical Genetics, The Hospital for Sick Children, Toronto, ON, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Joanne E Sutherland
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Megan A Day
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elise Héon
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Gray TF, Allgood SJ, Nolan MT, Gallo JJ, Han HR, Clayman ML, Budhathoki C, Lansey DG, Wenzel J. "It All Depends": Patient and Decision Partner Experiences in Cancer Clinical Trial Decision-Making. QUALITATIVE HEALTH RESEARCH 2022; 32:887-901. [PMID: 35343318 DOI: 10.1177/10497323221083355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
While the supporting role of families and friends has been widely recognized in cancer care, little data exist on how they influence patients' decisions regarding clinical trial participation, accounting for patients' decisional preferences. The goal of our study was to examine the process of clinical trial decision-making from the perspective of adults with cancer and their decision partners. Semi-structured interviews were conducted with 12 patients and 12 decision partners-family and friends engaged in the medical decision-making. Themes included: (1) having the ability and confidence to make decisions; (2) gaining insight about clinical trials; (3) trusting someone in the process; and (4) realizing readiness and context. Our findings will enhance understanding of how patients make clinical trial decisions based on decisional preferences from the perspectives of patients and decision partners. The findings may also help to increase clinician awareness and inclusion of decision partners in conversations regarding clinical trials.
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Affiliation(s)
- Tamryn F Gray
- 1855Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Marie T Nolan
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Joseph J Gallo
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hae-Ra Han
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marla L Clayman
- 560937Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Bedford, MA, USA
| | | | - Dina G Lansey
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer Wenzel
- 15851Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Oncology, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
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Noirmain C, Gil-Wey B, Pichon I, Brindel P, Haller G. Factors associated with patient willingness to participate in anaesthesia clinical trials: a vignette-based cross-sectional study. BMC Med Res Methodol 2020; 20:67. [PMID: 32192447 PMCID: PMC7082904 DOI: 10.1186/s12874-020-00949-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Clinical trials are essential to improve knowledge of anesthesia and perioperative medicine. Unfortunately, many studies face participant-recruitment issues and fail to include the planned number of participants. There is limited published data about how information delivered about the study or how the experiences and attitudes of prospective participants influence willingness to participate. The purpose of this study was to identify such factors in the domain of anesthesia care. Methods We performed a cross-sectional study at the Geneva University Hospitals (Switzerland) using a newly developed paper-based questionnaire on a sample of outpatients with a recent hospital stay and that were aged over 18 years, confident speaking French and free of any disease that could hinder participation. We explored patient personal factors, such as current health, past exposure to clinical research and anesthesia, as well as study-related factors. Six different scenarios for clinical studies were assessed. Linear regression modeling was used to assess the specific association between personal and study-related factors and willingness to participate in the studies described in the scenarios. Results On the 1318 eligible patients, 398 fully completed the questionnaire. Multivariable adjustment revealed that factors related to altruistic values (β, 9.6, 95% CI 3.4 to 15.7, P = 0.002), to the feeling of benefiting from a more effective treatment (β, 4.7, 95% CI 0.2 to 9.2, P = 0.041) and to the absence of fear about double blinding (β, 5.7, 95% CI 1.3 to 10.2, P = 0.012) were positively associated with willingness to participate. Conversely, concerns about drug-related adverse effects (β, − 11.7, 95% CI − 16.9 to − 6.5, P < 0.001) and anxiety about surgery (β, − 5.2, 95% CI − 10.0 to − 0.5, P = 0.031) were negatively associated with willingness to participate. Conclusion Our study was based on vignettes illustrating typical scenarios of clinical trials performed in anesthesia. However, their similarities with real studies still remains hypothetical and our results should be interpreted as such. Nevertheless, the study contributes to improve understanding of factors that may act as incentives or barriers to participation in clinical trials. It highlights the importance of providing appropriate information and reassurance to patients.
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Affiliation(s)
- Caroline Noirmain
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland
| | - Béatrice Gil-Wey
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland
| | - Isabelle Pichon
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland
| | - Pauline Brindel
- Clinical Research Center and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Guy Haller
- Division of Anesthesia, Department of Acute Care Medicine, Geneva University Hospitals and Faculty of Medicine University of Geneva, Rue Perret-Gentil 4, Geneva, Switzerland. .,Health Services Management and Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic 3004, Australia.
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Uveges MK, Lansey DG, Mbah O, Gray T, Sherden L, Wenzel J. Patient navigation and clinical trial participation: A randomized controlled trial design. Contemp Clin Trials Commun 2018; 12:98-102. [PMID: 30364638 PMCID: PMC6197623 DOI: 10.1016/j.conctc.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/07/2018] [Accepted: 09/18/2018] [Indexed: 11/05/2022] Open
Abstract
Background To our knowledge, no published studies utilizing a randomized controlled design have examined the efficacy of patient navigation for improving clinical trial enrollment. Methods This patient navigation and clinical trial participation study is a randomized controlled trial to assess the effect of a patient navigator on enrollment into therapeutic cancer clinical trials. Participants are randomly assigned to high intensity, patient navigator-delivered patient educational materials (PEM) and needs assessment vs. low intensity patient navigation (patient navigator-delivered patient educational materials [PEM] alone). Discussion: Effective enrollment strategies may include utilization of patient navigators as away to meet individual needs, barriers, and concerns of participants enrolled in clinical trials.
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Affiliation(s)
- Melissa Kurtz Uveges
- Harvard Medical School, Center for Bioethics, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Dina George Lansey
- Department of Oncology, Johns Hopkins School of Medicine, 1600 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Olive Mbah
- The University of North Carolina at Chapel Hill, School of Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Tamryn Gray
- Dana-Farber/Harvard Cancer Center, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Lisa Sherden
- Department of Oncology, Johns Hopkins School of Medicine, 1600 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Jennifer Wenzel
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
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Factors affecting patient participation in clinical trials in Ireland: A narrative review. Contemp Clin Trials Commun 2016; 3:23-31. [PMID: 29736453 PMCID: PMC5935836 DOI: 10.1016/j.conctc.2016.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/11/2016] [Accepted: 01/20/2016] [Indexed: 11/24/2022] Open
Abstract
Objective Clinical trials have long been considered the ‘gold standard’ of research generated evidence in health care. Patient recruitment is an important determinant in the success of the trials, yet little focus is placed on the decision making process of patients towards recruitment. Our objective was to identify the key factors pertaining to patient participation in clinical trials, to better understand the identified low participation rate of patients in one clinical research facility within Ireland. Design Narrative literature review of studies focussing on factors which may act to facilitate or deter patient participation in clinical trials. Studies were identified from Medline, PubMed, Cochrane Library and CINAHL. Results Sixty-one studies were included in the narrative review: Forty-eight of these papers focused specifically on the patient's perspective of participating in clinical trials. The remaining thirteen related to carers, family and health care professional perspectives of participation. The primary factor influencing participation in clinical trials amongst patients was related to personal factors and these were collectively associated with obtaining a form of personal gain through participation. Cancer was identified as the leading disease entity included in clinical trials followed by HIV and cardiovascular disease. Conclusion The vast majority of literature relating to participation in clinical trials emanates predominantly from high income countries, with 63% originating from the USA. No studies for inclusion in this review were identified from low income or developing countries and therefore limits the generalizability of the influencing factors.
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Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients' relational autonomy. Support Care Cancer 2015; 23:1169-96. [PMID: 25591627 DOI: 10.1007/s00520-014-2581-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Oncology clinical trials are necessary for the improvement of patient care as they have the ability to confirm the efficacy and safety of novel cancer treatments and in so doing, contribute to a solid evidence base on which practitioners and patients can make informed treatment decisions. However, only 3-5 % of adult cancer patients enroll in clinical trials. Lack of participation compromises the success of clinical trials and squanders an opportunity for improving patient outcomes. This literature review summarizes the factors and contexts that influence cancer patient decision making related to clinical trial participation. METHODS An integrative review was undertaken within PubMed, CINAHL, and EMBASE databases for articles written between 1995 and 2012 and archived under relevant keywords. Articles selected were data-based, written in English, and limited to adult cancer patients. RESULTS In the 51 articles reviewed, three main types of factors were identified that influence cancer patients' decision making about participation in clinical trials: personal, social, and system factors. Subthemes included patients' trust in their physician and the research process, undue influence within the patient-physician relationship, and systemic social inequalities. How these factors interact and influence patients' decision-making process and relational autonomy, however, is insufficiently understood. CONCLUSIONS Future research is needed to further elucidate the sociopolitical barriers and facilitators of clinical trial participation and to enhance ethical practice within clinical trial enrolment. This research will inform targeted education and support interventions to foster patients' relational autonomy in the decision-making process and potentially improve clinical trial participation rates.
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Luzurier Q, Damm C, Lion F, Daniel C, Pellerin L, Tavolacci MP. Strategy for recruitment and factors associated with motivation and satisfaction in a randomized trial with 210 healthy volunteers without financial compensation. BMC Med Res Methodol 2015; 15:2. [PMID: 25559410 PMCID: PMC4293827 DOI: 10.1186/1471-2288-15-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/23/2014] [Indexed: 11/22/2022] Open
Abstract
Background The aim was to describe a strategy for recruitment of healthy volunteers (HV) to a randomized trial that assessed the efficacy of different telephone techniques to assist HV in performing cardiac massage for vital emergency. Participation in the randomized trial was not financially compensated, however HV were offered emergency first-aid training. We also studied factors associated with HV motivation and satisfaction regarding participation in the trial. Methods Strategy for recruitment of 210 HV aged 18 to 60 years was based on: (1) the updated records of all telephone number since January 2000 of HV registered in the Rouen Clinical Investigation Centre HV database, (2) a communication campaign for the general public focussing on posters and media advertisements. Data on the recruitment, socio-demographics, motivation and satisfaction of the 210 HV were collected by anonymous self-administered questionnaire. Results Of the 210 HV included, 63.3% (n = 133) were recruited from the HV database and 36.7% (n = 77) by the communication campaign. On the one hand, the HV database enabled screening of 1315 HV, 54.8% (n = 721) of whom were reached by phone, 55.2% (n = 398) of these latter accepted to participate in the study and 10.1% of the initial screening (n = 133) were finally included. One the other hand, for the 77 HV not recruited from the HV database, word-of-mouth (56.1%) was the main means of recruitment. The male/female ratio of the 210 HV was 0.5 and mean age 43.5 years (Standard Deviation = 12.4). The main motivations given for participating in the trial were to support research (87.6%) and receive emergency first-aid training (85.7%). Overall satisfaction with the welcome process was significantly higher for older HV (46–60 years) (adjusted odds ratio (AOR): 3.44; 95% confidence interval (95% CI): 1.48-7.99), and for HV in management jobs (AOR: 4.26; 95% CI: 1.22-14.87). Satisfaction with protocol management was higher for women (AOR: 2.33; 95% CI: 1.18-4.60) and for older HV (46–60 years) (AOR: 4.76; 95% CI: 1.97-11.52). Conclusions Recruitment of non-compensated HV required broad screening with a primary HV database alongside word-of-mouth communication which seemed more efficient than media advertising. To enhance HV recruitment to randomized trials without financial compensation it seems crucial to provide them not only with a direct interest but also to ensure their satisfaction.
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Affiliation(s)
| | | | | | | | | | - Marie-Pierre Tavolacci
- Rouen University Hospital, Clinical Investigation Centre - Biological Resource Centre, CIC-CRB, Inserm 1404, 1 rue de Germont, F 76031 Rouen Cedex, France.
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Wiernik PH. Update: APOR. Clin Transl Sci 2011; 4:399. [DOI: 10.1111/j.1752-8062.2011.00359.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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