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Lingler JH, Ren D, Tamres LK, Knox ML, Mbawuike U, Williams IC, Robinson RAS, Cameron JL, Terry MH, Garrett M. Mechanisms by which Cultural-Centric Narrative Influences Interest in ADRD Research Among African American Adults. THE GERONTOLOGIST 2022:6955299. [PMID: 36544399 DOI: 10.1093/geront/gnac179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Insufficient ethnoracial diversity is a pervasive challenge in Alzheimer's disease (AD) research. The Recruitment Innovations for Diversity Enhancement (RIDE) is grounded in the premise that culturally informed narratives of research participation can inspire individuals from a given culture-sharing group to consider research enrollment. This study examines factors associated with interest in AD research among Black or African American adults following exposure to RIDE narrative campaign materials. RESEARCH DESIGN AND METHODS A community-based sample of 500 Black or African American adults viewed RIDE narrative materials online and completed a survey of perceptions about research, AD risk, and likelihood of enrolling in AD research. Logistic regression examined predictors and mediators of self-reported likelihood of participating in AD research. RESULTS Most (72%) participants reported interest in being contacted for AD research opportunities. After controlling for key variables, prior experience with clinical research and trust in medical researchers emerged as independent predictors of likelihood of enrolling in AD research. Perceived burden of AD research partially mediated the effects of prior research experience and trust on likelihood of enrollment. Perceived benefits of AD research also played a mediating role, accounting for over one third of the effect of trust on likelihood of enrollment. DISCUSSION AND IMPLICATIONS This study advances the field's understanding of how narrative may function to enhance diversity in AD research. Findings suggest that participant narratives should address experiences regarding the burdens and potential benefits of AD research participation as these factors may influence decisions leading to subsequent research enrollment.
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Affiliation(s)
- Jennifer H Lingler
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh Alzheimer's Disease Research Center, Pittsburgh, Pennsylvania, USA
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lisa K Tamres
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melissa L Knox
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Renã A S Robinson
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Judy L Cameron
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melita H Terry
- University of Pittsburgh Alzheimer's Disease Research Center, Pittsburgh, Pennsylvania, USA
| | - Marita Garrett
- Civically, Inc., Pittsburgh, Pennsylvania, USA.,Graduate School of Public & International Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Li M, Kim H, Sereika SM, Nissley TJ, Lingler JH. Willingness to Participate in Clinical Research Among Individuals With Cognitive Impairment. Res Gerontol Nurs 2022; 15:76-84. [PMID: 35148207 DOI: 10.3928/19404921-20220131-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This secondary analysis examined (1) factors associated with willingness to participate in clinical research for cognitive health among individuals with cognitive impairment and their care partners, and (2) concordance regarding such willingness between individuals with cognitive impairment and their care partners (dyads). Neuropsychological factors and willingness to participate in clinical research were collected using self-reported questionnaires. Participants' sociodemographic and clinical information was extracted from the University of Pittsburgh Alzheimer's Disease Research Center record. Binary logistic regression and Cohen's kappa coefficient analyses were performed. Greater trust in medical researchers (p = 0.031, B = 0.127) and more severe cognitive impairment (p = 0.009, B = -0.289) were associated with willingness to participate in clinical research among individuals with cognitive impairment. Dyadic agreement on willingness to have the individual with cognitive impairment enroll in clinical research was poor to fair (κ = 0.380). Findings suggest that individuals with cognitive impairment with greater trust in health professionals are more likely to agree to clinical research participation. Nurses and other health care providers who counsel individuals with cognitive impairment and their care partners should work to build trusting relationships with participants and be mindful of how increased trust can alter power dynamics between participants and health care professionals. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Götz SC, Marckmann G, Hasford J, Jox RJ. [Critical evaluation of the new legal regulation of pharmaceutical trials with adults who lack decision-making capacity: a survey of human research ethics committees in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 63:465-474. [PMID: 31773175 DOI: 10.1007/s00103-019-03058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Germany, the drug law was revised in 2016 to include new regulations on clinical drug trials with adults who lack decision-making capacity. For the first time, trials with a merely indirect benefit (benefit for other patients with similar characteristics) will be possible if several safeguards are respected. The ethical justification and practicality of this regulation are controversially discussed. OBJECTIVES (1) Eliciting the current pertinent practice of research ethics committees in Germany regarding research with indirect benefit on adults without decision-making capacity; (2) exploring the possibilities and difficulties of implementing the new law. METHODS Semiquantitative, anonymous questionnaire among 249 members of all 53 human research ethics committees in Germany. RESULTS Eighty-four questionnaires were analyzed (response rate 34%). The participants disagreed on assigning research projects to the categories of research with direct benefit to the subject, with an indirect benefit, and without any benefit. Moreover, the criteria of minimum risk and minimum burden were interpreted heterogeneously. More than half of the participants judged the newly introduced research advance directive to be unnecessary, given the legal safeguards in place. The applicability of these directives was doubted because of the strict requirements for anticipatory informed consent and the restricted predictability of future research. CONCLUSION In spite of the new legal regulation, significant ethical uncertainties remain concerning research with indirect benefit on adults without decision-making capacity. It remains an open question whether we need a better explanation of the law, additional legal regulation, practice evaluation, or a completely new law.
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Affiliation(s)
- Sophie-Charlotte Götz
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Joerg Hasford
- Institut für Med. Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Ralf J Jox
- Unité d'Éthique Clinique, Universitätsklinikum Lausanne (CHUV), Universität Lausanne, Lausanne, Schweiz.
- Institut des Humanités en Médecine, Universitätsklinikum Lausanne (CHUV), Universität Lausanne, Avenue de Provence 82, 1007, Lausanne, Schweiz.
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Ries N, Mansfield E, Sanson-Fisher R. Planning Ahead for Dementia Research Participation: Insights from a Survey of Older Australians and Implications for Ethics, Law and Practice. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:415-429. [PMID: 31297689 DOI: 10.1007/s11673-019-09929-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
People with dementia have commonly been excluded from research. The adverse impacts of this exclusion are now being recognized and research literature, position statements, and ethics guidelines increasingly call for inclusion of people with dementia in research. However, few published studies investigate the views of potential participants on taking part in research should they experience dementia-related cognitive impairment. This cross-sectional survey examined the views of people aged sixty and older (n=174) attending hospital outpatient clinics about clinical research participation if they had dementia and impaired decision-making ability. Over 90 percent of respondents were agreeable to participating in a wide range of research activities, such as cognitive testing, physical measurements, imaging procedures, and blood draws. For drug studies, however, agreement dropped to 60 percent. Altruism was a strong motivator for research participation. In regard to who should be involved in decisions about their participation in research during periods of incapacity, respondents mostly preferred the person they appoint as their substitute decision-maker for healthcare matters (88%) or a doctor or health professional on the research team (78%). Over three-quarters (79%) expressed interest in making an advance research directive. The study findings are discussed in relation to law reforms in Australia that aim to strengthen respect and inclusion for people with impaired decision-making capacity, especially by providing frameworks for advance planning for research participation.
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Affiliation(s)
- Nola Ries
- Faculty of Law, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Elise Mansfield
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Lee JY, Crooks RE, Pham T, Korngut L, Patten S, Jetté N, Smith EE, Roach P. "If it helps someone, then I want to do it": Perspectives of persons living with dementia on research registry participation. DEMENTIA 2019; 19:2525-2541. [PMID: 30722693 DOI: 10.1177/1471301219827709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Registries are an important platform to which persons with dementia and other cognitive impairments can contribute to research studies. Registries also provide an opportunity for patients to stay informed about current studies. Engaging patients in registry development can increase sustainability of a registry and patient retention in clinical registries. We sought the perspective of persons with dementia and their accompanying family members about their registry participation experiences, barriers and facilitators to participation, and potential avenues for improvement of registry processes such as recruitment, data collection, and knowledge translation. Two semi-structured focus groups with persons with dementia and their family members (n = 18) were conducted and analyzed using thematic content analysis. Participants were recruited from an existing patient registry made up of patients currently being seen in a dementia assessment clinic. The main themes identified included altruistic motives with regards to registry participation; and access to and privacy of personal health information. As electronic health records are becoming more common, understanding barriers and facilitators from the perspectives of people with dementia is essential to inform the future development of cognitive condition-related registries. The results from our focus groups identified engagement strategies and solutions to overcome perceived barriers for individuals experiencing progressive cognitive decline to participate in longitudinal registry projects.
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Affiliation(s)
- Jeanie Yy Lee
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Rachel E Crooks
- Hotchkiss Brain Institute; Department of Clinical Neurosciences; Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Tram Pham
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - L Korngut
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - S Patten
- Pediatric Mental Health; Department of Community Health Sciences; Department of Psychiatry, University of Calgary, Calgary, Canada
| | - N Jetté
- Hotchkiss Brain Institute; Department of Clinical Neurosciences; Department of Community Health Sciences, University of Calgary, Calgary, Canada; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E E Smith
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Pamela Roach
- Hotchkiss Brain Institute; Department of Clinical Neurosciences; Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Calamia M, Bernstein JPK, Keller JN. I'd Do Anything for Research, But I Won't Do That: Interest in Pharmacological Interventions in Older Adults Enrolled in a Longitudinal Aging Study. PLoS One 2016; 11:e0159664. [PMID: 27438465 PMCID: PMC4954686 DOI: 10.1371/journal.pone.0159664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/05/2016] [Indexed: 12/15/2022] Open
Abstract
Alzheimer’s disease (AD) ranks as the 6th leading cause of death in the United States, yet unlike other diseases in this category, there are no disease-modifying medications for AD. Currently there is significant interest in exploring the benefits of pharmacological treatment before the onset of dementia (e.g., in those with mild cognitive impairment); however, recruitment for such studies is challenging. The current study examined interest in pharmacological intervention trials relative to other types of clinical interventions. A total of 67 non-demented older adults enrolled in a longitudinal cognitive aging study completed a questionnaire assessing interest in participating in a variety of hypothetical research study designs. Consistent with past research, results showed that the opportunities for participants to advance science, receive feedback about their current health, and help themselves or others, were associated with increased interest in clinical trial participation. Some factors were not associated with change in interest (e.g., a doctor not recommending participation) while others were associated with decreased interest (e.g., having to come in for multiple visits each week). Relative to other types of interventions, pharmacological intervention trials were associated with the least interest in participation, despite pharmacological interventions being rated as more likely to result in AD treatment. Decreased interest was not predicted by subjective memory concerns, number of current medications, cardiovascular risk, or beliefs about the likely success of pharmacological treatments. These results highlight the challenges faced by researchers investigating pharmacological treatments in non-demented older individuals, and suggest future research could contribute to more effective ways of recruiting participants in AD-related clinical trials.
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Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
- * E-mail:
| | - John P. K. Bernstein
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Jeffrey N. Keller
- Pennington Biomedical Research Center, Institute for Dementia Research and Prevention, Baton Rouge, Louisiana, United States of America
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Barrio-Cantalejo IM, Simón-Lorda P, Molina-Ruiz A, Herrera-Ramos F, Martínez-Cruz E, Bailon-Gómez RM, López-Rico A, Gorlat PP. Stability over time in the preferences of older persons for life-sustaining treatment. JOURNAL OF BIOETHICAL INQUIRY 2013; 10:103-114. [PMID: 23288442 DOI: 10.1007/s11673-012-9417-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 06/24/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. DESIGN Longitudinal cohort study. SETTING Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. RESULTS 86 percent of the patients did not change preferences. Sex, age, marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. CONCLUSION Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning.
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Hunsaker A, Sarles CE, Rosen D, Lingler JH, Johnson MB, Morrow L, Saxton J. Exploring the reasons urban and rural-dwelling older adults participate in memory research. Am J Alzheimers Dis Other Demen 2011; 26:227-34. [PMID: 21343152 DOI: 10.1177/1533317511399569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines how underrepresented older urban and rural-dwelling individuals conceptualize participation in cognitive impairment studies. Nine focus groups were held with urban and rural-dwelling older adults who had participated in a community-based memory screening study. Expected and experienced benefits of research participation were motivators for study participation in all focus groups. Results indicate that participation in memory research was believed to lead to an understanding of memory function. Focus group participants expressed an active interest in research on dementia, and viewed research participation as a way to address memory concerns and provide a benefit to society.
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Affiliation(s)
- Amanda Hunsaker
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA.
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