1
|
Krutsinger DC, Maloney SI, Courtright KR, Bartels K. Barriers and Facilitators of Surrogates Providing Consent for Critically Ill Patients in Clinical Trials: A Qualitative Study. Chest 2024; 166:304-310. [PMID: 38387647 DOI: 10.1016/j.chest.2024.02.027] [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] [Received: 08/16/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Enrollment into critical care clinical trials is often hampered by the need to rely on surrogate decision-makers. To identify potential interventions facilitating enrollment into critical care clinical trials, a better understanding of surrogate decision-making for critical care clinical trial enrollment is needed. RESEARCH QUESTION What are the barriers and facilitators of critical care trial enrollment? What are surrogate decision-makers' perspectives on proposed interventions to facilitate trial enrollment? STUDY DESIGN AND METHODS We conducted semistructured interviews with 20 surrogate decision-makers of critically ill patients receiving mechanical ventilation. The interviews were recorded and transcribed verbatim, and analyzed for themes using an inductive approach. RESULTS Thematic analysis confirmed previous research showing that trust in the system, assessing the risks and benefits of trial participation, the desire to help others, and building medical knowledge as important motivating factors for trial enrollment. Two previously undescribed concerns among surrogate decision-makers of critically ill patients were identified, including the potential to interfere with clinical treatment decisions and negative sentiment about placebos. Surrogates viewed public recognition and charitable donations for participation as favorable potential interventions to encourage trial enrollment. However, participants viewed direct financial incentives and prioritizing research participants during medical rounds negatively. INTERPRETATION This study confirms and extends previous findings that health system trust, study risks and benefits, altruism, knowledge generation, interference with clinical care, and placebos are key concerns and barriers for surrogate decision-makers to enroll patients in critical care trials. Future studies are needed to evaluate if charitable giving on the patient's behalf and public recognition are effective strategies to promote enrollment into critical care trials.
Collapse
Affiliation(s)
- Dustin C Krutsinger
- Divisions of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE; Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
| | - Shannon I Maloney
- Maurer College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Katherine R Courtright
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Karsten Bartels
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
2
|
Li J, Liu Y, Nehl E, Tucker JD. A behavioral economics approach to enhancing HIV preexposure and postexposure prophylaxis implementation. Curr Opin HIV AIDS 2024; 19:212-220. [PMID: 38686773 DOI: 10.1097/coh.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW The 'PrEP cliff' phenomenon poses a critical challenge in global HIV PrEP implementation, marked by significant dropouts across the entire PrEP care continuum. This article reviews new strategies to address 'PrEP cliff'. RECENT FINDINGS Canadian clinicians have developed a service delivery model that offers presumptive PEP to patients in need and transits eligible PEP users to PrEP. Early findings are promising. This service model not only establishes a safety net for those who were not protected by PrEP, but it also leverages the immediate salience and perceived benefits of PEP as a natural nudge towards PrEP use. Aligning with Behavioral Economics, specifically the Salience Theory, this strategy holds potential in tackling PrEP implementation challenges. SUMMARY A natural pathway between PEP and PrEP has been widely observed. The Canadian service model exemplifies an innovative strategy that leverages this organic pathway and enhances the utility of both PEP and PrEP services. We offer theoretical insights into the reasons behind these PEP-PrEP transitions and evolve the Canadian model into a cohesive framework for implementation.
Collapse
Affiliation(s)
- Jingjing Li
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health
| | - Yaxin Liu
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Eric Nehl
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health
| | - Joseph D Tucker
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
3
|
Uneno Y, Fukuyama K, Nishimura A, Eguchi K, Kojima H, Umino T, Miyazaki K, Negora E, Minashi K, Sugiyama O, Shimazu T, Muto M, Matsumoto S. Barriers and Facilitators to the Implementation of an Electronic Patient-Reported Outcome System at Cancer Hospitals in Japan. Cureus 2024; 16:e58611. [PMID: 38770482 PMCID: PMC11102941 DOI: 10.7759/cureus.58611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Background and objective Implementing electronic patient-reported outcomes (ePROs) in oncology practice has shown substantial clinical benefits. However, it can be challenging in routine practice, warranting strategies to adapt to different clinical contexts. In light of this, this study aimed to describe the implementation process of the ePRO system and elucidate the provider-level implementation barriers and facilitators to a novel ePRO system at cancer hospitals in Japan. Methods We implemented an ePRO system linked to electronic medical records at three cancer hospitals. Fifteen patients with solid cancers at the outpatient oncology unit were asked to regularly complete the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) questionnaire and European Organization for Research and Treatment Core Quality of Life questionnaire (EORTC QLQ C30) by using the smartphone app between October 2021 and June 2022. Thirteen healthcare professionals were interviewed to identify implementation barriers and facilitators to the ePRO system by using the Consolidated Framework for Implementation Research framework. Results The healthcare professionals identified a lack of clinical resources and a culture and system that emphasizes treatment over care as the main barriers; however, the accumulation of successful cases, the leadership of managers, and the growing needs of patients can serve as facilitators to the implementation. Conclusions Our experience implementing an ePRO system in a few Japanese oncology practices revealed comprehensive barriers and facilitators. Further efforts are warranted to develop more successful implementation strategies.
Collapse
Affiliation(s)
- Yu Uneno
- Department of Medical Oncology, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Keita Fukuyama
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, JPN
| | - Ayumi Nishimura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, JPN
| | - Kana Eguchi
- Department of Real World Data R&D, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Hideki Kojima
- Healthcare Solution Department, Marketing Insight Division, INTAGE Healthcare Inc., Tokyo, JPN
| | - Takeshi Umino
- Clinical Research Department, Medical Evidence Division, INTAGE Healthcare Inc., Tokyo, JPN
| | - Kikuko Miyazaki
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, JPN
| | - Eiju Negora
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, JPN
| | - Keiko Minashi
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, JPN
| | - Osamu Sugiyama
- Department of Informatics, Kindai University, Higashiosaka, JPN
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, JPN
| | - Manabu Muto
- Department of Medical Oncology, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Shigemi Matsumoto
- Department of Real World Data R&D, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| |
Collapse
|
4
|
Karthic A, Orgil Z, Tram NK, Rice-Weimer J, Stevens J, Olbrecht VA. Application of behavioral economic strategies to enhance recruitment into a pediatric randomized clinical trial for postoperative pain relief: A randomized clinical trial. Paediatr Anaesth 2023; 33:1091-1098. [PMID: 37712489 DOI: 10.1111/pan.14755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION A major challenge in conducting clinical trials is recruitment. Trial under-enrollment leads to underpowered studies. Behavioral economics offers strategies that may enhance trial recruitment. This study assessed the impact of behavioral economic strategies versus a standard biological approach to recruit children into a randomized clinical trial assessing a biofeedback-based virtual reality intervention for postoperative pain management. We hypothesized the behavioral economics-informed approach would increase enrollment into the future trial, intention to adhere to therapy, acceptability of the intervention, and perceived efficacy while decreasing perception of treatment burden and risk. METHODS This single-center, prospective, randomized trial recruited patients 12-18 years old undergoing surgery requiring postoperative admission and narcotic administration. Patient-parent dyads were randomized to watch a behavioral economics-informed (n = 64) or standard biological (n = 66) recruitment video about a study designed to assess impact of a virtual reality pain management intervention. RESULTS There was no difference in rates of intention to enroll in the study between groups (behavioral economics: 75%, control: 79%, p = 0.744) or in median response scores to questions regarding intention to adhere to therapy (4.0 [3.0, 4.0] vs. 4.0 [3.0, 4.0], p=0.084), acceptability of therapy (4.0 [3.0, 4.0] vs. 4.0 [3.0, 4.0], p = 0.376), perceptions of treatment burden (3.0 [3.0, 4.0] vs. 4.0 [3.0, 4.0], p=0.251), and efficacy (3.0 [3.0, 4.0] vs. 3.0 [3.0, 4.0], p = 0.914). Patients in the behavioral economics group were less likely to perceive risk associated with virtual reality versus the control group (behavioral economics: 2.0 [1.0, 2.0], control: 2.0 [2.0, 3.0], p = 0.023). DISCUSSION A behavioral economics-informed video did not increase patients' intentions to enroll into a clinical trial assessing the impact of virtual reality intervention for postoperative pain management. CONCLUSION Either approach would be sufficient for patient recruitment for this type of clinical trial since the overall intention to enroll rate was 77%.
Collapse
Affiliation(s)
- Anitra Karthic
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Zandantsetseg Orgil
- Department of Clinical Research Services, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nguyen K Tram
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Julie Rice-Weimer
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jack Stevens
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Vanessa A Olbrecht
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
5
|
Greene B, Bernardo L, Thompson M, Loughead J, Ashare R. Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial. JMIR Form Res 2023; 7:e47121. [PMID: 37477975 PMCID: PMC10403799 DOI: 10.2196/47121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Nearly 1 in 3 clinical trials end prematurely due to underenrollment. Strategies to enhance recruitment are often implemented without scientific rigor to evaluate efficacy. Evidence-based, cost-effective behavioral economic strategies designed to influence decision-making may be useful to promote clinical trial enrollment. OBJECTIVE This study evaluated 2 behavioral economic strategies to improve enrollment and retention rates across 4 clinical trials: information provision (IP) and contingency management (CM; ie, lottery). IP targets descriptive and injunctive norms about participating in research and CM provides participants incentives to reinforce a target behavior. METHODS A sample of 212 participants was enrolled across 4 clinical trials focused on tobacco use: 2 focused on HIV and 2 focused on neuroimaging. The CM condition included a lottery: for each study visit completed, participants received 5 "draws" from a bowl containing 500 "chips" valued at US $0, US $1, US $5, or US $100. In the IP condition, text messages that targeted injunctive norms about research (eg, "Many find it a rewarding way to advance science and be part of a community") were sent through the Way to Health platform before all study visits. Participants were randomized to 1 of 4 conditions: IP, CM, IP+CM, or standard recruitment (SR). We performed logistic regression, controlling for sex and study, with condition as a between-subject predictor. Outcomes were the percentage of participants who attended a final eligibility visit (primary), met intent-to-treat (ITT) criteria (secondary), and completed the study (secondary). Recruitment was evaluated by the percentage of participants who attended a final eligibility visit, enrollment by ITT status, and retention by the percentage of participants who completed the study. RESULTS Rates of attending the eligibility visit and meeting ITT status were 58.9% (33/56) and 33.9% (19/56) for IP+CM; 45.5% (25/55) and 18.2% (10/55) for IP only; 41.5% (22/53) and 18.9% (10/53) for CM only; and 37.5% (18/48) and 12.5% (6/48) for SR, respectively. In the logistic regression, females were more likely to meet ITT status than males (odds ratio [OR] 2.7, 95% CI 1.2-5.7; P=.01). The IP+CM group was twice as likely to attend the final eligibility visit than the SR group (OR 2.4, 95% CI 1.1-5.2; P=.04). The IP+CM group was also significantly more likely to reach ITT status than the SR condition (OR 3.9, 95% CI 1.3-11.1; P=.01). Those who received any active intervention (IP, CM, or IP+CM) had a higher study completion rate (33/53, 63.5%) compared to those who received SR (5/12, 41.7%), but this difference was not significant (P=.26). CONCLUSIONS Combining IP and CM strategies may motivate participants to participate in research and improve recruitment and retention rates. Evidence from this study provides preliminary support for the utility of behavioral economics strategies to improve enrollment and reduce attrition in clinical trials.
Collapse
Affiliation(s)
- Brittney Greene
- State University of New York at Buffalo, Buffalo, NY, United States
| | - Leah Bernardo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Morgan Thompson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - James Loughead
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Ashare
- State University of New York at Buffalo, Buffalo, NY, United States
| |
Collapse
|
6
|
Michaud TL, Estabrooks PA, You W, Ern J, Scoggins D, Gonzales K, King KM, Dai H, Su D. Effectiveness of incentives to improve the reach of health promotion programs- a systematic review and meta-analysis. Prev Med 2022; 162:107141. [PMID: 35809822 DOI: 10.1016/j.ypmed.2022.107141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/31/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
The reach (i.e., enrollment, engagement, and retention) of health promotion evidence-based programs (EBPs) at the participant level has been challenging. Incentives based on behavioral economics may be used to improve EBP reach. We aimed to systematically review and synthesize the evidence of the effectiveness of incentives as a dissemination strategy to increase EBP reach. We conducted a literature search in PubMed, SCOPUS, EMBASE, Cochrane Review and Cochrane CENTRAL for articles published between January 2000 and March 2020 to identify incentive strategies used to increase program reach among health promotion EBPs. Inclusion criteria included studies published in English, experimental or quasi-experimental designs, comparison of incentive to non-incentive or control strategies, and reported on reach (n = 35 health promotion studies). Monetary incentives using cash and a fixed schedule of reinforcement were the most used incentive schemes (71%). Incentives alone or combined with other strategies as a multicomponent approach were effective in improving program enrollment, engagement, and retention. Specifically, incentive strategies were associated with higher odds of program enrollment (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; n = 10) and retention (OR, 2.54, 95% CI, 1.34-4.85; n = 9) with considerable heterogeneity (I2 = 94% and 91%, respectively). Incentives are a promising individual-level dissemination strategy to improve the reach of health promotion EBPs. However, understanding the optimal amount, type, frequency, and target of incentives, and how incentives fit in a multicomponent approach in different contexts requires further research.
Collapse
Affiliation(s)
- Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Paul A Estabrooks
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Jessica Ern
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dylan Scoggins
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kelly Gonzales
- College of Nursing, Omaha Division, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hongying Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
7
|
Zimmermann BM, Willem T, Bredthauer CJ, Buyx A. Ethical Issues in Social Media Recruitment for Clinical Studies: Ethical Analysis and Framework. J Med Internet Res 2022; 24:e31231. [PMID: 35503247 PMCID: PMC9115665 DOI: 10.2196/31231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/11/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social media recruitment for clinical studies holds the promise of being a cost-effective way of attracting traditionally marginalized populations and promoting patient engagement with researchers and a particular study. However, using social media for recruiting clinical study participants also poses a range of ethical issues. OBJECTIVE This study aims to provide a comprehensive overview of the ethical benefits and risks to be considered for social media recruitment in clinical studies and develop practical recommendations on how to implement these considerations. METHODS On the basis of established principles of clinical ethics and research ethics, we reviewed the conceptual and empirical literature for ethical benefits and challenges related to social media recruitment. From these, we derived a conceptual framework to evaluate the eligibility of social media use for recruitment for a specific clinical study. RESULTS We identified three eligibility criteria for social media recruitment for clinical studies: information and consent, risks for target groups, and recruitment effectiveness. These criteria can be used to evaluate the implementation of a social media recruitment strategy at its planning stage. We have discussed the practical implications of these criteria for researchers. CONCLUSIONS The ethical challenges related to social media recruitment are context sensitive. Therefore, social media recruitment should be planned rigorously, taking into account the target group, the appropriateness of social media as a recruitment channel, and the resources available to execute the strategy.
Collapse
Affiliation(s)
- Bettina M Zimmermann
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Theresa Willem
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Science, Technology and Society, School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - Carl Justus Bredthauer
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alena Buyx
- Institute of History and Ethics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
8
|
Krutsinger DC, Hetland BD, O’Leary KL, Halpern SD, Courtright KR. A Qualitative Analysis of Factors Influencing Critical Care Trial Enrollment Among Surrogates. J Intensive Care Med 2022; 37:430-434. [PMID: 33655801 PMCID: PMC9815468 DOI: 10.1177/0885066621998978] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND We sought to identify factors that influence surrogate decision makers' decisions to enroll patients into a critical care randomized controlled trial. METHODS We conducted a qualitative study embedded within a randomized controlled trial testing the effect of a behavioral nudge intervention for surrogate decision makers on enrollment rate in a sham ventilatory weaning trial among patients with acute respiratory failure. Participants were adult surrogate decision makers of patients receiving mechanical ventilation for acute respiratory failure. The study was conducted in 10 ICUs across 2 urban hospitals within an academic medical center in Philadelphia, Pennsylvanaia, United States. Immediately following their trial enrollment decision, surrogate decision makers were asked to enter free-text responses about the factors that influenced their decision. Responses were analyzed using content analysis. RESULTS Of the 90 (49%) participants who provided free-text responses, the mean age was 54.9 years (SD 14.3), 69 (79%) were Caucasian, and 48 (53%) were the spouse of the eligible patient. We identified 5 themes influencing enrollment decisions: (i) trial characteristics, (ii) patient clinical condition, (iii) decision making processes, (iv) altruism, and (v) enrollment attempt. Among surrogates who enrolled the patient in the trial (n = 40), the most commonly cited factors were helping future patients (n = 24, 60%) and following the patient's wishes (n = 11, 28%). In contrast, those who declined enrollment (n = 50) most commonly reported that the patient was too sick (n = 27, 54%) and that they feared complicating the patient's condition (n = 11, 22%). CONCLUSIONS Surrogates who enroll patients into trials most often cite altruistic motivations, while those who decline enrollment are most often concerned with the severity of the patients' condition.
Collapse
Affiliation(s)
- Dustin C. Krutsinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Breanna D. Hetland
- University of Nebraska Medical Center College of Nursing, Omaha, NE, USA
| | | | - Scott D. Halpern
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Palliative and Advanced Illness Research (PAIR) Center, Philadelphia, PA, USA
- Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics (CHIBE), Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine R. Courtright
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Palliative and Advanced Illness Research (PAIR) Center, Philadelphia, PA, USA
- Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics (CHIBE), Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
9
|
Krutsinger DC, Yadav KN, Harhay MO, Bartels K, Courtright KR. A systematic review and meta-analysis of enrollment into ARDS and sepsis trials published between 2009 and 2019 in major journals. Crit Care 2021; 25:392. [PMID: 34781998 PMCID: PMC8591428 DOI: 10.1186/s13054-021-03804-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enrollment problems are common among randomized controlled trials conducted in the ICU. However, little is known about actual trial enrollment rates and influential factors. We set out to determine the overall enrollment rate in recent randomized controlled trials (RCTs) of patients with acute respiratory distress syndrome (ARDS), acute lung injury (ALI), or sepsis, and which factors influenced enrollment rate. METHODS We conducted a systematic review by searching Pubmed using predefined terms for ARDS/ALI and sepsis to identify individually RCTs published among the seven highest impact general medicine and seven highest impact critical care journals between 2009 and 2019. Cluster randomized trials were excluded. Data were extracted by two independent reviewers using an electronic database management system. We conducted a random-effects meta-analysis of the eligible trials for the primary outcome of enrollment rate by time and site. RESULTS Out of 457 articles identified, 94 trials met inclusion criteria. Trials most commonly evaluated pharmaceutical interventions (53%), were non-industry funded (78%), and required prospective informed consent (81%). The overall mean enrollment rate was 0.83 (95% confidence interval: 0.57-1.21) participants per month per site. Enrollment in ARDS/ALI and sepsis trials were 0.48 (95% CI 0.32-0.70) and 0.98 (95% CI 0.62-1.56) respectively. The enrollment rate was significantly higher for single-center trials (4.86; 95% CI 2.49-9.51) than multicenter trials (0.52; 95% CI 0.41-0.66). Of the 36 trials that enrolled < 95% of the target sample size, 8 (22%) reported slow enrollment as the reason. CONCLUSIONS In this systematic review and meta-analysis, recent ARDS/ALI and sepsis clinical trials had an overall enrollment rate of less than 1 participant per site per month. Novel approaches to improve critical care trial enrollment efficiency are needed to facilitate the translation of best evidence into practice.
Collapse
Affiliation(s)
- Dustin C. Krutsinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, 985910 NE Medical Center, Omaha, NE 68198 USA
| | - Kuldeep N. Yadav
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, 300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Michael O. Harhay
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, 300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Karsten Bartels
- Department of Anesthesiology, University of Nebraska Medical Center, 985910 NE Medical Center, Omaha, NE 68198 USA
| | - Katherine R. Courtright
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, 300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
10
|
Halpern SD, Chowdhury M, Bayes B, Cooney E, Hitsman BL, Schnoll RA, Lubitz SF, Reyes C, Patel MS, Greysen SR, Mercede A, Reale C, Barg FK, Volpp KG, Karlawish J, Stephens-Shields AJ. Effectiveness and Ethics of Incentives for Research Participation: 2 Randomized Clinical Trials. JAMA Intern Med 2021; 181:1479-1488. [PMID: 34542553 PMCID: PMC8453363 DOI: 10.1001/jamainternmed.2021.5450] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Incentivizing research participation is controversial and variably regulated because of uncertainty regarding whether financial incentives serve as undue inducements by diminishing peoples' sensitivity to research risks or unjust inducements by preferentially increasing enrollment among underserved individuals. OBJECTIVE To determine whether incentives improve enrollment in real randomized clinical trials (RCTs) or serve as undue or unjust inducements. DESIGN, SETTING, AND PARTICIPANTS Two RCTs of incentives that were embedded in 2 parent RCTs, 1 comparing smoking cessation interventions (conducted at smoking cessation clinics in 2 health systems) and 1 evaluating an ambulation intervention (conducted across wards of the Hospital of the University of Pennsylvania) included all persons eligible for the parent trials who did not have prior knowledge of the incentives trials. Recruitment occurred from September 2017 to August 2019 for the smoking trial and January 2018 through May 2019 for the ambulation trial; data were analyzed from January 2020 to July 2020. INTERVENTIONS Patients were randomly assigned to incentives of $0, $200, or $500 for participating in the smoking cessation trial and $0, $100, or $300 for the ambulation trial. MAIN OUTCOMES AND MEASURES The primary outcome of each incentive trial was the proportion of people assigned to each recruitment strategy that consented to participate. Each trial was powered to test the hypotheses that incentives served neither as undue inducements (based on the interaction between incentive size and perceived research risk, as measured using a 10-point scale, on the primary outcome), nor unjust inducements (based on the interaction between incentive size and participants' self-reported income). Noninferiority methods were used to test whether the data were compatible with these 2 effects of incentives and superiority methods to compare the primary and other secondary outcomes. RESULTS There were a total of 654 participants (327 women [50.0%]; mean [SD] age, 50.6 [12.1] years; 394 Black/African American [60.2%], 214 White [32.7%], and 24 multiracial individuals [3.7%]) in the smoking trial, and 642 participants (364 women [56.7%]; mean [SD] age, 46.7 [15.6] years; 224 Black/African American [34.9%], 335 White [52.2%], and 5 multiracial individuals [0.8%]) in the ambulation trial. Incentives significantly increased consent rates among those in the smoking trial in 47 of 216 (21.8%), 78 of 217 (35.9%), and 104 of 221 (47.1%) in the $0, $200, and $500 groups, respectively (adjusted odds ratio [aOR] for each increase in incentive, 1.70; 95% CI, 1.34-2.17; P < .001). Incentives did not increase consent among those in the ambulation trial: 98 of 216 (45.4%), 102 of 212 (48.1%), and 92 of 214 (43.0%) in the $0, $100, and $300 groups, respectively (aOR, 0.88; 95% CI, 0.64-1.22; P = .45). In neither trial was there evidence of undue or unjust inducement (upper confidence limits of ORs for undue inducement, 1.15 and 0.99; P < .001 showing noninferiority; upper confidence limits of ORs for unjust inducement, 1.21 and 1.26; P = .01 and P < .001, respectively). There were no significant effects of incentive size on the secondary outcomes in either trial, including time spent reviewing the risk sections of consent forms, perceived research risks, trial understanding, perceived coercion, or therapeutic misconceptions. CONCLUSIONS AND RELEVANCE In these 2 randomized clinical trials, financial incentives increased trial enrollment in 1 of 2 trials and did not produce undue or unjust inducement or other unintended consequences in either trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02697799.
Collapse
Affiliation(s)
- Scott D Halpern
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Marzana Chowdhury
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Bayes
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Elizabeth Cooney
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian L Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert A Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Su Fen Lubitz
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Celine Reyes
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mitesh S Patel
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - S Ryan Greysen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ashley Mercede
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Catherine Reale
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Frances K Barg
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Anthropology, University of Pennsylvania School of Arts and Sciences, Philadelphia
| | - Kevin G Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Jason Karlawish
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Penn Memory Center at the Penn Neuroscience Center, Philadelphia, Pennsylvania
| | - Alisa J Stephens-Shields
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
11
|
Abstract
The global diabetes burden is staggering, and prevention efforts are needed to reduce the impact on individuals and populations. There is strong evidence from efficacy trials showing that lifestyle interventions promoting increased physical activity, improvements in diet, and/or weight loss significantly reduce diabetes incidence and improve cardiometabolic risk factors. Implementation research assessing the feasibility, effectiveness, and cost-effectiveness of delivering these proven programs at the community level has shown success, but more research is needed to overcome barriers to implementation in different settings globally. New avenues of research should be considered to combat this public health issue.
Collapse
Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
| | - Saria Hassan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA; Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Rakale Quarells
- Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, SW NCPC-318, Atlanta, GA 30310, USA
| | - Megha Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| |
Collapse
|
12
|
Tomio AA, Dottori M, Hesse E, Torrente F, Flichtentrei D, Ibanez AM. Behavioural insights (BI) for childhood development and effective public policies in Latin America: a survey and a randomised controlled trial. BMJ Open 2021; 11:e047925. [PMID: 34373303 PMCID: PMC8354254 DOI: 10.1136/bmjopen-2020-047925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We developed (a) a survey to investigate the knowledge of childhood health experts on public policies and behavioural insights (BI), as well as its use in Latin American and the Caribbean countries (LACs), and (b) an intervention (randomised controlled trial) to test the influence of nudges on the effect of a simulated public health programme communication. PARTICIPANTS AND SETTINGS A total of 2003 LACs childhood health professionals participated in the study through a Hispanic online platform. PRIMARY AND SECONDARY OUTCOMES We used regression models analysing expertise-related information, individual differences and location. We extracted several outcome variables related to (a) 'Public Policy Knowledge Index' based on the participants' degree of knowledge on childhood health public policies and (b) BI knowledge, perceived effectiveness and usefulness of a simulated public programme communication. We also analysed a 'Behavioural Insights Knowledge Index' (BIKI) based on participants' performance in BI questions. RESULTS In general, health professionals showed low BI knowledge (knowledge of the term BI: χ2=210.29, df=1 and p<0.001; BIKI: χ2=160.5, df=1 and p<0.001), and results were modulated by different factors (age, academic formation, public policy knowledge and location). The use of BI principles for the communication of the public programme revealed higher impact and clarity ratings from professionals than control messages. CONCLUSIONS Our findings provide relevant knowledge about BI in health professionals to inform governmental and non-governmental organisations' decision-making processes related with childhood public policies and BI designs.
Collapse
Affiliation(s)
- Andrea A Tomio
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina
| | - Martin Dottori
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Eugenia Hesse
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Fernando Torrente
- Institute of Cognitive and Translational Neurosciences, CONICET-Favaloro University-INECO Foundation, Buenos Aires, Argentina
| | | | - Agustin M Ibanez
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute (GBHI), UCSF, San Francisco, California, USA
- Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| |
Collapse
|
13
|
Speight CD, Gregor C, Ko YA, Kraft SA, Mitchell AR, Niyibizi NK, Phillips BG, Porter KM, Shah SK, Sugarman J, Wilfond BS, Dickert NW. Reframing Recruitment: Evaluating Framing in Authorization for Research Contact Programs. AJOB Empir Bioeth 2021; 12:206-213. [PMID: 33719913 PMCID: PMC10788686 DOI: 10.1080/23294515.2021.1887962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The changing clinical research recruitment landscape involves practical challenges but introduces opportunities. Researchers can now identify large numbers of eligible patients through electronic health record review and can directly contact those who have authorized contact. Applying behavioral science-driven strategies to design and frame communication could affect patients' willingness to authorize contact and their understanding of these programs. The ethical and practical implications of various strategies warrant empirical evaluation. METHODS We conducted an online survey (n = 1070) using a nationally-representative sample. Participants were asked to imagine being asked for authorization for research contact in clinic. They were randomly assigned to view one of three flyers: #1-neutral text flyer; #2-a positive text flyer; or #3-positive graphics-based flyer. Primary outcomes included likelihood of enrollment and comprehension of the program. Chi-Square tests and regression analyses were used to examine whether those who saw the positive flyers were more likely to enroll and had increased comprehension. RESULTS Compared to the neutral flyer, individuals who received the positive text flyer were numerically more likely to enroll, but this was not statistically significant (24.2% v. 19.0%, p = 0.11). Individuals who received the positive graphics flyer were more likely to enroll (28.7% v. 19.0%, p = 0.002). After adjustment, individuals assigned to both novel flyers had increased odds of being likely to enroll (OR = 1.55 95%CI [1.04, 2.31] and OR = 1.95 95%CI [1.31, 2.91]). Flyer type did not affect overall comprehension (p = 0.21), and greater likelihood of enrollment was observed only in individuals with better comprehension. CONCLUSIONS This study demonstrated that employing behavioral science-driven communication strategies for authorization for research contact had an effect on likelihood of hypothetical enrollment but did not significantly affect comprehension. Strategies using simple, positive language and visual tools may be effective and ethically appropriate. Further studies should explore how these and other approaches can help to optimize research recruitment.
Collapse
Affiliation(s)
- Candace D. Speight
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Charlie Gregor
- Institute of Translational Health Sciences at the University of Washington, Seattle, WA
| | - Yi-An Ko
- Emory University Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Atlanta, GA
| | - Stephanie A. Kraft
- University of Washington School of Medicine, Department of Pediatrics and the Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Andrea R. Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Nyiramugisha K. Niyibizi
- Georgia Clinical and Translational Science Alliance at Emory University School of Medicine, Atlanta, GA
| | - Bradley G. Phillips
- University of Georgia College of Pharmacy and the Director of the University of Georgia Office of Research Clinical and Translational Research Unit, Athens, GA
| | - Kathryn M. Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Seema K. Shah
- Northwestern Feinberg School of Medicine and Associate Director of Research Ethics at the Stanley Manne Research Institute, Lurie Children’s Hospital
| | | | - Benjamin S. Wilfond
- University of Washington School of Medicine, Department of Pediatrics and the Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute, Seattle, WA
| | - Neal W. Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| |
Collapse
|
14
|
Wong CA, Song WB, Jiao M, O'Brien E, Ubel P, Wang G, Scales CD. Strategies for research participant engagement: A synthetic review and conceptual framework. Clin Trials 2021; 18:457-465. [PMID: 34011179 DOI: 10.1177/17407745211011068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research participant engagement, which we define as recruitment and retention in clinical trials, is a costly and challenging issue in clinical research. Research teams have leveraged a variety of strategies to increase research participant engagement in clinical trials, although a framework and evidence for effective participant engagement strategies are lacking. We (1) developed a novel conceptual framework for strategies used to recruit and retain participants in clinical trials based on their underlying behavioral principles and (2) categorized empirically tested recruitment and retention strategies in this novel framework. METHODS We conducted a synthetic analysis of interventions tested in studies from two Cochrane reviews on clinical trial recruitment and retention, which included studies from 1986 to 2015. We developed a conceptual framework of behavioral strategies for increasing research participant engagement using deductive and inductive approaches with the studies included in the Cochrane reviews. Reviewed interventions were then categorized using this framework. We examined the results of reviewed interventions and categorized the effects on clinical trial recruitment and retention as significantly positive, null, or significantly negative; summary statistics are presented for the frequency and effects of each behavioral strategy type. RESULTS We analyzed 141 unique interventions across 96 studies: 91 interventions targeted clinical trial research participant recruitment and 50 targeted retention. Our framework included 14 behavioral strategies to improve research participant engagement grouped into four general approaches: changing attitudes by appealing to social motivators, changing attitudes by targeting individual psychology, reducing barriers and cognitive burdens, and providing incentives. The majority of interventions (54%) aimed to reduce barriers or cognitive burdens, with improving comprehension (27%) as the most common specific strategy identified. For recruitment, the most common behavioral strategies tested were building legitimacy or trust (38%) and framing risks and benefits (32%), while financial or material incentives (32%) and reducing financial, time, and social barriers (32%) were most common for retention interventions. Among interventions tested in randomized controlled trials, 51% had a null effect on research participant engagement, and 30% had a statistically significant positive effect. DISCUSSION Clinical researchers have tested a wide range of interventions that leverage distinct behavioral strategies to achieve improved research participant recruitment and retention. Common behavioral strategies include building legitimacy or trust between research teams and participants, as well as improving participant comprehension of trial objectives and procedures. The high frequency of null effects among tested interventions suggests challenges in selecting the optimal interventions for increasing research participant engagement, although the proposed behavioral strategy categories can serve as a conceptual framework for developing and testing future interventions.
Collapse
Affiliation(s)
- Charlene A Wong
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Pediatrics, Duke Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, NC, USA
| | - William B Song
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Megan Jiao
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Emily O'Brien
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Peter Ubel
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Fuqua School of Business, Duke University, Durham, NC, USA.,Sanford School of Health Policy, Duke University, Durham, NC, USA
| | - Gary Wang
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Charles D Scales
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
15
|
Julbe-Delgado D, O'Brien JL, Abdulkarim R, Hudak EM, Maeda H, Edwards JD. Quantifying Recruitment Source and Participant Communication Preferences for Alzheimer's Disease Prevention Research. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2021; 8:299-305. [PMID: 34101787 DOI: 10.14283/jpad.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence on effective engagement of diverse participants in AD prevention research is lacking. OBJECTIVES To quantify recruitment source in relation to race, ethnicity, and retention. DESIGN Prospective cohort study. SETTING University lab. PARTICIPANTS Participants included older adults (N=1170) who identified as White (86%), Black (8%), and Hispanic/Latino ethnicity (6%). MEASUREMENTS The Cognitive Aging Lab Marketing Questionnaire assessed recruitment source, social media use, and research opportunity communication preferences. RESULTS Effective recruitment methods and communication preferences vary by race and ethnicity. The most common referral sources were postcards for racial minorities, friend/family referrals for Hispanic/Latinos, and the newspaper for Whites. Whereas Whites preferred email communications, Hispanic/Latinos preferred texts. CONCLUSIONS Recruiting diverse samples in AD prevention research is clinically relevant given high AD-risk of minorities and that health disparities are propagated by their under-representation in research. Our questionnaire and these results may be applied to facilitate effective research engagement.
Collapse
Affiliation(s)
- D Julbe-Delgado
- Jerri D. Edwards, University of South Florida, 3515 E. Fletcher Ave, MDT 200, Tampa, FL 33613, USA, Telephone: (813) 974-6703; Fax (813) 974-2882,
| | | | | | | | | | | |
Collapse
|
16
|
Using Behavioral Nudges to Engage Pregnant Women in a Smoking Cessation Trial: An Online Field Quasi-Experiment. Healthcare (Basel) 2020; 8:healthcare8040531. [PMID: 33276634 PMCID: PMC7761597 DOI: 10.3390/healthcare8040531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Evidence shows that behavioral nudges could be used to enhance enrollment rates in randomized controlled trials (RCTs) by addressing enrollment barriers, but research on this topic is limited. We conducted an online field quasi-experiment with separate pretest (October 2017-January 2018) and posttest (February-May 2018) samples designed to examine the use of behavioral nudges to engage pregnant smokers in a couple-focused smoking cessation RCT relying on online enrollment through paid Facebook ads and a dedicated website, by reporting aggregate Facebook ads and Google Analytics data. The Facebook ads pretest conversion rate of 1.6% doubled and reached 3.41% in the posttest period. The pretest eligibility assessment rate decreased from 10.3% to 6.46%, but registered a relative increase of approximately 50% in the posttest period, as opposed to the pretest. The number of women who signed the informed consent in the posttest period has increased with 63%, from a proportion of 8.54% in the pretest to 11.73% in the posttest period. These findings might lend support to integrating behavioral nudges in the recruitment and enrollment materials of RCTs to boost enrollment.
Collapse
|
17
|
Ibanez A, Flichtentrei D, Hesse E, Dottori M, Tomio A, Slachevsky A, Serrano CM, Gonzalez‐Billaut C, Custodio N, Miranda C, Bustin J, Cetckovitch M, Torrente F, Olavarria L, Leon T, Beber BC, Bruki S, Suemoto CK, Nitrini R, Miller BL, Yokoyama JS. The power of knowledge about dementia in Latin America across health professionals working on aging. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12117. [PMID: 33088898 PMCID: PMC7560513 DOI: 10.1002/dad2.12117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/01/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Expert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies' accessibility and transmission, stigma, diagnostic manuals, data-sharing platforms, and use of behavioral insights (BIs) are not well known. METHODS We investigated opinions among health professionals working on aging in LACs (N = 3365) with regression models including expertise-related information (public policies, BI), individual differences (work, age, academic degree), and location. RESULTS Experts specified low public policy knowledge (X2 = 41.27, P < .001), high levels of stigma (X2 = 2636.37, P < .001), almost absent BI knowledge (X2 = 56.58, P < .001), and needs for regional diagnostic manuals (X2 = 2893.63, df = 3, P < .001) and data-sharing platforms (X2 = 1267.5, df = 3, P < .001). Lack of dementia knowledge was modulated by different factors. An implemented BI-based treatment for a proposed prevention program improved perception across experts. DISCUSSION Our findings help to prioritize future potential actions of governmental agencies and non-governmental organizations (NGOs) to improve LACs' dementia knowledge.
Collapse
Affiliation(s)
- Agustin Ibanez
- Global Brain Health Institute and the Memory and Aging Center, Weill Institute for Neurosciences, Department of NeurologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
- Universidad de San AndrésBuenos AiresArgentina
- National Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
- Center for Social and Cognitive Neuroscience (CSCN), School of PsychologyUniversidad Adolfo IbáñezSantiago de ChileChile
- Universidad Autónoma del CaribeBarranquillaColombia
| | | | - Eugenia Hesse
- Universidad de San AndrésBuenos AiresArgentina
- National Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
| | - Martin Dottori
- Universidad de San AndrésBuenos AiresArgentina
- National Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
| | - Ailin Tomio
- Universidad de San AndrésBuenos AiresArgentina
| | - Andrea Slachevsky
- Memory and Neuropsychiatric Clinic (CMYN), Neurology DepartmentDel Salvador Hospital and University of Chile Faculty of MedicineSantiagoChile
- Geroscience Center for Brain Health and Metabolism (GERO), Faculty of MedicineUniversity of ChileSantiagoChile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department ‐ ICBM, Neuroscience and East Neuroscience Departments, Faculty of MedicineUniversity of ChileSantiagoChile
- Department of Neurology and PsychiatryClínica Alemana‐Universidad del DesarrolloSantiagoChile
| | - Cecilia M Serrano
- Cognitive Neurology, Neurology DepartmentDr César Milstein HospitalBuenos AiresArgentina
| | - Christian Gonzalez‐Billaut
- Geroscience Center for Brain Health and Metabolism (GERO), Faculty of MedicineUniversity of ChileSantiagoChile
| | - Nilton Custodio
- Unit Cognitive Impairment and Dementia Prevention, Cognitive Neurology CenterPeruvian Institute of NeurosciencesLimaPerú
| | - Claudia Miranda
- Faculty of NursingUniversidad Andres BelloSantiagoChile
- Millennium Institute for Research in Depression and PersonalitySantiagoChile
| | - Julian Bustin
- Institute of Translational and Cognitive Neuroscience (INCYT), INECO Foundation, Favaloro UniversityNational Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
| | - Marcelo Cetckovitch
- Institute of Translational and Cognitive Neuroscience (INCYT), INECO Foundation, Favaloro UniversityNational Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
| | - Fernando Torrente
- Institute of Translational and Cognitive Neuroscience (INCYT), INECO Foundation, Favaloro UniversityNational Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
| | - Loreto Olavarria
- Memory and Neuropsychiatric Clinic (CMYN), Neurology DepartmentDel Salvador Hospital and University of Chile Faculty of MedicineSantiagoChile
| | - Tomas Leon
- Memory and Neuropsychiatric Clinic (CMYN), Neurology DepartmentDel Salvador Hospital and University of Chile Faculty of MedicineSantiagoChile
| | - Barbara Costa Beber
- Department of Speech and Language Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA)Atlantic Fellow for Equity in Brain HealthPorto AlegreBrazil
| | - Sonia Bruki
- Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | | | - Ricardo Nitrini
- Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Bruce L. Miller
- Global Brain Health Institute and the Memory and Aging Center, Weill Institute for Neurosciences, Department of NeurologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Jennifer S. Yokoyama
- Global Brain Health Institute and the Memory and Aging Center, Weill Institute for Neurosciences, Department of NeurologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| |
Collapse
|
18
|
Langford AT. Health Communication and Decision Making about Vaccine Clinical Trials during a Pandemic. JOURNAL OF HEALTH COMMUNICATION 2020; 25:780-789. [PMID: 33719877 PMCID: PMC8765457 DOI: 10.1080/10810730.2020.1864520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has magnified the importance of clinical trials for finding a safe and effective vaccine to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Although communication about vaccines and vaccine hesitancy were challenges long before COVID-19, the twin facts of a pandemic and an "infodemic" of health information, misinformation, and disinformation have raised new challenges for vaccine-related communication and decision-making. The goal of this commentary is to highlight strategies to improve communication and decision-making for adults considering participation in COVID-19 vaccine clinical trials. First, I present a general conceptual model for clinical trial participation that can be applied to various vaccine and other clinical trial contexts. Next, I introduce the ASK (Assume, Seek, Know) approach for enhancing clinical trial participation: (1) assume that all patients will want to know their options, (2) seek the counsel of stakeholders, and (3) know your numbers. The ideas presented in this commentary are intended to enhance vaccine-specific clinical trial communication, decision-making, and literacy, while dually offering strategies and resources that may help reduce vaccine hesitancy and increase vaccine uptake over time.
Collapse
Affiliation(s)
- Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
19
|
Witbracht MG, Bernstein OM, Lin V, Salazar CR, Sajjadi SA, Hoang D, Cox CG, Gillen DL, Grill JD. Education and Message Framing Increase Willingness to Undergo Research Lumbar Puncture: A Randomized Controlled Trial. Front Med (Lausanne) 2020; 7:493. [PMID: 33043024 PMCID: PMC7530193 DOI: 10.3389/fmed.2020.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/20/2020] [Indexed: 12/26/2022] Open
Abstract
Reluctance to undergo lumbar puncture (LP) is a barrier to neurological disease biomarker research. We assessed whether an educational intervention increased willingness to consider research LP and whether message framing modified intervention effectiveness. We randomly assigned 851 recruitment registry enrollees who had previously indicated they were unwilling to be contacted about studies requiring LP to gain or loss framed video educational interventions describing the procedure and the probability of experiencing adverse events. The gain framed intervention emphasized the proportion of individuals free of adverse events; the loss frame emphasized the proportion experiencing adverse events. The primary outcome for the study was the participant's post-intervention agreement to be contacted about studies requiring LP. Participants were mean (SD) age 60.1 years (15.7), 69% female (n = 591), and mostly college educated and white. Among the 699 participants who completed the study, 43% (95% CI: 0.39, 0.47; n = 301) changed their response to agree to be contacted about studies requiring LP. We estimated that participants randomized to the gain framed intervention had 67% higher odds of changing their response compared to those randomized to the loss frame (Odds Ratio = 1.67; 95% CI: 1.24, 2.26; p < 0.001). A classification and regression tree model identified participants' pre-intervention willingness as the strongest predictor of changing response. Education, in particular education that alerts participants to the probability of not experiencing adverse events, may be an effective tool to increase participation rates in research requiring LP.
Collapse
Affiliation(s)
- Megan G Witbracht
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Olivia M Bernstein
- Department of Statistics, University of California, Irvine, Irvine, CA, United States
| | - Vanessa Lin
- Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, United States
| | - Christian R Salazar
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - S Ahmad Sajjadi
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Dan Hoang
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Chelsea G Cox
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Daniel L Gillen
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Statistics, University of California, Irvine, Irvine, CA, United States
| | - Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States.,Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States.,Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States.,Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
20
|
Krutsinger DC, O’Leary KL, Ellenberg SS, Cotner CE, Halpern SD, Courtright KR. A Randomized Controlled Trial of Behavioral Nudges to Improve Enrollment in Critical Care Trials. Ann Am Thorac Soc 2020; 17:1117-1125. [PMID: 32441987 PMCID: PMC7462327 DOI: 10.1513/annalsats.202003-194oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/21/2020] [Indexed: 01/04/2023] Open
Abstract
Rationale: Low and slow patient enrollment remains a barrier to critical care randomized controlled trials (RCTs). Behavioral economic insights suggest that nudges may address some enrollment challenges.Objectives: To evaluate the efficacy of a novel preconsent survey consisting of nudges on critical care RCT enrollment.Methods: We conducted an RCT in 10 intensive care units (ICUs) among surrogate decision-makers (SDMs). The novel multicomponent behavioral nudge survey was administered immediately before soliciting SDMs' informed consent for their patients' participation in a sham trial of two mechanical ventilation weaning approaches in acute respiratory failure. The primary outcome was the enrollment rate for the sham trial. Secondary outcomes included undue and unjust inducements. We also explored SDM and patient predictors of enrollment using multivariate regression.Results: Among 182 SDMs, 93 were randomized to receive the intervention survey and 89 to receive standard informed consent. There was no statistically significant difference in enrollment rates between the intervention (29%) and standard consent (34%) groups (percentage difference, 5%; 95% confidence interval [CI], -9% to 18%; P = 0.50). There was no evidence of undue or unjust inducement. White SDMs were more likely to enroll the patient compared with non-white SDMs (odds ratio, 3.7; 95% CI, 1.1 to 12.2; P = 0.03). SDMs who perceived a higher risk of participation were less likely to enroll the patient (odds ratio, 0.57; 95% CI, 0.46 to 0.71; P < 0.001).Conclusions: A preconsent behavioral nudge survey among SDMs of patients with acute respiratory failure in the ICU did not increase enrollment rates for a sham RCT compared with standard informed consent procedures.Clinical trial registered with ClinicalTrials.gov (NCT03284359).
Collapse
Affiliation(s)
- Dustin C. Krutsinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | | - Scott D. Halpern
- Department of Biostatistics, Epidemiology, and Informatics
- Palliative and Advanced Illness Research Center
- Fostering Improvement in End-of-Life Decision Science Program
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Katherine R. Courtright
- Palliative and Advanced Illness Research Center
- Fostering Improvement in End-of-Life Decision Science Program
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| |
Collapse
|
21
|
Liu J, Gutierrez E, Tiwari A, Padam S, Li D, Dale W, Pal SK, Stewart D, Subbiah S, Bosserman LD, Presant C, Phillips T, Yap K, Hill A, Bhatt G, Yeon C, Cianfrocca M, Yuan Y, Mortimer J, Sedrak MS. Strategies to Improve Participation of Older Adults in Cancer Research. J Clin Med 2020; 9:jcm9051571. [PMID: 32455877 PMCID: PMC7291007 DOI: 10.3390/jcm9051571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 02/02/2023] Open
Abstract
Cancer is a disease associated with aging. As the US population ages, the number of older adults with cancer is projected to dramatically increase. Despite this, older adults remain vastly underrepresented in research that sets the standards for cancer treatments and, consequently, clinicians struggle with how to interpret data from clinical trials and apply them to older adults in practice. A combination of system, clinician, and patient barriers bar opportunities for trial participation for many older patients, and strategies are needed to address these barriers at multiple fronts, five of which are offered here. This review highlights the need to (1) broaden eligibility criteria, (2) measure relevant end points, (3) expand standard trial designs, (4) increase resources (e.g., institutional support, interdisciplinary care, and telehealth), and (5) develop targeted interventions (e.g., behavioral interventions to promote patient enrollment). Implementing these solutions requires a substantial investment in engaging and collaborating with community-based practices, where the majority of older patients with cancer receive their care. Multifaceted strategies are needed to ensure that older patients with cancer, across diverse healthcare settings, receive the highest-quality, evidence-based care.
Collapse
Affiliation(s)
- Jennifer Liu
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Eutiquio Gutierrez
- Department of Internal Medicine, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA;
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Simran Padam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daneng Li
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA 91010, USA;
| | - Sumanta K. Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Daphne Stewart
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Shanmugga Subbiah
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Linda D. Bosserman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Cary Presant
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Kelly Yap
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Addie Hill
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Geetika Bhatt
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Christina Yeon
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mary Cianfrocca
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Yuan Yuan
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Joanne Mortimer
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
| | - Mina S. Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA; (J.L.); (A.T.); (S.P.); (D.L.); (S.K.P.); (D.S.); (S.S.); (L.D.B.); (C.P.); (T.P.); (K.Y.); (A.H.); (G.B.); (C.Y.); (M.C.); (Y.Y.); (J.M.)
- Correspondence:
| |
Collapse
|
22
|
McConnell M, Rogers W, Simeonova E, Wilson IB. Architecting Process of Care: A randomized controlled study evaluating the impact of providing nonadherence information and pharmacist assistance to physicians. Health Serv Res 2019; 55:136-145. [PMID: 31835278 PMCID: PMC6981078 DOI: 10.1111/1475-6773.13243] [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: 11/26/2022] Open
Abstract
OBJECTIVE To test the impact of connecting physicians, pharmacists, and patients to address medication nonadherence, and to compare different physician choice architectures. DATA SOURCES AND STUDY SETTING The study was conducted with 90 physicians and 2602 of their patients on medications treating chronic illness. STUDY DESIGN In this cluster randomized controlled trial, physicians were randomly assigned to an arm where the physician receives notification of patient nonadherence derived from real-time claims data, an arm where they receive this information and a pharmacist may contact patients either by default or by physician choice, and a control group. The primary outcome was resolving nonadherence within 30 days. We also considered physician engagement outcomes including viewing information about nonadherence and utilizing a pharmacist. DATA COLLECTION Physician engagement was constructed from metadata from the study website; adherence outcomes were constructed from medication claims. PRINCIPAL FINDINGS We see no differences between the treatment arms and control for the primary adherence outcome. The pharmacist intervention was 42 percentage points (95% CI: 28 pp-56 pp) more likely when it was triggered by default. CONCLUSIONS Access to a pharmacist and real-time nonadherence information did not improve patient adherence. Physician process of care was sensitive to choice architecture.
Collapse
Affiliation(s)
- Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - William Rogers
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | | | - Ira B Wilson
- Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
23
|
Baca-Motes K, Edwards AM, Waalen J, Edmonds S, Mehta RR, Ariniello L, Ebner GS, Talantov D, Fastenau JM, Carter CT, Sarich TC, Felicione E, Topol EJ, Steinhubl SR. Digital recruitment and enrollment in a remote nationwide trial of screening for undiagnosed atrial fibrillation: Lessons from the randomized, controlled mSToPS trial. Contemp Clin Trials Commun 2019; 14:100318. [PMID: 30656241 PMCID: PMC6329362 DOI: 10.1016/j.conctc.2019.100318] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/07/2018] [Accepted: 01/05/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives The advent of large databases, wearable technology, and novel communications methods has the potential to expand the pool of candidate research participants and offer them the flexibility and convenience of participating in remote research. However, reports of their effectiveness are sparse. We assessed the use of various forms of outreach within a nationwide randomized clinical trial being conducted entirely by remote means. Methods Candidate participants at possibly higher risk for atrial fibrillation were identified by means of a large insurance claims database and invited to participate in the study by their insurance provider. Enrolled participants were randomly assigned to one of two groups testing a wearable sensor device for detection of the arrhythmia. Results Over 10 months, the various outreach methods used resulted in enrollment of 2659 participants meeting eligibility criteria. Starting with a baseline enrollment rate of 0.8% in response to an email invitation, the recruitment campaign was iteratively optimized to ultimately include website changes and the use of a five-step outreach process (three short, personalized emails and two direct mailers) that highlighted the appeal of new technology used in the study, resulting in an enrollment rate of 9.4%. Messaging that highlighted access to new technology outperformed both appeals to altruism and appeals that highlighted accessing personal health information. Conclusions Targeted outreach, enrollment, and management of large remote clinical trials is feasible and can be improved with an iterative approach, although more work is needed to learn how to best recruit and retain potential research participants. Trial registration Clinicaltrials.govNCT02506244. Registered 23 July 2015.
Collapse
Affiliation(s)
- Katie Baca-Motes
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct, Plaza Level, La Jolla, CA, 92037, USA.,Wave Research Center, 8330 W Third St, Los Angeles, CA, 90048, USA
| | - Alison M Edwards
- Healthagen Outcomes, 123 N Wacker Dr STE 650, Chicago, IL, 60606, USA
| | - Jill Waalen
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct, Plaza Level, La Jolla, CA, 92037, USA
| | - Shawn Edmonds
- Healthagen Outcomes, 123 N Wacker Dr STE 650, Chicago, IL, 60606, USA
| | - Rajesh R Mehta
- Healthagen Outcomes, 123 N Wacker Dr STE 650, Chicago, IL, 60606, USA
| | - Lauren Ariniello
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct, Plaza Level, La Jolla, CA, 92037, USA.,Wave Research Center, 8330 W Third St, Los Angeles, CA, 90048, USA
| | - Gail S Ebner
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct, Plaza Level, La Jolla, CA, 92037, USA.,Wave Research Center, 8330 W Third St, Los Angeles, CA, 90048, USA
| | - Dimitri Talantov
- Janssen Scientific Affairs, 1125 Trenton-Harbourton Rd, PO Box 200, Titusville, NJ, 08560, USA
| | - John M Fastenau
- Janssen Scientific Affairs, 1125 Trenton-Harbourton Rd, PO Box 200, Titusville, NJ, 08560, USA
| | - Chureen T Carter
- Janssen Scientific Affairs, 1125 Trenton-Harbourton Rd, PO Box 200, Titusville, NJ, 08560, USA
| | - Troy C Sarich
- Janssen Scientific Affairs, 1125 Trenton-Harbourton Rd, PO Box 200, Titusville, NJ, 08560, USA
| | - Elise Felicione
- Janssen Scientific Affairs, 1125 Trenton-Harbourton Rd, PO Box 200, Titusville, NJ, 08560, USA
| | - Eric J Topol
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct, Plaza Level, La Jolla, CA, 92037, USA.,Wave Research Center, 8330 W Third St, Los Angeles, CA, 90048, USA
| | - Steven R Steinhubl
- Scripps Research Translational Institute, 3344 N Torrey Pines Ct, Plaza Level, La Jolla, CA, 92037, USA.,Wave Research Center, 8330 W Third St, Los Angeles, CA, 90048, USA
| |
Collapse
|
24
|
|
25
|
Affiliation(s)
- Scott D. Halpern
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, 19146
- Center for Health Incentives and Behavioral Economics (CHIBE), Leonard Davis Institute of Health Economics, University of Pennsylvania
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine
| |
Collapse
|
26
|
Affiliation(s)
- Steven R Steinhubl
- Scripps Translational Science Institute, La Jolla, CA 92037, USA; Wave Research Center, Los Angeles, CA, USA.
| | - Patrick McGovern
- Wondros, Los Angeles, CA, USA; Wave Research Center, Los Angeles, CA, USA
| | - Jesse Dylan
- Wondros, Los Angeles, CA, USA; Wave Research Center, Los Angeles, CA, USA
| | - Eric J Topol
- Scripps Translational Science Institute, La Jolla, CA 92037, USA; Wave Research Center, Los Angeles, CA, USA
| |
Collapse
|
27
|
Kong Q, Mei H, Lai Y, Shi S, Li Y, He L, Qin HY. Barriers and facilitators to participation in clinical trial among lymphoma patients from Sun Yat-sen University Cancer Center in China: An observation study. Medicine (Baltimore) 2017; 96:e8062. [PMID: 28906402 PMCID: PMC5604671 DOI: 10.1097/md.0000000000008062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Recruitment rate of clinical trials in cancer patients is pretty low in China. Little is known about factors influencing trial recruitment in Chinese cancer patients. The aim of present study is to evaluate the barriers and facilitators to participation in clinical trials among lymphoma patients in China.From December 2014 to August 2015, the survey was carried out in the Department of Medical Oncology in Sun Yat-sen University Cancer Center. A self-made questionnaire was used among lymphoma patients (N = 331) to evaluate their attitude toward clinical trials. The questionnaire included 2 parts: patients' basic information and whether they were willing to participate in future clinical trials and their reasons.There were 53.5% patients willing to participate in clinical trials. The most common reasons were thirst for new treatments, trust on hospital and doctors, the idea that clinical trials may be more effective than conventional therapy, and to get more management and monitoring. The following patients are more likely to participate in clinical trials: patients who have children (P = .019) or spouse (P = .037), cannot afford treatment cost (P = .019), have tumor relapse (P = .045), and cared about the medical development (P = .032). Patients who have little knowledge of clinical trials are less likely to participate in clinical trials (P = .047).Popularization of knowledge about clinical trial is helpful to improve clinical trial participation in Chinese lymphoma patients.
Collapse
Affiliation(s)
- Qiuhuan Kong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Hua Mei
- Department of Pharmacy, Guangdong No 2. People's hospital
| | - Yuerong Lai
- Department of Gynecology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Simei Shi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Yaner Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Lianzhu He
- Department of GCP, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine
| | - Hui-ying Qin
- Department of Nursing, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
28
|
Nabhan C, Feinberg BA. Value-Based Calculators in Cancer: Current State and Challenges. J Oncol Pract 2017; 13:499-506. [PMID: 28617618 DOI: 10.1200/jop.2017.022947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The ASCO Value Framework, National Comprehensive Cancer Network Evidence Blocks, Memorial Sloan Kettering's DrugAbacus, and Institute for Clinical and Economic Review incremental cost-effectiveness ratio calculator are value-based methodologies that attempt to address the disproportionate increase in cancer care spending. These calculators can be used as an initial step for discussing cost versus value, but they fall short in recognizing the importance of the cancer journey because they do not fully factor the patient's perspective or the global cost of care. This timely review highlights both the limitations and the advantages of each value calculator and suggests opportunities for refinement. Practicing oncologists, payers, and manufacturers should be familiar with value-based calculators because the role these tools play in cost containment is likely to be hotly debated.
Collapse
|
29
|
Grill JD. Recruiting to preclinical Alzheimer's disease clinical trials through registries. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:205-212. [PMID: 28439532 PMCID: PMC5399544 DOI: 10.1016/j.trci.2017.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Participant registries are repositories of individuals who have expressed willingness to learn about studies for which they may be eligible. Registries are increasingly being used to improve recruitment to preclinical Alzheimer's disease (AD) clinical trials, which require large screening efforts to identify adequate numbers of participants who meet enrollment criteria. Recruiting to preclinical AD trials from registries is made more efficient through registry collection of data that permits exclusion of those who will not be eligible and identifies individuals most likely to qualify for trials. Such data could include self-reported disease family history or other risk factors but could also include cognitive, genetic, or biomarker testing outcomes. Few data are available to guide investigators overseeing registries and important ethical questions are likely to arise related to their conduct, especially in registries collecting AD risk information. This article outlines three areas of consideration for registry investigators: informed consent, disclosure, and sponsorship.
Collapse
Affiliation(s)
- Joshua D Grill
- Department of Psychiatry and Human Behavior, Alzheimer's Disease Research Center, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine CA, USA
| |
Collapse
|
30
|
Zhou Y, Elashoff D, Kremen S, Teng E, Karlawish J, Grill JD. African Americans are less likely to enroll in preclinical Alzheimer's disease clinical trials. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 3:57-64. [PMID: 29067319 PMCID: PMC5651355 DOI: 10.1016/j.trci.2016.09.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction Alzheimer's disease (AD) incidence is disproportionately high in African Americans, yet, recruitment of this community to AD clinical trials is challenging. Methods We compared 47 African Americans and 78 whites in their willingness to enroll in a hypothetical preclinical AD trial and examined barriers and facilitators in their decision making. Results African American race (OR = 0.45; 95% CI, 0.22–0.93) and score on the research attitude questionnaire (OR = 1.12; 95% CI, 1.04–1.22) were independently associated with willingness to participate. African Americans rated study risks, the requirement of a study partner, study procedures, the ratio of drug to placebo, and study location as more important factors in the decision whether to enroll than did whites. Discussion These results suggest that researchers will encounter challenges in recruiting African Americans to preclinical AD trials. Future research will be necessary to understand the optimal means to improve recruitment of underrepresented populations.
Collapse
Affiliation(s)
- Yan Zhou
- American Board of Anesthesiology, Raleigh, NC, USA
| | - David Elashoff
- Department of Neurology, Mary S. Easton Center for Alzheimer's Disease Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah Kremen
- Department of Neurology, Mary S. Easton Center for Alzheimer's Disease Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Edmond Teng
- Department of Neurology, Mary S. Easton Center for Alzheimer's Disease Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jason Karlawish
- Departments of Medicine and Medical Ethics and Health Policy, Alzheimer's Disease Core Center, Penn Neurodegenerative Disease Ethics and Policy Program, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua D Grill
- Department of Psychiatry and Human Behavior, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| |
Collapse
|