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Natale P, Saglimbene V, Ruospo M, Gonzalez AM, Strippoli GF, Scholes-Robertson N, Guha C, Craig JC, Teixeira-Pinto A, Snelling T, Tong A. Transparency, trust and minimizing burden to increase recruitment and retention in trials: a systematic review. J Clin Epidemiol 2021; 134:35-51. [PMID: 33515656 DOI: 10.1016/j.jclinepi.2021.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe patient perspectives on recruitment and retention in clinical trials. STUDY DESIGN AND SETTING Systematic review of qualitative studies that reported the perspective of adult patients with any health condition who accepted or declined to participate in clinical trials. RESULTS Sixty-three articles involving 1681 adult patients were included. Six themes were identified. Four themes reflected barriers: ambiguity of context and benefit - patients were unaware of the research question and felt pressured in making decisions; lacking awareness of opportunities - some believed health professionals obscured trials opportunities, or felt confused because of language barriers; wary of added burden - patients were without capacity because of sickness or competing priorities; and skepticism, fear and mistrust - patients feared loss of privacy, were suspicious of doctor's motivation, afraid of being a guinea pig, and disengaged from not knowing outcomes. Two themes captured facilitators: building confidence - patients hoped for better treatment, were supported from family members and trusted medical staff; and social gains and belonging to the community - altruism, a sense of belonging and peer encouragement motivated participation in trials. CONCLUSION Improving the visibility and transparency of trials, supporting informed decision making, minimizing burden, and ensuring confidence and trust may improve patient participation in trials.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
| | - Valeria Saglimbene
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marinella Ruospo
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Giovanni Fm Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Tom Snelling
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Nielsen ZE, Berthelsen CB. Cancer patients' perceptions of factors influencing their decisions on participation in clinical drug trials: A qualitative meta-synthesis. J Clin Nurs 2019; 28:2443-2461. [PMID: 30673153 DOI: 10.1111/jocn.14785] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/28/2018] [Accepted: 01/13/2019] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To examine cancer patients' perceptions of factors that may influence their decisions on participating in phase I-III clinical drug trials. BACKGROUND The number of cancer participants in clinical drug trials has increased rapidly in Denmark in recent years. The rights, safety and well-being of patients considering participation are protected by the international, ethical and scientific principles. A meta-synthesis was conducted to enable health professionals to support cancer patients who are considering trial participation in accordance with the above principles. DESIGN Meta-synthesis. METHODS A qualitative meta-synthesis, as described by Sandelowski and Barroso, was conducted based on a literature search in PubMed, CINAHL, EMBASE and PsycINFO. Nine reports were found eligible and were included. The PRISMA checklist was used. RESULTS A framework was developed, and patients' perceptions of the factors influencing their decisions were identified, namely patients' perceptions of their relatives, the physician, the hope of therapeutic benefit, altruism, having other options and living with cancer. CONCLUSIONS This study shows that cancer patients' decisions on participation in clinical drug trials are influenced by their perceptions of trust towards the physician, their relatives' attitudes and the consequences participation might have for their families. Patients are motivated to participate due to the hope of therapeutic benefit and for altruistic reasons. The factors influencing their decisions to participate include a cost-benefit consideration, which in turn may be subject to the patient's perception of having other options available besides participation. This may be related to the patient's attitude towards living with cancer, and the decision can be a way of trying to cope with the psychological aspects of living with cancer. RELEVANCE TO CLINICAL PRACTICE The results of this meta-synthesis offer insight into patients' perceptions of what may influence their decisions, and they enable health professionals to support patients making such decisions.
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Affiliation(s)
- Zandra Engelbak Nielsen
- Clinical Research Unit, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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González-Saldivar G, Rodríguez-Gutiérrez R, Viramontes-Madrid JL, Salcido-Montenegro A, Álvarez-Villalobos NA, González-Nava V, González-González JG. Participants' awareness of ethical compliance, safety and protection during participation in pharmaceutical industry clinical trials: a controlled survey. BMC Med Ethics 2019; 20:2. [PMID: 30621692 PMCID: PMC6323663 DOI: 10.1186/s12910-018-0344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid increase of industry-sponsored clinical research towards developing countries has led to potentially complex ethical issues to assess. There is scarce evidence about the perception of these participants about the ethical compliance, security, and protection. We sought to evaluate and contrast the awareness and perception of participants and non-participants of industry-sponsored research trials (ISRT) on ethical, safety, and protection topics. METHODS A Cases-control survey conducted at twelve research sites in México. Previous and current participants of ISRT (cases) as well as non-participants (controls) with one of four chronic diseases, were asked to complete the survey which focused on ethical compliance and protection issues of ISRT, and the perception of participating in a trial. RESULTS A total of 604 cases and 604 controls were surveyed. Cases significantly answered that ethics committees are aware of what is happening in studies (50.5% vs. 33.8%, P = ≤ 0.001), and that medical care of industry-sponsored research trials is better than their usual medical care (77.2% vs. 38.2%, P = < 0.001). The same proportion of cases and controls thought patients must receive economical reimbursement for participating in a research study (49.5% vs. 53.1%, P = 0.205). The informed consent of the pharmaceutical clinical trial was fully read by 90.4% of the cases. Most cases were satisfied or very satisfied with their overall study participation (35.6 and 62.3%, respectively). CONCLUSION Previous and current participants of industry-sponsored research trials have a more positive attitude towards ethics committees, the quality of medical care of the research trials, and the main purpose of economical reimbursements, when compared to non-participants.
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Affiliation(s)
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico.,Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA.,Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Alejandro Salcido-Montenegro
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA.,Clinical Research Unit, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico
| | - Victoria González-Nava
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico.,Clinical Research Unit, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico. .,Clinical Research Unit, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico. .,Servicio de Endocrinología, Departamento de Medicina Interna, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Av. Francisco I. Madero y Av. Gonzalitos s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo León, Mexico.
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González-Saldivar G, Rodríguez-Gutiérrez R, Viramontes-Madrid JL, Salcido-Montenegro A, Carlos-Reyna KEG, Treviño-Alvarez AM, Álvarez-Villalobos NA, González-González JG. Participants' perception of pharmaceutical clinical research: a cross-sectional controlled study. Patient Prefer Adherence 2016; 10:727-34. [PMID: 27199549 PMCID: PMC4857804 DOI: 10.2147/ppa.s96021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is scarce scientific information assessing participants' perception of pharmaceutical research in developed and developing countries concerning the risks, safety, and purpose of clinical trials. METHODS To assess the perception that 604 trial participants (cases) and 604 nonparticipants (controls) of pharmaceutical clinical trials have about pharmaceutical clinical research, we surveyed participants with one of four chronic diseases from 12 research sites throughout Mexico. RESULTS Participation in clinical trials positively influences the perception of pharmaceutical clinical research. More cases (65.4%) than controls (50.7%) perceived that the main purpose of pharmaceutical research is to cure more diseases and to do so more effectively. In addition, more cases considered that there are significant benefits when participating in a research study, such as excellent medical care and extra free services, with this being the most important motivation to participate for both groups (cases 52%, controls 54.5%). We also found a sense of trust in their physicians to deal with adverse events, and the perception that clinical research is a benefit to their health, rather than a risk. More controls believed that clinical trial participants' health is put at risk (57% vs 33.3%). More cases (99.2%) than controls (77.5%) would recommend participating in a clinical trial, and 90% of cases would enroll in a clinical trial again. CONCLUSION Participation in clinical trials positively influences the perception that participants have about pharmaceutical clinical research when compared to nonparticipants. This information needs to be conveyed to clinicians, public health authorities, and general population to overcome misconceptions.
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Affiliation(s)
- Gerardo González-Saldivar
- Ophthalmology Department, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | | | - Alejandro Salcido-Montenegro
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Kevin Erick Gabriel Carlos-Reyna
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Andrés Marcelo Treviño-Alvarez
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Medical Statistics Department, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
- Correspondence: José Gerardo González-González, Endocrinology Division, Hospital Universitario “Dr. José E. González,” Facultad de Medicina, Universidad Autónoma de Nuevo León, Ave Madero y Gonzalitos s/n, Col Mitras Centro, CP 64460 Monterrey, Nuevo León, Mexico, Tel/fax +52 81 8348 3220, Email
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Manders DB, Paulsen A, Richardson DL, Kehoe SM, Miller DS, Lea JS. Factors associated with clinical trial screening failures in gynecologic oncology. Gynecol Oncol 2014; 134:450-4. [DOI: 10.1016/j.ygyno.2014.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 12/26/2022]
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