Understanding parents' decision-making on participation in clinical trials in children's heart surgery: a qualitative study

Parents' and children's experiences of participating in a randomized controlled clinical trial: AIDIT-QS

Participation in a paediatric, complex randomized controlled trial (RCT) might add to the family burden when a child is diagnosed with a severe disease. Although important, there are only a limited number of papers describing this aspect of research from the family point of view. This study explored parents' and children's experiences of participation in a research study shortly after the child had been diagnosed with type 1 diabetes. Sixteen parents (nine mothers, seven fathers) and nine children were interviewed by an independent researcher about their inducement, the decision-making process within the family which led to their participation, and their experience of having done so. The result showed that the parents wanted to contribute to improve treatment for children with diabetes in general but also specifically for their own child. Older children were more involved in the decision making than the younger children. Study information needs to be communicated clearly and effectively since decision-making based on information of a clinical trial directly after the child's diabetes onset proved difficult. Being randomized to the intervention group in this specific study was considered somewhat burdensome. However, parental participants in both intervention and control group claimed that they would recommend participation in research studies to other parents in a similar situation, and so did the children. There was no difference between the mothers' and fathers' experiences.

Parental motivations and perceived barriers to participating in pediatric vaccine clinical trials: Findings from the OCV-S trial in Nepal

Background

Pediatric vaccine clinical trials are crucial for evaluating and ensuring the safety and efficacy of new vaccines for children. However, in low-resource settings like Nepal, where clinical trials are relatively new, recruitment and retention of participants are challenging particularly due to diverse parental backgrounds, motivations and concerns. As such, parental motivations, perceived barriers, and experiences of participating in pediatric vaccine trial in Nepal, which hasn't previously been explored, needs to be understood.

Materials and Methods

We performed face-to-face exit interviews from April 6, 2022 to June 7, 2022, with parents whose children participated in the phase III clinical trial of the Oral Cholera Vaccine - Simplified (OCV-S) using a structured questionnaire on motivations for enrolling and barriers faced during the trial. Data were initially cleaned and encoded in Microsoft Excel before being analyzed with R version 4.3.1. Descriptive statistics were used to summarize demographic and other participants' characteristics. Bivariate and multivariate analyses, using odds ratios and their 95% confidence intervals, applying a significance level of 0.05 was used to analyze relationship between participant characteristics and trial experiences. Additionally, thematic analysis was performed on responses to open-ended questions.

Results

A total of 258 parents responded, out of which 252 (97.7 %) were first-time clinical trial participants with median age of 32 years. A majority, 196 (76.0 %), had a positive initial attitude towards the trial, and 204 (79.1 %) reported a positive overall experience. The primary motivations for participation included the potential health benefits for their children (56.2 %, n = 145). Despite 69 (26.7 %) participants receiving discouraging information from others, only 4 (5.8 %) were influenced by it. Most participants (n = 219, 84.9 %), felt that the trial had met their expectations. Challenges faced included loss of time (n = 30, 11.6 %) and missed school for children (n = 22, 8.5 %). Nonetheless, 179 participants (69.4 %) expressed a willingness to enroll their children in future trials. Participants who received specific details about the study before visiting the study site were significantly more likely to report positive experience, with an adjusted odds ratio of 1.97 (95 % CI: 1.03 - 3.72).

Conclusion

Majority of parents were supportive of their children's participation in the OCV-S trial, motivated largely by anticipated health benefits for their child. Key barriers identified included logistical issues, costs (both financial and opportunity costs), misinformation, and concerns about trial procedures and potential side effects. Focus on reducing logistical and participation-related burdens, catering of trial-specific information, enhancing the clarity of the informed consent process, addressing safety concerns proactively and implementing continuous follow-up can help improve participation rates and retention in future trials. The high level of enthusiasm for clinical trials among parents, despite these barriers, highlights the promising potential for future research endeavors in Nepal.

Anything is better than nothing': exploring attitudes towards novel therapies in leukodystrophy clinical trials

BACKGROUND/AIM

Leukodystrophies comprise a group of genetic white matter disorders that lead to progressive motor and cognitive impairment. Recent development of novel therapies has led to an increase in clinical trials for leukodystrophies. To enable recruitment of individuals with a leukodystrophy into clinical trials, clinical trial acceptability should be ascertained. We sought therefore, to identify the motivations for and barriers to clinical trial participation in addition to clinical trial features that may be of concern to individuals with a leukodystrophy and/or their carers.

METHODS

Adults with a leukodystrophy and parents/carers of individuals with a leukodystrophy were recruited through the Australian Leukodystrophy Registry and through online advertisements. Qualitative semi-structured interviews were used to explore participants views on what clinical trials involve, the perceived risks and benefits of clinical trials, their desire to participate in clinical trials and their personal experience with leukodystrophy. Thematic analysis of data was performed with co-coding of interview transcripts.

RESULTS

5 interviews were held with parents of children with leukodystrophy, 4 with parents of adults with leukodystrophy and 3 with adults diagnosed with leukodystrophy. Motivations for clinical trial enrolment include access to potentially lifesaving novel treatments and improved prognostic outcomes. Participants were concerned about adverse clinical trial outcomes, including side effects and exacerbation of illness. Despite this, majority of participants were willing to try anything in clinical trials, demonstrating a high tolerance for first in human trials and trials utilising invasive treatment options.

CONCLUSIONS

Interviewees communicated a strong desire to participate in interventional clinical trials involving novel therapies. To support enrolment into future leukodystrophy clinical trials we suggest the provision of transparent information regarding clinical trial treatments, consideration of alternative trial control measures, and inclusion of treating clinicians in the trial recruitment process. Clinicians play an integral role in initiating transparent conversations regarding trial risks and adverse outcomes.

"There is nothing better than participating in this study": Living the PAPAartis cardiovascular randomised controlled trial

Qualitative research can bring new dimensions of understanding decision-making process in clinical trials. Participating in a randomized clinical trial requires patients to accept complex information and make decisions in a context of uncertainty. It becomes especially complicated in the case of serious diseases in which the treatment itself implies unknown risks. This study examines these issues in the context of the PAPAartis randomized clinical trial, which aims to prevent spinal cord injuries that can occur as an adverse event following complex surgical repair of thoracoabdominal aneurysm. In this study, we accessed a group of 16 patients participating in the trial and, through in-depth interviews, sought to understand the decision-making process when taking part in the trial and their experience of it. Our results showed that patients participated for different reasons: due to trust in doctors, the hope of having a better treatment or for altruistic and collaborative reasons with science. Many patients felt they did not fully understand the extraneous information provided about the study and the complex nature of the procedure. Avoidance of paraplegia played a fundamental role in the decision to participate in this trial. Family support and the socioeconomic conditions of the patients influenced the recovery process after surgery.