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Weiss EM, Donohue PK, Wootton SH, Stevens E, Merhar SL, Puia-Dumitrescu M, Mercer A, Oslin E, Porter KM, Wilfond BS. Motivations for and against Participation in Neonatal Research: Insights from Interviews of Diverse Parents Approached for Neonatal Research in the US. J Pediatr 2024:113923. [PMID: 38492913 DOI: 10.1016/j.jpeds.2024.113923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To describe parents' motivations for and against participation in neonatal research, including the views of those who declined participation. STUDY DESIGN We performed 44 semi-structured, qualitative interviews of parents approached for neonatal research. Here we describe their motivations for and against participation. RESULTS Altruism was an important reason parents chose to participate. Some hoped participation in research would benefit their infant. Burdens of participation to the family, such as transportation to follow up (distinct from risks/burdens to the infant), were often deciding factors among those who declined participation. Perceived risks to the infant were reasons against participation, but parents often did not differentiate between baseline risks and incremental risk of study participation. Concerns regarding their infant being treated like a "guinea pig" were common among those who declined. Finally, historical abuses and institutional racism were reported as important concerns by some research decliners from minoritized populations. CONCLUSIONS Within a diverse sample of parents approached to enroll their infant in neonatal research, motivations for and against participation emerged, which may be targets of future interventions. These motivations included reasons for participation which we may hope to encourage, such as altruism. They also included reasons against participation, which we may hope to, as feasible, eliminate, mitigate, or at least acknowledge. These findings can help clinical trialists, regulators, and funders attempting to improve neonatal research recruitment processes.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan H Wootton
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Emily Stevens
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX; Children's Memorial Hermann Hospital, Houston, TX
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati OH and Department of Pediatrics, University of Cincinnati College of Medicine
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Amanda Mercer
- Counselor Education Department, Portland State University, Portland, Oregon
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Nathe JM, Oskoui TT, Weiss EM. Parental Views of Facilitators and Barriers to Research Participation: Systematic Review. Pediatrics 2023; 151:e2022058067. [PMID: 36477217 PMCID: PMC9808610 DOI: 10.1542/peds.2022-058067] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Low enrollment within pediatric research increases the cost of research, decreases generalizability, and threatens to exacerbate existing health disparities. To assess barriers and facilitators to pediatric research participation and evaluate differences by enrollment status. METHODS Data Sources include PubMed, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. Study selection include peer reviewed articles that contained information related to facilitators and barriers to the parental decision whether to enroll their child in research and included the views of parents who declined. We extracted barriers and facilitators to research, enrollment status, and study characteristics, including study design, quality, and patient population. RESULTS Seventy articles were included for analysis. Facilitators of participation included: benefits, trust, support of research, informational and consent related, and relational issues. Common facilitators within those categories included health benefit to child (N = 39), altruism (N = 30), and the importance of research (N = 26). Barriers to participation included: study-related concerns, burdens of participation, lack of trust, general research concerns, informational and consent related, and relational issues. Common barriers within those categories included risks to child (N = 46), burdens of participation (N = 35), and the stress of the decision (N = 29). We had a limited ability to directly compare by enrollment status and no ability to analyze interactions between facilitators and barriers. We only included studies written in English. CONCLUSIONS This review identified key facilitators and barriers to research participation in pediatrics. The findings from this review may guide researchers aiming to create interventions to improve the parental experience of recruitment for pediatric studies and to optimize enrollment rates.
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Affiliation(s)
- Julia M. Nathe
- University of Washington School of Medicine, Seattle, Washington
| | - Tira T. Oskoui
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Elliott Mark Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
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Ursin L, Ytterhus B, Christensen E, Skolbekken JA. «If you give them your little finger, they'll tear off your entire arm»: losing trust in biobank research. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:565-576. [PMID: 32734531 PMCID: PMC7538395 DOI: 10.1007/s11019-020-09969-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Why do some people withdraw from biobank studies? To our knowledge, very few studies have been done on the reflections of biobank ex-participants. In this article, we report from such a study. 16 years ago, we did focus group interviews with biobank participants and ex-participants. We found that the two groups interestingly shared worries concerning the risks involved in possible novel uses of their biobank material, even though they drew opposite conclusions from their worries. Revisiting these interviews today reveals a remarkable relevance to present concerns, since the possible developments that worried ex-participants and participants 16 years ago now are becoming realities. Drawing on conceptual distinctions by sociologist and philosopher Niklas Luhmann, we argue that while ex-participants express a loss of trust in the biobank institution to manage the use of their biobank material in a legitimate way, remaining participants expressed confidence in the management of the biobank institution to secure their interests. This analysis brings out important aspects of emerging trends in biobank research participation.
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Affiliation(s)
- Lars Ursin
- Department of Philosophy and Religious Studies, NTNU, 7491, Trondheim, Norway.
| | - Borgunn Ytterhus
- Department of Public Health and Nursing, NTNU, 7491, Trondheim, Norway
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Mancera BM, Mungal AS, De Santis J, Provencio-Vasquez E. Accessing and Recruiting a Community-Based Sample of Men of Mexican Origin to Explore Intimate Partner Violence. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:1540415318803950. [PMID: 30278782 DOI: 10.1177/1540415318803950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Vulnerable populations are at greater risk for the burden of disease and negative health outcomes including alcohol abuse, high-risk sexual behavior, and intimate partner violence (IPV). Moreover, health disparities experienced by vulnerable populations are mediated by socioeconomic, ethnic, and racial factors. Risk factors for IPV perpetration are exacerbated by cultural and gender norms, particularly among men of Mexican origin. PURPOSE To discuss research methods used in a community-based sample of men of Mexican origin and ways to overcome recruitment barriers through community engaged approaches. DISCUSSION Barriers can impede sampling, recruitment, and enrollment of vulnerable populations (e.g., IPV) but can be overcome. Strategies include: qualitative research methods, identifying key informants, and community engagement approaches, such as listening to the concerns of the community, incorporating the community's knowledge to inform and improve the study, and building rapport to establish trust. CONCLUSION Conducting research within vulnerable populations can be challenging but can be mitigated by incorporating multiple strategies. Thus, allowing researchers to gain access and valuable insight into traditionally underrepresented and understudied populations.
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Lernmark B, Lynch K, Baxter J, Roth R, Simell T, Smith L, Swartling U, Johnson SB, TEDDY Study Group. Participant Experiences in the Environmental Determinants of Diabetes in the Young Study: Common Reasons for Withdrawing. J Diabetes Res 2015; 2016:2720650. [PMID: 26682228 PMCID: PMC4670659 DOI: 10.1155/2016/2720650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/02/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To characterize participant reasons for withdrawing from a diabetes focused longitudinal clinical observational trial (TEDDY) during the first three study years. METHODS 8677 children were recruited into the TEDDY study. At participant withdrawal staff recorded any reason parents provided for withdrawal. Reasons were categorized into (1) family characteristics and (2) protocol reasons. Families who informed staff of their withdrawal were classified as active withdrawals (AW); families without a final contact were considered passive withdrawals (PW). RESULTS Withdrawal was highest during the first study year (n = 1220). Most families were AW (n = 1549; 73.4%). PW was more common in the United States (n = 1001; 37.8%) and among young mothers (p = 0.001). The most frequent protocol characteristic was blood draw (55%) and the most common family reason was not having enough time (66%). The blood draw was more common among female participants; being too busy was more common among males. Both reasons were associated with study satisfaction. CONCLUSIONS Results suggest that, for families of children genetically at risk for diabetes, procedures that can be painful/frightening should be used with caution. Study procedures must also be considered for the demands placed on participants. Study satisfaction should be regularly assessed as an indicator of risk for withdrawal.
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Affiliation(s)
- Barbro Lernmark
- Department of Clinical Sciences, Lund University, CRC, Jan Waldenströms Gata 35, Skåne University Hospital (SUS), 20502 Malmö, Sweden
| | - Kristian Lynch
- Health Informatics Institute, University of South Florida, 3650 Spectrum Boulevard, Suite 100, Tampa, FL 33612, USA
| | - Judith Baxter
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Denver-AMC, 1775 Aurora Court, Aurora, CO 80045, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, University of Colorado Denver-AMC, 13001 E. 17th Place, Aurora, CO 80045, USA
| | - Roswith Roth
- Institute of Diabetes Research, Helmholtz Center Munich and Clinic on the right of Isar, Technical University Munich, Research Group Diabetes e.V., Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Tuula Simell
- Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8, 20100 Turku, Finland
| | - Laura Smith
- Health Informatics Institute, University of South Florida, 3650 Spectrum Boulevard, Suite 100, Tampa, FL 33612, USA
| | - Ulrica Swartling
- Department of Clinical Sciences, Lund University, CRC, Jan Waldenströms Gata 35, Skåne University Hospital (SUS), 20502 Malmö, Sweden
| | - Suzanne Bennett Johnson
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, 1115 West Call Street, Tallahassee, FL 32306, USA
| | - TEDDY Study Group
- Department of Clinical Sciences, Lund University, CRC, Jan Waldenströms Gata 35, Skåne University Hospital (SUS), 20502 Malmö, Sweden
- Health Informatics Institute, University of South Florida, 3650 Spectrum Boulevard, Suite 100, Tampa, FL 33612, USA
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Denver-AMC, 1775 Aurora Court, Aurora, CO 80045, USA
- Institute of Diabetes Research, Helmholtz Center Munich and Clinic on the right of Isar, Technical University Munich, Research Group Diabetes e.V., Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
- Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8, 20100 Turku, Finland
- Pacific Northwest Diabetes Research Institute, 720 Broadway, Seattle, WA 98122, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Georgia Regents University, 1120 15th Street, CA-4123, Augusta, GA 30912, USA
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Overby CL, Maloney KA, Alestock TD, Chavez J, Berman D, Sharaf RM, Fitzgerald T, Kim EY, Palmer K, Shuldiner AR, Mitchell BD. Prioritizing Approaches to Engage Community Members and Build Trust in Biobanks: A Survey of Attitudes and Opinions of Adults within Outpatient Practices at the University of Maryland. J Pers Med 2015. [PMID: 26226006 PMCID: PMC4600147 DOI: 10.3390/jpm5030264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Achieving high participation of communities representative of all sub-populations is needed in order to ensure broad applicability of biobank study findings. This study aimed to understand potentially mutable attitudes and opinions commonly correlated with biobank participation in order to inform approaches to promote participation in biobanks. Methods: Adults from two University of Maryland (UMD) Faculty Physicians, Inc. outpatient practices were invited to watch a video and complete a survey about a new biobank initiative. We used: Chi-square to assess the relationship between willingness to join the biobank and participant characteristics, other potentially mutable attitudes and opinions, and trust in the UMD. We also used t-test to assess the relationship with trust in medical research. We also prioritize proposed actions to improve attitudes and opinions about joining biobanks according to perceived responsiveness. Results: 169 participants completed the study, 51% of whom indicated a willingness to join the biobank. Willingness to join the biobank was not associated with age, gender, race, or education but was associated with respondent comfort sharing samples and clinical information, concerns related to confidentiality, potential for misuse of information, trust in UMD, and perceived health benefit. In ranked order, potential actions we surveyed that might alleviate some of these concerns include: increase chances to learn more about the biobank, increase opportunities to be updated, striving to put community concerns first, including involving community members as leaders of biobank research, and involving community members in decision making. Conclusions: This study identified several attitudes and opinions that influence decisions to join a biobank, including many concerns that could potentially be addressed by engaging community members. We also demonstrate our method of prioritizing ways to improve attitudes and opinions about joining a biobank according to perceived responsiveness.
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Affiliation(s)
- Casey Lynnette Overby
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
- Center for Health-related Informatics and Bioimaging, University of Maryland, Baltimore, MD 21201, USA.
| | - Kristin A Maloney
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Tameka DeShawn Alestock
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Justin Chavez
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
- University of Maryland, Baltimore County, Baltimore, MD 21250, USA.
| | - David Berman
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
- King's College London, London WC2R 2LS, UK.
| | - Reem Maged Sharaf
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Tom Fitzgerald
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Eun-Young Kim
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan 614-735, Korea.
| | - Kathleen Palmer
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Alan R Shuldiner
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Braxton D Mitchell
- Program in Personalized & Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
- Geriatric Research and Education Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD 21201, USA.
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Swartling U, Helgesson G, Ludvigsson J, Hansson MG, Nordgren A. Children's Views on Long-Term Screening for Type 1 Diabetes. J Empir Res Hum Res Ethics 2015; 9:1-9. [PMID: 25747292 DOI: 10.1177/1556264614544456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are an increasing number of medical research studies involving children, including many long-term birth cohort studies. Involving children raises many issues, and little is known about children's own views. This study explored children's views (N = 5,851) on participation in a long-term screening study for type 1 diabetes. The results show that children 10 to 13 years of age have in general a positive attitude to pediatric research and emphasized trust in researchers. The children stressed the importance to receive information and to be involved in decisions. The children also reported feeling concerned about blood sampling and disease risk. Researchers involved in long-term pediatric research need to address these issues to promote involvement and decrease worry.
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Tercyak KP, Mays D, Johnson SB, Ludvigsson J, Swartling U. Psychometric properties of the Pediatric Testing Attitudes Scale-Diabetes (P-TAS-D) for parents of children undergoing predictive risk screening. Pediatr Diabetes 2013; 14:602-10. [PMID: 23763537 PMCID: PMC3785558 DOI: 10.1111/pedi.12053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/26/2013] [Accepted: 05/03/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Examine the factor structure, reliability, and validity of the Pediatric Testing Attitudes Scale-Diabetes (P-TAS-D), a measure of parental attitudes about predictive risk screening for type 1 diabetes in children. METHODS Surveys were completed by 3720 Swedish parents of children participating in the adolescent follow-up of a birth cohort study of type 1 diabetes onset. Parents averaged 43.5 years, 42.3% were college-educated, and 10.6% of children had a family history of type 1 diabetes. The parent sample was randomly divided, an exploratory factor analysis (EFA; n = 1860) was conducted, followed by confirmatory factor analysis (CFA; n = 1860) and testing. RESULTS EFA/CFA revealed the P-TAS-D has three factors/scales: Attitudes and Beliefs toward type 1 diabetes predictive risk screening (α = 0.92), Communication about risk screening results (α = 0.71), and Decision Making (r = 0.19, p < 0.001). This solution fit the data well (χ(2) [42] = 536.0, RMSEA = 0.08, CFI = 0.95) and internal consistency for the full scale was high (α = 0.86, M = 36.2, SD = 8.2). After adjusting for covariates, more favorable attitudes toward children's risk screening were associated with greater worry about type 1 diabetes (B = 1.1, p < 0.001), less worry about health overall (B = -0.10, p = 0.001), and more positive attitudes toward (B = 0.28, p < 0.001) and less worry about (B = 0.41, p < 0.001) diabetes research. CONCLUSIONS The P-TAS-D is a stable, reliable, and valid measure for assessing parents' type 1 diabetes risk screening attitudes. Scale data can help target parent education efforts in risk screening trials.
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Affiliation(s)
- Kenneth P. Tercyak
- Department of Oncology, Georgetown University, Washington, District of Columbia,Department of Pediatrics, Georgetown University, Washington, District of Columbia
| | - Darren Mays
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Suzanne Bennett Johnson
- Department of Medical Humanities & Social Sciences, Florida State University, Tallahassee, Florida
| | - Johnny Ludvigsson
- Department of Clinical & Experimental Medicine, Linköping University, Linköping, Sweden
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Nobile H, Vermeulen E, Thys K, Bergmann MM, Borry P. Why do participants enroll in population biobank studies? A systematic literature review. Expert Rev Mol Diagn 2013; 13:35-47. [PMID: 23256702 DOI: 10.1586/erm.12.116] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Therapeutic misconception has been extensively studied and addressed within clinical trials. An equivalent in the genetic research context has been identified as diagnostic misconception. There is not much data on this phenomenon in population-based biobank studies. Since misconceptions may generate undue motives to enroll, the authors aimed at reviewing studies addressing the reasons to participate in biobank studies. The main databases were searched using relevant keywords. Studies were included if peer-reviewed, in English and describing the reasons to enroll was provided by actual and apparently healthy donors. Although the 13 studies retrieved were heterogeneous, a scheme summarizing the main aspects involved in the decision-making process was developed. Expectation of personal benefit through health-related information was found in eight studies. Three of them discussed whether this expectation could be considered a form of therapeutic misconception. The magnitude of this phenomenon is an important ethical concern and ought to be further studied.
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Affiliation(s)
- Hélène Nobile
- German Institute of Human Nutrition, Nuthetal, Germany.
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10
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Ojha RP, Oancea SC, Ness KK, Lanctot JQ, Srivastava DK, Robison LL, Hudson MM, Gurney JG. Assessment of potential bias from non-participation in a dynamic clinical cohort of long-term childhood cancer survivors: results from the St. Jude Lifetime Cohort Study. Pediatr Blood Cancer 2013; 60:856-64. [PMID: 23024097 PMCID: PMC3548083 DOI: 10.1002/pbc.24348] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 09/04/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate long-term health outcomes among childhood cancer survivors, St. Jude Children's Research Hospital (SJCRH) has established the St. Jude Lifetime Cohort Study (SJLIFE), comprised of adult survivors who undergo risk-directed clinical assessments. As in any human research study, SJLIFE participants are volunteers who may not represent the source population from which they were recruited. A lack of proportional representation could result in biased estimates of exposure-outcome associations. We compared available demographic, disease, and neighborhood level characteristics between participants and the source population to assess the potential for selection bias. PROCEDURES Potentially eligible patients for SJLIFE were enumerated as of October 31, 2011. Data from electronic medical records were combined with geocoded census data to develop an analytic data set of 3,108 patients (the evaluable source population) of whom 1,766 (57%) underwent clinical assessment (participants). The ratio of relative frequencies (RRFs) for characteristics was compared between participants and the source population, where RRF = 1.0 indicates equal frequency of the characteristic. RESULTS Participants and the source population had similar frequencies for most characteristics. Characteristics with modest relative differences (RRFs between 0.86 and 1.11) included sex, distance from SJCRH, primary diagnosis, median household income, median home value, and urbanicity. CONCLUSIONS Our results indicate a lack of substantive differences in the relative frequencies of demographic, disease, or neighborhood characteristics between participants and the source population in SJLIFE, thus alleviating serious concerns about selective non-participation in this cohort. Bias in specific exposure-outcome relations is still possible and will be considered in individual analyses.
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Affiliation(s)
- Rohit P. Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - S. Cristina Oancea
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - D. Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis TN, USA
| | - James G. Gurney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis TN, USA
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11
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Tercyak KP, Swartling U, Mays D, Johnson SB, Ludvigsson J. Behavioral Science Research Informs Bioethical Issues in the Conduct of Large-Scale Studies of Children's Disease Risk. AJOB PRIMARY RESEARCH 2013; 4:4-14. [PMID: 23977442 DOI: 10.1080/21507716.2013.806968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Birth cohort studies of the natural history of pediatric common disease risk raise many bioethical issues, including re-consenting participants over time as children mature and cohort retention. Understanding participants' study-specific knowledge, attitudes, beliefs, and behavior may offer insights into these issues from a psychological perspective. METHODS We conducted an analysis of factors associated with parent-child communication about minor children's participation in a population-based birth cohort; children's knowledge about their own participation; and parental willingness to be re-contacted for future study among Swedish parents (N = 3,605) of children originally enrolled at birth in a prospective study of type 1 diabetes risk. RESULTS More open parent-child communication about disease risk screening research and greater knowledge among children about their own research participation facilitated greater parent willingness to participate in further study. Parents' decisions about further study participation were most strongly favorable among those who communicated openly with their child and with high study-specific knowledge. CONCLUSIONS Epidemiologists, bioethicists, and others involved in the design and conduct of large-scale, prospective birth cohorts may consider embedding periodic assessments of participants' study-specific attitudes and behavior to address long-term retention and willingness to engage in future research.
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Affiliation(s)
- Kenneth P Tercyak
- Associate Professor, Director of Behavioral Prevention Research, Division of Population Sciences, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100 Washington, DC 20007, USA
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12
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Swartling U, Hansson MG, Ludvigsson J, Nordgren A. "My parents decide if I can. I decide if I want to." Children's views on participation in medical research. J Empir Res Hum Res Ethics 2012; 6:68-75. [PMID: 22228061 DOI: 10.1525/jer.2011.6.4.68] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The participation of children in medical research raises many ethical issues, in particular regarding assent. However, little is known about children's own views on participation. This study presents results from interviews with children 10-12 years old with and without experience in a large-scale longitudinal screening study. We identified five themes: (1) knowledge about research, (2) a sense of altruism, (3) shared decision-making and right to dissent, (4) notions of integrity, privacy, and access, and (5) understanding of disease risk and personal responsibilities. We conclude that the children feel positive towards medical research, and want to take an active part in decisions and have their integrity respected. However, the study also indicates that children who had participated in longitudinal screening had a limited understanding, suggesting the vital importance of providing information appropriate to their age and maturity. This information should be provided out of respect for the children as persons, but also to promote their willingness to continue participating in longitudinal studies.
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Affiliation(s)
- Ulrica Swartling
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden.
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Lernmark B, Lynch K, Ballard L, Baxter J, Roth R, Simell T, Johnson SB. Reasons for Staying as a Participant in the Environmental Determinants of Diabetes in the Young (TEDDY) Longitudinal Study. JOURNAL OF CLINICAL TRIALS 2012; 2:1000114. [PMID: 23894727 PMCID: PMC3723141 DOI: 10.4172/2167-0870.1000114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess parents' opinions about their participation in the longitudinal, multicenter study - The Environmental Determinants of Diabetes in the Young (TEDDY) consortium. METHODS A survey was given to parents who had been in the study for ≥ 1 year. Parents rated the importance of different reasons for staying in TEDDY and how well different study components were working. Parents were also asked if they had suggestions for making TEDDY better and if they ever had thought of leaving TEDDY and if so, why. RESULTS Out of the 3336 eligible families, 2000 completed the survey (59.1%); most (77.6%) were mothers. Survey completion was more common in European than US TEDDY sites and was associated with greater maternal education, more accurate perceptions about their child's risk of type 1 diabetes, longer participation in TEDDY and excellent attendance at TEDDY visits. "Having someone watching the child for development of T1DM" was most important reason given for staying in the study; other important reasons included "Helping science discover causes of diabetes" and "Getting child's antibody results". Most parents were very satisfied with the different components of TEDDY and had not thought of leaving the study. A minority (24%) of parents acknowledged some thoughts of leaving TEDDY and cited the blood draws, being too busy/not having enough time, the demanding protocol, and food diaries as their reasons for considering leaving. CONCLUSIONS The study highlights factors important for successful implementation of demanding, longitudinal protocols. Friendly, devoted, skilled and knowledgeable staff with continuity makes the family comfortable. Keeping parents involved and informed on study progress is essential as is making procedures as smooth and painless as possible. Although the study is international the survey results were convergent across countries suggesting that the results have relevance to other similar studies to retain study participants.
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Affiliation(s)
- Barbro Lernmark
- Department of Clinical Sciences, Lund University, Skane University Hospital, CRC 72-60-11, SE-20502 Malmö, Sweden
| | - Kristian Lynch
- Department of Clinical Sciences, Lund University, Skane University Hospital, CRC 72-60-11, SE-20502 Malmö, Sweden
| | - Lori Ballard
- Pediatrics Epidemiology Center, University of South Florida, 3650 Spectrum Blvd., Suite 100, Tampa FL 33612, USA
| | - Judith Baxter
- Barbara Davis Center for Childhood Diabetes, School of Medicine and Colorado School of Public Health, Department of Community and Behavioral Health, University of Colorado Denver-AMC, Mail Stop F527, 1775 Aurora Court, Aurora, CO, 80045, USA
| | - Roswith Roth
- Institut für Diabetesforschung, Helmholtz Zentrum München, Ingolstädter Landstraße 1, D-85764 Neuherberg, Germany
| | - Tuula Simell
- Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8 FIN-20520 Turku, Finland
| | - Suzanne Bennett Johnson
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, 1115 West Call Street, Tallahassee FL 32306-4300, USA
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Lernmark B, Johnson SB, Vehik K, Smith L, Ballard L, Baxter J, McLeod W, Roth R, Simell T. Enrollment experiences in a pediatric longitudinal observational study: The Environmental Determinants of Diabetes in the Young (TEDDY) study. Contemp Clin Trials 2011; 32:517-23. [PMID: 21419878 PMCID: PMC3118988 DOI: 10.1016/j.cct.2011.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 02/03/2011] [Accepted: 03/09/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our objective was to identify characteristics of infants and their families who were enrolled, refused to enroll, or were excluded from The Environmental Determinants of Diabetes in the Young (TEDDY) study. METHOD 16,435 infants screened at birth and identified as at increased genetic risk for type 1 diabetes (T1DM) were placed into one of three categories: enrolled, excluded, or refused to enroll. Enrollment, exclusion and refusal rates were compared across countries and between infants from the general population (GP) and infants with a first degree T1DM relative (FDR). A multivariate logistic model was used to identify factors associated with TEDDY enrollment. RESULTS TEDDY enrollment, exclusion, and refusal rates differed by country and by GP/FDR status but reasons for refusal to enroll were similar across countries and GP/FDR populations. Sweden had the highest enrollment rate, US had the highest exclusion rate, and Finland had the highest refusal rate. FDR infants were more likely to enroll than GP infants. Inability to re-contact the family was the most common reason for exclusion. Primary reasons for refusal to enroll included protocol factors (e.g. blood draws) or family factors (e.g., too busy). Study enrollment was associated with FDR status, European country of origin, older maternal age, a singleton birth, and having another child in TEDDY. CONCLUSIONS Findings highlight the importance of country specific estimates for enrollment targets in longitudinal pediatric studies and suggest that enrollment estimates should be lowered when the study involves the general population, painful procedures, or makes multiple demands on families.
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Affiliation(s)
- Barbro Lernmark
- Department of Clinical Sciences, Lund University, Skåne University Hospital, CRC 72-60-11, 20502 Malmö, SWEDEN
| | - Suzanne Bennett Johnson
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, 1115 West Call Street, Tallahassee FL 32306-4300, USA
| | - Kendra Vehik
- Pediatric Epidemiology Center, University of South Florida, 3650 Spectrum Blvd., Suite 100, Tampa FL 33612 USA
| | - Laura Smith
- Department of Pediatrics, University of South Florida, 12901 Bruce B. Downs Blvd, MCD 62, Tampa, FL 33612 USA
| | - Lori Ballard
- Pediatric Epidemiology Center, University of South Florida, 3650 Spectrum Blvd., Suite 100, Tampa FL 33612 USA
| | - Judy Baxter
- Barbara Davis Center for Childhood Diabetes, School of Medicine, University of Colorado Denver-AMC, Mail Stop F527, 1775 Aurora Court, Aurora, CO, 80045 USA and Colorado School of Public Health, Dept. of Community and Behavioral Health
| | - Wendy McLeod
- Pediatric Epidemiology Center, University of South Florida, 3650 Spectrum Blvd., Suite 100, Tampa FL 33612 USA
| | - Roswith Roth
- Institute of Psychology, Graz University, Universitätsplatz 2/III, A-8010 Graz, AUSTRIA
| | - Tuula Simell
- Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8, FIN-20520 Turku, FINLAND
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Knapp CA, Madden VL, Curtis C, Sloyer PJ, Shenkman EA. Assessing non-response bias in pediatric palliative care research. Palliat Med 2010; 24:340-7. [PMID: 20123943 DOI: 10.1177/0269216309351466] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
National experts have recognized a need for increased research in pediatric palliative care. However, when conducting research it is important to use rigorous methods, report significant and non-significant findings, and include information on responders and non-responders. Most studies do not present information on non-responders, yet this is critical as the results many not be generalizable if there are inherent differences between the two groups. Using survey data from parents whose children with life-limiting illnesses were enrolled in Florida's publicly funded pediatric palliative care program called Partners in Care: Together for Kids; this study investigates whether non-response bias exists, and if so, what characteristics are associated with non-response. Bivariate and multivariate analyses were conducted to determine whether individual characteristics differed between responders and non-responders. Throughout our analyses, we conducted the analyses using different ways in which 'non-response' can be defined. Our results suggest that regardless of how non-response is defined, Black, non-Hispanic parents were less likely to participate than White non-Hispanic parents. However, we also found that of the Black, non-Hispanic parents who did not participate, their primary reason for doing so was that they had non-working or disconnected phone numbers. Only 3% of the Black, non-Hispanic parents who did not participate flatly refused. Information from this study can be used to design interventions aimed at increasing minority participation in pediatric palliative care research.
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Affiliation(s)
- Caprice A Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville FL, USA.
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