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van der Vaart M, Hauck AG, Mansfield R, Adams E, Bhatt A, Cobo MM, Crankshaw D, Dhami A, Hartley C, Monk V, Evans Fry R, Moultrie F, Robinson S, Yong J, Poorun R, Baxter L, Slater R. Parental experience of neonatal pain research while participating in the Parental touch trial (Petal). Pain 2024; 165:1727-1734. [PMID: 38284396 PMCID: PMC11247449 DOI: 10.1097/j.pain.0000000000003177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024]
Abstract
ABSTRACT Parental involvement in neonatal comfort care is a core component of family-centred care. Yet, parents experience a range of positive and negative feelings when providing pain-relieving interventions for their infants. Parents of infants who participated in the Parental touch trial ( Petal ), a multicentre randomised controlled trial investigating the impact of gentle parental touch on neonatal pain, were asked to complete an anonymous survey. This survey aimed to (1) explore parent-reported motivations in deciding to participate in the Petal trial; (2) understand parent-reported experiences related to trial participation; (3) understand parents' willingness to participate in future studies; and (4) evaluate parent-reported feelings while they were delivering a gentle touch intervention either before or after a clinically necessary blood test. One hundred six parents (1 parent per infant) took part in the survey. Primary motivators for participation were altruistic. Parents most frequently reported that they wanted their child to take part in the research because it has a potential benefit to babies in the future and because they wanted to improve scientific understanding. Parents reported that providing gentle touch to their children during painful procedures was associated with positive emotions, such as feeling "useful" (64%) and "reassured" (53%). Furthermore, nearly all parents (98%) were pleased to have participated in the Petal trial and would consider, or maybe consider, participating in further research studies. These results underscore the importance of structuring trials around parental involvement and providing opportunities for parents to be involved in providing comfort to their infants during necessary painful clinical procedures.
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Affiliation(s)
| | | | - Roshni Mansfield
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Eleri Adams
- Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Aomesh Bhatt
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Maria M. Cobo
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Colegio de Ciencias Biologicas y Ambientales, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Daniel Crankshaw
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Amraj Dhami
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Caroline Hartley
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Vaneesha Monk
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ria Evans Fry
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Shellie Robinson
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jean Yong
- Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ravi Poorun
- University of Exeter Medical School, Exeter, United Kingdom
- Children's Services, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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2
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Weiss EM, Porter KM, Oslin E, Puia-Dumitrescu M, Donohue PK, Merhar SL, Stephens E, Mercer A, Wilfond BS. Experiences and preferences for learning about neonatal research: insights from parent interviews. J Perinatol 2024; 44:404-414. [PMID: 38001157 PMCID: PMC10939889 DOI: 10.1038/s41372-023-01790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Parents struggle with being asked to participate in neonatal research. Past work has largely failed to include views of minoritized parents, low-socioeconomic status parents, and those who declined research. We aimed to describe parents' preferences related to learning about eligibility for neonatal research. METHODS Qualitative interviews of parents who were asked to enroll their infant in neonatal research. Themes related to parental experiences and preferences for learning about neonatal research were identified using content analysis. RESULTS Many parents desired greater involvement of their clinical team. Emotions at the time of recruitment were critically important to parents' experience, where were deeply impacted by interpersonal relationships with research staff. DISCUSSION Increased involvement of the clinical team and greater sensitivity to the stressors around parent and infant conditions at the time of recruitment for neonatal research should be considered by those attempting to improve recruitment for neonatal research.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA.
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
| | - Ellie Oslin
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
| | - Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Emily Stephens
- McGovern Medical Center at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Amanda Mercer
- Counselor Education Department, Portland State University, Portland, OR, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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3
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Kazi AW, Yoo EJ, Oxman D. Trust in the ICU: What every clinician should know. J Crit Care 2024:154540. [PMID: 38423934 DOI: 10.1016/j.jcrc.2024.154540] [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: 07/13/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 03/02/2024]
Abstract
Trust is an essential element in the relationship between patients and intensive care unit (ICU) clinicians. Without a foundation of trust, communication is difficult, conflict is more likely, and even clinical outcomes can be affected. The ICU is a particularly challenging environment for trust to flourish. Illness occurs suddenly, emotions can be charged, the environment is impersonal, and there is rarely a prior relationship between patients and their caregivers. Therefore, intensivists must have some understanding of the factors that impact patient and family trust, as well as the actions they can take to improve it.
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Affiliation(s)
- Abdul W Kazi
- Thomas Jefferson University Hospital, Division of Pulmonary, Allergy, and Critical Care, Philadelphia, PA 19107, United States of America.
| | - Erika J Yoo
- Thomas Jefferson University Hospital, Division of Pulmonary, Allergy, and Critical Care, Philadelphia, PA 19107, United States of America
| | - David Oxman
- Thomas Jefferson University Hospital, Division of Pulmonary, Allergy, and Critical Care, Philadelphia, PA 19107, United States of America
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Nathe JM, Oskoui TT, Weiss EM. Parental Views of Facilitators and Barriers to Research Participation: Systematic Review. Pediatrics 2023; 151:e2022058067. [PMID: 36477217 PMCID: PMC9808610 DOI: 10.1542/peds.2022-058067] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Low enrollment within pediatric research increases the cost of research, decreases generalizability, and threatens to exacerbate existing health disparities. To assess barriers and facilitators to pediatric research participation and evaluate differences by enrollment status. METHODS Data Sources include PubMed, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. Study selection include peer reviewed articles that contained information related to facilitators and barriers to the parental decision whether to enroll their child in research and included the views of parents who declined. We extracted barriers and facilitators to research, enrollment status, and study characteristics, including study design, quality, and patient population. RESULTS Seventy articles were included for analysis. Facilitators of participation included: benefits, trust, support of research, informational and consent related, and relational issues. Common facilitators within those categories included health benefit to child (N = 39), altruism (N = 30), and the importance of research (N = 26). Barriers to participation included: study-related concerns, burdens of participation, lack of trust, general research concerns, informational and consent related, and relational issues. Common barriers within those categories included risks to child (N = 46), burdens of participation (N = 35), and the stress of the decision (N = 29). We had a limited ability to directly compare by enrollment status and no ability to analyze interactions between facilitators and barriers. We only included studies written in English. CONCLUSIONS This review identified key facilitators and barriers to research participation in pediatrics. The findings from this review may guide researchers aiming to create interventions to improve the parental experience of recruitment for pediatric studies and to optimize enrollment rates.
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Affiliation(s)
- Julia M. Nathe
- University of Washington School of Medicine, Seattle, Washington
| | - Tira T. Oskoui
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Elliott Mark Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
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5
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Weiss EM, Guttmann KF, Olszewski AE, Magnus BE, Li S, Kim SYH, Shah AR, Juul SE, Wu YW, Ahmad KA, Bendel-Stenzel E, Isaza NA, Lampland AL, Mathur AM, Rao R, Riley D, Russell DG, Salih ZNI, Torr CB, Weitkamp JH, Anani UE, Chang T, Dudley J, Flibotte J, Havrilla EM, O’Kane AC, Perez K, Stanley BJ, Shah SK, Wilfond BS. Parental Enrollment Decision-Making for a Neonatal Clinical Trial. J Pediatr 2021; 239:143-149.e3. [PMID: 34400207 PMCID: PMC8610170 DOI: 10.1016/j.jpeds.2021.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the parental experience of recruitment and assess differences between parents who participated and those who declined to enroll in a neonatal clinical trial. STUDY DESIGN This was a survey conducted at 12 US neonatal intensive care units of parents of infants who enrolled in the High-dose Erythropoietin for Asphyxia and encephaLopathy (HEAL) trial or who were eligible but declined enrollment. Questions assessed 6 factors of the parental experience of recruitment: (1) interactions with research staff; (2) the consent experience; (3) perceptions of the study; (4) decisional conflict; (5) reasons for/against participation; and (6) timing of making the enrollment decision. RESULTS In total, 269 of 387 eligible parents, including 183 of 242 (75.6%) of those who enrolled their children in HEAL and 86 of 145 (59.3%) parents who declined to enroll their children in HEAL, were included in analysis. Parents who declined to enroll more preferred to be approached by clinical team members rather than by research team members (72.9% vs 49.2%, P = .005). Enrolled parents more frequently reported positive initial impressions (54.9% vs 10.5%, P < .001). Many parents in both groups made their decision early in the recruitment process. Considerations of reasons for/against participation differed by enrollment status. CONCLUSIONS Understanding how parents experience recruitment, and how this differs by enrollment status, may help researchers improve recruitment processes for families and increase enrollment. The parental experience of recruitment varied by enrollment status. These findings can guide future work aiming to inform optimal recruitment strategies for neonatal clinical trials.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Katherine F Guttmann
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aleksandra E Olszewski
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Brooke E Magnus
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts
| | - Sijia Li
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Scott YH Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda Maryland
| | - Anita R Shah
- Division of Neonatology, Children’s Hospital of Orange County, Orange, California
| | - Sandra E Juul
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Yvonne W Wu
- Departments of Neurology and Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | - Kaashif A Ahmad
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas
| | | | - Natalia A Isaza
- Division of Neonatology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Andrea L Lampland
- Department of Neonatology, Children’s Minnesota Hospital, Minneapolis, Minnesota
| | - Amit M Mathur
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Rakesh Rao
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - David Riley
- Department of Pediatrics, Cook Children’s Medical Center, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, Texas
| | - David G Russell
- Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Zeynep N I Salih
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Carrie B Torr
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Uchenna E Anani
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Taeun Chang
- Department of Neurology, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Juanita Dudley
- Division of Neonatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - John Flibotte
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Erin M Havrilla
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra C O’Kane
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Krystle Perez
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Seema K Shah
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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6
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Schleif W, Hamblin F, Everett AD, Graham EM, Cross J, Fernald C, Follett R, Lopes B, Martinez D, Monforte H, Ross-Wilkinson J, Sellers A, Brooks S. Tiny Bodies, Big Needs: Prospective Biobanking of Neonatal Clinical Remnant Samples. Biopreserv Biobank 2021; 19:106-110. [PMID: 33481645 DOI: 10.1089/bio.2020.0113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Repurposing biological samples collected for required diagnostic purposes into suitable biobanking projects is a particularly useful method for enabling research in vulnerable populations. This approach is especially appropriate for the neonate in the neonatal intensive care unit (NICU), where blood volume reductions can quickly increase beyond minimal risk for adverse events, such as iatrogenic anemia, and proxy consent provided by parents or guardians is required. The method described in this study provides a framework to prospectively collect and store blood-derived clinical samples after all clinical and regulatory requirements are fulfilled. The consent approach incorporated a 30-day window to allow parents and guardians ample consideration time with follow-up involvement with NICU embedded study team members. The study enrolled 875 participants over a 3-year period. This established a critically needed biobank to support investigator-initiated research with explicit study aims requiring samples at defined day of life frequencies within the NICU and created a normative control reference bank for case comparisons for premature and full-term neonates with brain injury.
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Affiliation(s)
- William Schleif
- Program in Pediatric Biospecimen Science, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Frances Hamblin
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Allen D Everett
- Blalock-Taussig-Thomas Congenital Heart Center, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ernest M Graham
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Cross
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Christy Fernald
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Robert Follett
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Bryan Lopes
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Denise Martinez
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Hector Monforte
- Program in Pediatric Biospecimen Science, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Jennifer Ross-Wilkinson
- Johns Hopkins All Children's Pediatric Biorepository, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Austin Sellers
- Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Sandra Brooks
- Johns Hopkins All Children's Maternal, Fetal, and Neonatal Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA.,Division of Neonatology, Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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7
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Jackson SM, Daverio M, Perez SL, Gesualdo F, Tozzi AE. Improving Informed Consent for Novel Vaccine Research in a Pediatric Hospital Setting Using a Blended Research-Design Approach. Front Pediatr 2021; 8:520803. [PMID: 33511090 PMCID: PMC7835206 DOI: 10.3389/fped.2020.520803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 09/22/2020] [Indexed: 02/02/2023] Open
Abstract
It is necessary to conduct Clinical Trials in children, including for novel vaccines. Children cannot legally provide valid consent, but can assent to research participation. Informed consent and assent communications are frequently criticized for their lack of comprehensibility and often, researchers do not involve patients in informed consent design. We tested a blended research-design approach to co-design multimedia informed consent prototypes for experimental vaccine studies targeted at the pediatric population. We report details on the methodology utilized, and the insights, ideas, and prototype solutions we generated using social media data analysis, a survey, and workshops. A survey of clinical trial researchers indicated that while the most did not use technology for informed consent, they considered its utilization favorable. Social media analysis enabled researchers to quickly understand where community perspectives were concordant and discordant and build their understanding of the types of topics that they may want to focus on during the design workshops. Participatory design workshops for children and their families reaped insights, ideas, and prototypes for a range of tools including apps and websites. Participants felt that the prototypes were better able to communicate necessary content than the original text document format. We propose using a participatory, mixed-methods approach to design informed consent so that it is better adapted to patients' needs. Such an approach would be helpful in better addressing the needs of different segments of the populations involved in clinical trials. Further evidence should be gained about the impact of this strategy in improving recruitment, decreasing withdrawals and litigations, and improving patient satisfaction during clinical trials.
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Affiliation(s)
- Sally M. Jackson
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | | | - Francesco Gesualdo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alberto E. Tozzi
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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8
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Weiss EM, Olszewski AE, Guttmann KF, Magnus BE, Li S, Shah AR, Juul SE, Wu YW, Ahmad KA, Bendel-Stenzel E, Isaza NA, Lampland AL, Mathur AM, Rao R, Riley D, Russell DG, Salih ZNI, Torr CB, Weitkamp JH, Anani UE, Chang T, Dudley J, Flibotte J, Havrilla EM, Kathen CM, O'Kane AC, Perez K, Stanley BJ, Wilfond BS, Shah SK. Parental Factors Associated With the Decision to Participate in a Neonatal Clinical Trial. JAMA Netw Open 2021; 4:e2032106. [PMID: 33433595 PMCID: PMC7804922 DOI: 10.1001/jamanetworkopen.2020.32106] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE It remains poorly understood how parents decide whether to enroll a child in a neonatal clinical trial. This is particularly true for parents from racial or ethnic minority populations. Understanding factors associated with enrollment decisions may improve recruitment processes for families, increase enrollment rates, and decrease disparities in research participation. OBJECTIVE To assess differences in parental factors between parents who enrolled their infant and those who declined enrollment for a neonatal randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTS This survey study conducted from July 2017 to October 2019 in 12 US level 3 and 4 neonatal intensive care units included parents of infants who enrolled in the High-dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial or who were eligible but declined enrollment. Data were analyzed October 2019 through July 2020. EXPOSURE Parental choice of enrollment in neonatal clinical trial. MAIN OUTCOMES AND MEASURES Percentages and odds ratios (ORs) of parent participation as categorized by demographic characteristics, self-assessment of child's medical condition, study comprehension, and trust in medical researchers. Survey questions were based on the hypothesis that parents who enrolled their infant in HEAL differ from those who declined enrollment across 4 categories: (1) infant characteristics and parental demographic characteristics, (2) perception of infant's illness, (3) study comprehension, and (4) trust in clinicians and researchers. RESULTS Of a total 387 eligible parents, 269 (69.5%) completed the survey and were included in analysis. This included 183 of 242 (75.6%) of HEAL-enrolled and 86 of 145 (59.3%) of HEAL-declined parents. Parents who enrolled their infant had lower rates of Medicaid participation (74 [41.1%] vs 47 [55.3%]; P = .04) and higher rates of annual income greater than $55 000 (94 [52.8%] vs 30 [37.5%]; P = .03) compared with those who declined. Black parents had lower enrollment rates compared with White parents (OR, 0.35; 95% CI, 0.17-0.73). Parents who reported their infant's medical condition as more serious had higher enrollment rates (OR, 5.7; 95% CI, 2.0-16.3). Parents who enrolled their infant reported higher trust in medical researchers compared with parents who declined (mean [SD] difference, 5.3 [0.3-10.3]). There was no association between study comprehension and enrollment. CONCLUSIONS AND RELEVANCE In this study, the following factors were associated with neonatal clinical trial enrollment: demographic characteristics (ie, race/ethnicity, Medicaid status, and reported income), perception of illness, and trust in medical researchers. Future work to confirm these findings and explore the reasons behind them may lead to strategies for better engaging underrepresented groups in neonatal clinical research to reduce enrollment disparities.
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Affiliation(s)
- Elliott Mark Weiss
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Aleksandra E Olszewski
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Katherine F Guttmann
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brooke E Magnus
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts
| | - Sijia Li
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Anita R Shah
- Division of Neonatology, Children's Hospital of Orange County, Orange, California
| | - Sandra E Juul
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Yvonne W Wu
- Departments of Neurology and Pediatrics, University of California San Francisco School of Medicine, San Francisco
| | - Kaashif A Ahmad
- Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas
| | | | - Natalia A Isaza
- Division of Neonatology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrea L Lampland
- Department of Neonatology, Children's Minnesota Hospital, Minneapolis
| | - Amit M Mathur
- Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Rakesh Rao
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - David Riley
- Department of Pediatrics, Cook Children's Medical Center, Fort Worth, Texas
| | - David G Russell
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Zeynep N I Salih
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Carrie B Torr
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | | | - Uchenna E Anani
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Taeun Chang
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Juanita Dudley
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - John Flibotte
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erin M Havrilla
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Alexandra C O'Kane
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Krystle Perez
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Seema K Shah
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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De Sutter E, Coopmans B, Vanendert F, Dooms M, Allegaert K, Borry P, Huys I. Clinical Research in Neonates: Redesigning the Informed Consent Process in the Digital Era. Front Pediatr 2021; 9:724431. [PMID: 34540773 PMCID: PMC8441012 DOI: 10.3389/fped.2021.724431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Currently, many initiatives are devoted to optimizing informed consent for participation in clinical research. Due to the digital transformation in health care, a shift toward electronic informed consent (eIC) has been fostered. However, empirical evidence on how to implement eIC in clinical research involving neonates is lacking. Methods: Semi-structured interviews were conducted with 31 health care professionals active in Belgium or the Netherlands. All health care professionals had experience in conducting clinical research involving neonates. Interviews were audio-recorded, transcribed and analyzed using the framework method. Results: Interviewees generally supported the use of eIC in clinical research involving neonates. For example, eIC could enable parents to receive study feedback via the eIC system. Requirements were expressed for parental involvement to decide on which feedback would be appropriate to return. Moreover, experts specialized in presenting information and designing electronic systems should be involved. Broad consensus among health care professionals indicates that the face-to-face-interaction between parents and the research team is vital to establish a relationship of trust. Therefore, it is necessary that the use of eIC runs alongside personal interactions with the parents. Concerns were raised about the accessibility of eIC to parents. For this reason, it was suggested that parents should always be given the possibility to read and sign a paper-based informed consent form or to use eIC. Conclusions: Health care professionals' views indicate that the use of eIC in clinical research with neonates may offer various opportunities. Further development and implementation will require a multi-stakeholder approach.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Birte Coopmans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Femke Vanendert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marc Dooms
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Clinical Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Guttmann KF, Wu YW, Juul SE, Weiss EM. Consent Related Challenges for Neonatal Clinical Trials. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:38-40. [PMID: 32364480 DOI: 10.1080/15265161.2020.1745940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | - Yvonne W Wu
- University of California San Francisco School of Medicine
| | | | - Elliott M Weiss
- University of Washington School of Medicine
- Seattle Children's Research Institute
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