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Ambuehl S. An experimental test of whether financial incentives constitute undue inducement in decision-making. Nat Hum Behav 2024; 8:835-845. [PMID: 38459262 PMCID: PMC11132984 DOI: 10.1038/s41562-024-01817-8] [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: 01/05/2023] [Accepted: 01/04/2024] [Indexed: 03/10/2024]
Abstract
Around the world, laws limit the incentives that can be paid for transactions such as human research participation, egg donation or gestational surrogacy. A key reason is concerns about 'undue inducement'-the influential but empirically untested hypothesis that incentives can cause harm by distorting individual decision-making. Here I present two experiments (n = 671 and n = 406), including one based on a highly visceral transaction (eating insects). Incentives caused biased information search-participants offered a higher incentive to comply more often sought encouragement to do so. However, I demonstrate theoretically that such behaviour does not prove that incentives have harmful effects; it is consistent with Bayesian rationality. Empirically, although a substantial minority of participants made bad decisions, incentives did not magnify them in a way that would suggest allowing a transaction but capping incentives. Under the conditions of this experiment, there was no evidence that higher incentives could undermine welfare for transactions that are permissible at low incentives.
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Affiliation(s)
- Sandro Ambuehl
- Department of Economics and UBS Center for Economics in Society, University of Zurich, Zürich, Switzerland.
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2
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Gabel M, Denny A, Llibre-Guerra J, Morris JC, Phillips J, Vaidyanathan A. Remuneration and Recruitment of Study Participants for AD Cohort Studies From the General Public and From Minority Communities. Alzheimer Dis Assoc Disord 2023; 37:107-112. [PMID: 37145978 PMCID: PMC10239367 DOI: 10.1097/wad.0000000000000556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/12/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Offering remuneration for participation in studies of aging and Alzheimer Disease (AD) may improve recruitment, particularly among minoritized and low-income groups. But remuneration may also raise ethical problems and reduce altruistic motivations for participation. METHODS A nationally representative sample of Americans (N=2030) with large (N=500) Black and Hispanic oversamples was asked about willingness to participate in a longitudinal AD cohort study after random assignment of remuneration ($0, $50/visit, $100/visit). Respondents were then asked about their perceived burden, risks, and societal contribution from participation. RESULTS An offer of remuneration increased willingness to participate, with no difference between $50 and $100. The increase was similar across racial, ethnic, and income groups. Remuneration did not affect perceived risks or altruistic benefits. Compensation caused Whites and Hispanics, but not Blacks, to lower the perceived burden. DISCUSSION Modest levels of remuneration are likely to improve recruitment to AD research studies without causing collateral ethical or motivation problems. Remuneration does not differentially enhance minority recruitment.
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Russo S, Bani M, Terraneo M, Quaglia V, Nuvolati G, Cavaliere R, Capici S, Cazzaniga ME, Strepparava MG. Why not? Motivations for entering a volunteer register for clinical trials during the COVID-19 pandemic. Eur J Clin Pharmacol 2022; 78:1791-1800. [PMID: 36102931 PMCID: PMC9471028 DOI: 10.1007/s00228-022-03385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
Abstract
Abstract
Backgrounds
Healthy volunteers play a key role in clinical trials and it is crucial to develop recruitment strategies that capitalise on their motivations and maximise their participation. The COVID-19 pandemic has shown the importance of finding motivated healthy volunteers for the development of new vaccines. Public registers represent a promising way to promote the participation of healthy volunteers in the research field, but their adoption is still limited. The current study aimed to explore the motivations of healthy volunteers to enrol in an Italian public register for clinical trials during the COVID-19 pandemic and their attitude toward participating in a phase 1 COVID-19 vaccine clinical trial. The impacts of different enrolling interview modalities (in person, by phone, by mail) on motivation, understanding of information and trust in researchers were also investigated.
Methods
An online survey investigating experience with COVID-19, motivations to enrol, trust in researchers, political and healthcare authorities and pharmacological companies was presented to people applying as healthy volunteers in the public register for clinical trials at Phase 1 Unit Research Centre of ASST Monza, Italy, and considering to participate in a COVID-19 vaccine clinical trial. Data were collected in June 2021.
Results
Altruistic motivations were the main driver for enrolling in the public register, while self-interested motivations were secondary. No gender differences were found. As for enrolling modalities, no differences emerged between in-person and interviews for motivation to enrol, understanding of information and trust in researchers. Email modality led to significantly lower volunteers’ satisfaction and understanding of information but similar trust in research.
Conclusions
This study supports the validity of different interview modalities (in person and by phone) for the enrolment of healthy volunteers for clinical trials and highlights the positive role of public registers for the recruitment procedures.
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The ethical anatomy of payment for research participants. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:449-464. [PMID: 35610403 PMCID: PMC9427899 DOI: 10.1007/s11019-022-10092-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
In contrast to most publications on the ethics of paying research subjects, which start by identifying and analyzing major ethical concerns raised by the practice (in particular, risks of undue inducement and exploitation) and end with a set of—more or less well-justified—ethical recommendations for using payment schemes immune to these problems, this paper offers a systematic, principle-based ethical analysis of the practice. It argues that researchers have a prima facie moral obligation to offer payment to research subjects, which stems from the principle of social beneficence. This principle constitutes an ethical “spine” of the practice. Other ethical principles of research ethics (respect for autonomy, individual beneficence, and justice/fairness) make up an ethical “skeleton” of morally sound payment schemes by providing additional moral reasons for offering participants (1) recompense for reasonable expenses; and (2a) remuneration conceptualized as a reward for their valuable contribution, provided (i) it meets standards of equality, adequacy and non-exploitation, and (ii) it is not overly attractive (i.e., it does not constitute undue inducement for participation or retention, and does not encourage deceptive behaviors); or (2b) remuneration conceptualized as a market-driven price, provided (i) it is necessary and designed to help the study achieve its social and scientific goals, (ii) it does not reinforce wider social injustices and inequalities; (iii) it meets the requirement of non-exploitation; and (iv) it is not overly attractive. The principle of justice provides a strong ethical reason for not offering recompenses for lost wages (or loss of other reasonably expected profits).
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Perception of clinical research among patients and healthy volunteers of clinical trials. Eur J Clin Pharmacol 2022; 78:1647-1655. [PMID: 35896802 PMCID: PMC9482583 DOI: 10.1007/s00228-022-03366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
Purpose Clinical research relies on data from patients and volunteers, yet the target sample size is often not achieved. Here, we assessed the perception of clinical research among clinical trial participants to improve the recruitment process for future studies. Methods We conducted a single-center descriptive and exploratory study of 300 current or former participants in various phase I–III clinical trials. Questionnaires were either distributed to current clinical trial participants or emailed to former subjects. Results Subjects strongly agreed or agreed that contributing to improving medical care (> 81%), contributing to scientific research (> 79%), and trusting their treating physicians (> 77%) were motives for study participation. Among healthy volunteers, financial motives positively correlated with the number of clinical trials they had participated in (p < 0.05). Higher age positively correlated with expectation of best available treatment during study participation among patients (p < 0.05). Less than 8% of all subjects expressed “great concern” about the potential risks of sharing their personal information as part of the study. Subjects displayed “great trust” or “trust” in medical staff (86.6%) and in government research institutions (76.4%), and “very little trust” or “little trust” in pharmaceutical companies (35.4%) and health insurance companies (16.9%). Conclusion Altruistic motives and trust in treating physicians were predominant motives for clinical trial participation. Older patients expected to receive the best available treatment during participation. Healthy volunteers who reported financial motives had participated in more clinical trials. Consistent with great trust in medical staff and government research institutions, little concern was expressed about the misuse of personal data during the trial. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03366-3.
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Rissanen R. A snapshot of an eCohort: A comparison of the LifeGene population at baseline with the Swedish general population. Scand J Public Health 2022; 50:930-934. [PMID: 35365049 DOI: 10.1177/14034948211047776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS With access to technologies and internet around the globe, opportunities have been provided to contact and recruit participants at a more rapid pace, without face-to-face contact. However, 'eCohorts' may yield substantial volunteer bias. Few studies have compared eCohorts to general populations or samples where traditional research methods have been applied. To our knowledge, no prior analyses have reported on Swedish-based LifeGene eCohort, in comparison with the Swedish general population. The aim of this study was to compare the LifeGene eCohort at baseline with the Swedish general population. METHODS The LifeGene eCohort (n = 39,862) was compared with the general population in Sweden represented by weighted data from the Swedish Public Health agency and Statistics Sweden. LifeGene is a nationwide project with yearly data collection. Descriptive statistics were used to compare demographic characteristics, and self-reported data on diagnosis of depression. RESULTS The LifeGene eCohort overrepresented younger people, females, those with a higher socio-economic status, non-smokers and people with a diagnosis of depression. Surprisingly, the eCohort included a larger percentage of people born outside of Sweden compared to the general population, which is not in line with previous studies. CONCLUSION The results show that the participants in the LifeGene eCohort are different regarding demographic variables and some health indicators from the Swedish general population. Hence, if comparisons are made between the LifeGene eCohort and a general population it becomes important to be aware of the differences that might exist between the different cohort populations and how these might affect the estimates.
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Affiliation(s)
- Ritva Rissanen
- Department of Global Public Health, Karolinska Institutet, Sweden
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Wexler A, Choi RJ, Ramayya AG, Sharma N, McShane BJ, Buch LY, Donley-Fletcher MP, Gold JI, Baltuch GH, Goering S, Klein E. Ethical Issues in Intraoperative Neuroscience Research: Assessing Subjects' Recall of Informed Consent and Motivations for Participation. AJOB Empir Bioeth 2022; 13:57-66. [PMID: 34227925 PMCID: PMC9188847 DOI: 10.1080/23294515.2021.1941415] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BackgroundAn increasing number of studies utilize intracranial electrophysiology in human subjects to advance basic neuroscience knowledge. However, the use of neurosurgical patients as human research subjects raises important ethical considerations, particularly regarding informed consent and undue influence, as well as subjects' motivations for participation. Yet a thorough empirical examination of these issues in a participant population has been lacking. The present study therefore aimed to empirically investigate ethical concerns regarding informed consent and voluntariness in Parkinson's disease patients undergoing deep brain stimulator (DBS) placement who participated in an intraoperative neuroscience study.MethodsTwo semi-structured 30-minute interviews were conducted preoperatively and postoperatively via telephone. Interviews assessed participants' motivations for participation in the parent intraoperative study, recall of information presented during the informed consent process, and participants' postoperative reflections on the research study.ResultsTwenty-two participants (mean age = 60.9) completed preoperative interviews at a mean of 7.8 days following informed consent and a mean of 5.2 days prior to DBS surgery. Twenty participants completed postoperative interviews at a mean of 5 weeks following surgery. All participants cited altruism or advancing medical science as "very important" or "important" in their decision to participate in the study. Only 22.7% (n = 5) correctly recalled one of the two risks of the study. Correct recall of other aspects of the informed consent was poor (36.4% for study purpose; 50.0% for study protocol; 36.4% for study benefits). All correctly understood that the study would not confer a direct therapeutic benefit to them.ConclusionEven though research coordinators were properly trained and the informed consent was administered according to protocol, participants demonstrated poor retention of study information. While intraoperative studies that aim to advance neuroscience knowledge represent a unique opportunity to gain fundamental scientific knowledge, improved standards for the informed consent process can help facilitate their ethical implementation.
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Affiliation(s)
- Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebekah J. Choi
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashwin G. Ramayya
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nikhil Sharma
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brendan J. McShane
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Love Y. Buch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Joshua I. Gold
- Department of Neuroscience, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon H. Baltuch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sara Goering
- Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Philosophy, University of Washington, Seattle, Washington, USA
| | - Eran Klein
- Center for Neurotechnology, University of Washington, Seattle, Washington, USA,Department of Philosophy, University of Washington, Seattle, Washington, USA,Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
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Vandormael A, Hachaturyan V, Adam M, Favaretti C, Gates J, Bärnighausen T. Effect of a story-based, animated video to reduce added sugar consumption: A web-based randomized controlled trial. J Glob Health 2021; 11:04064. [PMID: 34737864 PMCID: PMC8564880 DOI: 10.7189/jogh.11.04064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Short and animated story-based (SAS) videos, which can be rapidly distributed through social media channels, are a novel and promising strategy for promoting health behaviors. In this study, we evaluate the effectiveness of a SAS video intervention to reduce the consumption of added sugars. METHODS In December 2020, we randomized 4159 English-speaking participants from the United Kingdom (1:1:1) to a sugar intervention video, a content placebo video about sunscreen use (no sugar message), or a placebo video about earthquakes (no health or sugar message). We nested six list experiments in each arm and randomized participants (1:1) to a control list or a control list plus an item about consuming added sugars. The primary end-points were mean differences (on a scale of 0-100) in behavioral intent and direct restoration of freedom to consume added sugars. RESULTS Participants (N = 4013) who watched the sugar video had significantly higher behavioral intent to cut their daily intake of added sugar (mean difference (md) = 16.7, 95% confidence interval (CI) = 1.5-31.8, P = 0.031), eat fresh fruit daily (md = 16.7, 95% CI = 0.5-32.9, P = 0.043), and check food labels for sugar content (md = 20.5, 95% CI = 2.6-38.5, P = 0.025) when compared with the sunscreen (content placebo) video. The sugar video did not arouse intent to restore freedom and consume added sugars when compared with the two placebo videos. CONCLUSIONS Our SAS intervention video did not arouse reactance and increased short-term behavioral intent among participants to reduce their consumption of added sugars. SAS videos, which draw on best practices from the entertainment-education media, communication theory, and the animation industry, can be an effective strategy for delivering emotionally compelling narratives to promote health behavior change. TRIAL REGISTRATION German Clinical Trials Register: DRKS00022340.
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Affiliation(s)
- Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Violetta Hachaturyan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Maya Adam
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Caterina Favaretti
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jennifer Gates
- Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute (AHRI), Durban, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Characterization of Individuals Interested in Participating in a Phase I SARS-CoV-2 Vaccine Trial. Vaccines (Basel) 2021; 9:vaccines9101208. [PMID: 34696316 PMCID: PMC8538230 DOI: 10.3390/vaccines9101208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
The development of an effective vaccine against SARS-CoV-2 marks one of the highest priorities during the ongoing pandemic. However, recruitment of participants for clinical trials can be challenging, and recruitment failure is among the most common reasons for discontinuation in clinical trials. From 20 May 2020, public announcements about a planned phase I trial of the vaccine candidate MVA-SARS-2-S against SARS-CoV-2 began, and interested individuals started contacting the study team via designated e-mail. All emails received from these individuals between 20 May 2020–30 September 2020 were assessed. Of the 2541 interested volunteers, 62% contacted the study team within three days after the first media announcement. The average age was 61 years (range 16–100), 48% of volunteers were female and 52% male. A total of 274, 186, and 53 individuals, respectively, reported medical pre-conditions, were health-care workers, or had frequent inter-person contacts. In conclusion, we report a high number of volunteers, with a considerable percentage stating factors for an elevated risk to acquire COVID-19 or develop severe disease. Factors such as media coverage and the perception of a disease as an acute threat may influence the individual’s choice to volunteer for a vaccine trial. Our data provide first important insights to better understand reasons to participate in such trials to facilitate trial implementation and recruitment.
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Rodríguez-Torres E, González-Pérez MM, Díaz-Pérez C. Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews. Contemp Clin Trials Commun 2021; 23:100829. [PMID: 34401599 PMCID: PMC8358641 DOI: 10.1016/j.conctc.2021.100829] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The demand for clinical trial participants is today one of the highest it has ever been and continues to increase. At the same time, subject recruitment continues to be problematic and the major reason for clinical trial premature terminations. The literature on clinical trial recruitment, which spans several decades and includes hundreds of studies, has an abundance of findings that can be synthesized by way of an overview to provide a well-informed and complete picture of the factors that determine subject participation. OBJECTIVES An overview of the systematic reviews that report barriers and facilitators to clinical trial participation was conducted. The extracted data were synthesized, and a thematic framework of the factors that affect subject participation in clinical trials was developed. The overview extended across medical subjects and demographics. METHODS Thirty reviews that complied with the inclusion criteria were included. These reviews covered 753 relevant primary studies and reported 881 barriers and facilitators. The barriers and facilitators were thematically synthesized and a thematic framework of 20 themes was developed. The quality of the included reviews was assessed and reported. MAIN RESULTS Several opportunities to increase clinical trial participation, by developing interventions and changing the trial design, derived from an analysis of the thematic framework. That analysis also showed that most of the 20 themes operate mainly as a barrier or as a facilitator, and that most have an effect across medical subjects. As to the quality elements assessed, some reviews complied almost fully but most only partially.
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Affiliation(s)
| | | | - Clemente Díaz-Pérez
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, USA
- The Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico, Medical Sciences Campus, USA
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Faro EZ, Sauder KA, Anderson AL, Dunlop AL, Kerver JM, McGrath M, Roary M, Roman CW, Weidinger C, Huddleston KC. Characteristics of Environmental influences on Child Health Outcomes (ECHO) Cohorts Recruited During Pregnancy. MCN Am J Matern Child Nurs 2021; 46:230-235. [PMID: 33993167 PMCID: PMC8225566 DOI: 10.1097/nmc.0000000000000725] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to characterize the study designs, recruitment strategies, and other study characteristics among cohorts that initiated during pregnancy as part of the Environmental influences on Child Health Outcomes (ECHO) program. METHODS ECHO research programs (cohorts) were reviewed. Only those who had or were currently recruiting during pregnancy were surveyed in 2018 about research recruitment strategies (participant incentives, study burden, community collaboration, and cultural adaptations). Data are presented with cohort characteristics (location, inclusion and exclusion criteria, sociodemographics, medical information, behavioral factors, and biospecimens). RESULTS Forty-seven of the 84 ECHO pediatric cohorts recruited during pregnancy. Findings demonstrate various recruitment strategies, domains of data collection, and biospecimen collection are all characteristics of successful cohorts. CLINICAL IMPLICATIONS These data that include over 50,000 children from families across the country, many in underserved areas, will be used for research with the potential to lead to profound policy changes. Prenatal conditions such as maternal age, obesity, depression, and drug use can be examined using study data, including biological markers, from pregnancy through childbirth and into childhood and will inform national policies on the role of early life exposures and underlying mechanisms of disease progression.
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Pedersen SH, Bergman H, Berlin J, Hartvigsson T. Perspectives on Recruitment and Representativeness in Forensic Psychiatric Research. Front Psychiatry 2021; 12:647450. [PMID: 34220570 PMCID: PMC8247569 DOI: 10.3389/fpsyt.2021.647450] [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: 12/29/2020] [Accepted: 05/18/2021] [Indexed: 01/07/2023] Open
Abstract
Participant representativeness and statistical power are crucial elements of robust research with human participants, both of which relate to the successful recruitment of research participants. Nevertheless, such core features may often not be fully reported or duly considered in psychiatric research. Building on our experiences of collecting data in the context of forensic mental health services, we discuss issues regarding participant recruitment and representativeness in our field with its particular characteristics. A quick sampling and brief overview of the literature in four specialized forensic mental health journals is presented, demonstrating that published manuscripts rarely describe the data in sufficient detail for the reader to assess sample representativeness and statistical power. This lack of transparency leads not only to difficulties in interpreting the research; it also entails risks relating to the already meager evidence base of forensic mental health services being relevant only to a subset of patients. Accordingly, we provide suggestions for increased transparency in reporting and improved recruitment of research participants. We also discuss the balance of ethical considerations pertinent to the pursuit of increased participation rates in forensic mental health research.
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Affiliation(s)
- Sven H. Pedersen
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Bergman
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Berlin
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Research and Development, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Thomas Hartvigsson
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- School of Philosophy and Art History, Faculty of Humanities, University of Essex, Colchester, United Kingdom
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Terry N, Lipsky LM, Siega-Riz AM, Liu A, Nansel TR. The effect of remuneration schedule on data completion and retention in the pregnancy eating attributes study (PEAS). PLoS One 2021; 16:e0251533. [PMID: 33984020 PMCID: PMC8118263 DOI: 10.1371/journal.pone.0251533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
Maximizing data completion and study retention is essential in population research. This study examined the effect of remuneration schedule and data collection modality on data completion and retention in the Pregnancy Eating Attributes Study cohort. Participants (n = 458) completed online surveys and attended six in-person study visits. Initially, remuneration was a prespecified amount per visit, then was changed mid-study to be prorated based on the number of forms completed. Additionally, survey data collection modality was changed to in-person at the sixth study visit. In this secondary data analysis, there was no effect of remuneration schedule on withdrawal rates or time-to-withdrawal. Survey completion was significantly lower under prorated remuneration at the first visit but did not significantly differ at subsequent visits. The lump sum group had significantly greater odds of completely the first and second trimester dietary record (OR = 4.1, OR = 2.6, respectively) then the prorated group but were almost half as likely to complete the dietary record at the 6-month postpartum visit (OR = 0.5). Survey completion at sixth visit was significantly higher for in-person versus online completion (68.6% vs. 93.1%). Findings suggest that remuneration schedule and data collection modality can impact completion of self- reported assessments.
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Affiliation(s)
- Ndeah Terry
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Leah M. Lipsky
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Anna Maria Siega-Riz
- Department of Nutrition and Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Aiyi Liu
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
| | - Tonja R. Nansel
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United States of America
- * E-mail:
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Lynch HF, Darton TC, Levy J, McCormick F, Ogbogu U, Payne RO, Roth AE, Shah AJ, Smiley T, Largent EA. Promoting Ethical Payment in Human Infection Challenge Studies. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:11-31. [PMID: 33541252 DOI: 10.1080/15265161.2020.1854368] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To prepare for potential human infection challenge studies (HICS) involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SARS-CoV-2 HICS participants should be paid. Because the goals of paying HICS participants, as well as the relevant ethical concerns, are the same as those arising for other types of clinical research, the same basic framework for ethical payment can apply. This framework divides payment into reimbursement, compensation, and incentives, focusing on fairness and promoting adequate recruitment and retention as counterweights to concerns about undue inducement. Within the basic framework, several factors are especially salient for HICS, and for SARS-CoV-2 HICS in particular, including the nature of participant confinement, anticipated discomfort, risks and uncertainty, participant motivations, and trust. These factors are reflected in a payment worksheet created to help sponsors, researchers, and ethics reviewers systematically develop and assess ethically justifiable payment amounts.
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Wang Z, Chen G, Liu X, Liu C, Song Q, Wang J. The motivations, barriers, and sociodemographic characteristics of healthy Chinese volunteers in phase I research. Eur J Clin Pharmacol 2020; 77:557-568. [PMID: 33188452 DOI: 10.1007/s00228-020-03040-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the motivations, barriers, and sociodemographic characteristics of healthy Chinese volunteers in phase I research and to demonstrate the factors influencing their willingness to participate in subsequent trials. METHODS Healthy subjects who participated in seven phase I trials at two centres were invited to participate in the cross-sectional survey at discharge by anonymously and voluntarily completing the self-administered questionnaire. RESULTS From 442 subjects asked to complete the questionnaire, a response rate of 94.8% (419) was obtained, and 72.8% of the respondents had participated in a mean of 2.0 ± 1.3 previous studies. Over 90% of the subjects indicated that the main motivations to participate trials were to help more people, to contribute to scientific research, and to obtain money. The top 5 barriers were time inconvenience, advertisement sources, potential risks associated with the drug, privacy, and the route of drug administration. Nearly half (49.6%) of the subjects were willing to participate in the next trial. The factors impacting the willingness of the subjects to participate in subsequent trials were gender, screening frequency, enrolment frequency, level of understanding of the research, two motivating factors (to make money and receive a free check-up), and ten barriers (e.g. risk, distance, living conditions, and trust). CONCLUSIONS The majority of healthy Chinese subjects were young, were less well educated, had low income levels, and had poor medical insurance coverage. Given the multiple sources of motivation and complex barriers to trial participation, investigators and recruitment staff should consider ethics aspects to guarantee volunteer safety and well-being.
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Affiliation(s)
- Zejuan Wang
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China
| | - Gang Chen
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China
| | - Xiaona Liu
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China
| | - Chen Liu
- Phase I Clinical Trial Centre, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Qingkun Song
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Road, Haidian District, Beijing, 100038, People's Republic of China
| | - Jin Wang
- Department of Clinical Pharmacology, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, People's Republic of China.
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Davies E, Craufurd D, MacLeod R. "It's being part of the big picture, even though you're a tiny jigsaw piece"-motivations and expectations of individuals participating in the Enroll-HD observational study. J Community Genet 2020; 11:421-432. [PMID: 32157658 PMCID: PMC7475145 DOI: 10.1007/s12687-020-00459-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/21/2020] [Indexed: 01/28/2023] Open
Abstract
Predictive test guidelines for Huntington's disease (HD) recommend individuals are offered opportunities to participate in research regardless of test outcome. Consistent with most HD centres of excellence, the Manchester Centre for Genomic Medicine (MCGM) invites eligible individuals to participate in the observational study, Enroll-HD. Limited research has been conducted to date on the views of research participants and the possible impact of participation. The aim of this qualitative study was to explore the experiences of ten individuals taking part in the Enroll-HD study following pre-symptomatic testing for HD. Half of the individuals had tested positive for the HD mutation and the other half had tested negative. Participants were generally motivated to take part in the study by both personal and altruistic reasons. Overall, they were very positive about participation in Enroll-HD. Valuable aspects included good relationships with the research/clinical team, increased understanding of the condition, an enhanced self-image and a shared experience with affected parents. Issues for improvement to encourage participation included access to study site and more regular communication about study progress. Participants, while generally optimistic about research progress, were realistic about challenges.
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Affiliation(s)
- E Davies
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.
- Department of Clinical Genetics, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
| | - D Craufurd
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Jia P, Furuya-Kanamori L, Qin ZS, Jia PY, Xu C. Association between response rates and monetary incentives in sample study: a systematic review and meta-analysis. Postgrad Med J 2020; 97:501-510. [PMID: 32848082 DOI: 10.1136/postgradmedj-2020-137868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/12/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the effect of monetary incentive and the dose-response relationship of participants' response rates in surveys. METHODS Three databases were searched for randomised controlled trials (RCTs) that investigated the effect of monetary incentives on participants' first and final response rates. First response is defined as the responses after the participant was initially contacted and final response is defined as the responses after several reminders were sent. The potential dose-response relationship of the amount of monetary incentive on the relative response rate (RRR) was established by fitting a restricted cubic spline function based on the robust-error meta-regression model. RESULTS 105 RCTs were identified. The first RRR increased by 49% (RRR=1.49; 95% CI 1.29 to 1.72) when monetary incentives were provided. Dose-response analysis revealed that an amount between US$6.25 and US$8 had the maximum effect on increasing the first response rate. On average, the final RRR increased almost by 20% (RRR=1.18; 95% CI 1.11 to 1.25) with monetary incentive compared to no-monetary incentive. An amount between US$10 and US$15 had the maximum effect on the final response rate, with an increase in the final RRR of 34% (RRR=1.34; 95% CI 1.19 to 1.51). There was a significant increase in the response rate when two or more reminders were sent. CONCLUSION Monetary incentives and reminders improve the response rates. Future studies need to consider providing monetary incentives and sending at least two reminders to increase the response rate and reduce the chances of non-response bias.
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Affiliation(s)
- Pengli Jia
- School of Management, Shanxi Medical University, Taiyuan, China
| | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Zong-Shi Qin
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng-Yan Jia
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agricultural Science and Technology, Lanzhou University, Lanzhou, China
| | - Chang Xu
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
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Gelinas L, White SA, Bierer BE. Economic vulnerability and payment for research participation. Clin Trials 2020; 17:264-272. [DOI: 10.1177/1740774520905596] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There has been significant analysis of the ethical and regulatory issues involved with paying research participants, but less attention has been focused specifically on paying economically vulnerable individuals and the unique challenges it may present. This is important, as individuals of lower socio-economic standing are present in all disease groups and study populations. Moreover, clinical research is often conducted in economically under-developed locales, such as lower- or middle-income countries as well as impoverished locales of otherwise wealthy nations (such as, for example, rural Appalachia in the United States). Is it ethical to offer payment in such contexts? What are the ethical considerations relevant for determining payment rates and practices to individuals who are economically vulnerable? We offer an analysis of these issues, focusing on four unique areas of concern: (1) whether the risk of undue influence is greater for economically vulnerable individuals than for wealthier ones; (2) whether payment unacceptably raises the risk of ‘unjust influence’ or disproportionate representation of poor people in clinical research; (3) the positive reasons in favor of paying economically vulnerable people that stem from the ethical value of fairness; and (4) appropriate compensation rates for economically vulnerable populations. Our analysis supports the position that payment to economically vulnerable populations is ethically justified and indeed desirable when certain conditions are met.
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Affiliation(s)
- Luke Gelinas
- Advarra IRB, Columbia, MD, USA
- Multi-Regional Clinical Trials Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah A White
- Multi-Regional Clinical Trials Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara E Bierer
- Multi-Regional Clinical Trials Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Oguti B, Gibani M, Darlow C, Waddington CS, Jin C, Plested E, Campbell D, Jones C, Darton TC, Pollard AJ. Factors influencing participation in controlled human infection models: a pooled analysis from six enteric fever studies. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15469.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Enteric fever is an acute febrile-illness caused by infection with the human-restricted Salmonella serovars Typhi and Paratyphi. Controlled human infection models (CHIM) of S. Typhi and Paratyphi infection are used to accelerate vaccine development and to better understand host-pathogen interactions. The primary motivations for participants to take part in these studies are unknown. We studied participant motivations, attitudes and the factors influencing CHIM study participation. Methods: Participant surveys were nested in six enteric fever CHIM studies conducted at a single centre in Oxford, UK, between 2011 and 2017. All eligible participants received one invitation to complete an anonymous, self-administered paper or online survey on either day 28 or 60 after challenge. A descriptive analysis was performed on these pooled data. All studies were included, to minimize selection bias. Results: Survey response rates varied from 33.0%-86.1%, yielding 201 participants. In the cohort, 113/198(57.0%) were educated to bachelor’s level, 61.6% were employed, 30.3% were students and 4.6% were unemployed. The most commonly cited motivations for CHIM study participation were a desire to contribute to the progression of medicine (170/201; 84.6%); the prospect of financial reimbursement (166/201; 82.6%) and curiosity about clinical trials (117/201; 57.2%). The majority of respondents (139/197; 70.6%) reported that most people advised them against participation. Conclusion: Motivation to participate in a CHIM study was multi-factorial and heavily influenced by internal drivers beyond monetary reimbursement alone. High educational attainment and employment may be protective factors against financial inducement; however, further research is needed, particularly with CHIM studies expanding to low-income and middle-income countries.
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Lee HY, Lee MH, Sharratt M, Lee S, Blaes A. Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach. JMIR Mhealth Uhealth 2019; 7:e13256. [PMID: 31199340 PMCID: PMC6592403 DOI: 10.2196/13256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke’s thematic analysis was used to identify core themes. Results Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population’s perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, AL, United States
| | - Mi Hwa Lee
- School of Social Work, College of Heath and Human Performance, East Carolina University, Greenville, NC, United States
| | - Monica Sharratt
- School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, MN, United States
| | - Sohye Lee
- Loewenberg College of Nursing, University of Memphis, Memphis, TN, United States
| | - Anne Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Twin Cities, MN, United States
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Brönnimann BVE, Hou MY, Zembic A, Parkinson CX, Meier ML, Ettlin DA. Dentin hypersensitivity monitored by cold air quantitative sensory testing. J Oral Rehabil 2019; 46:549-555. [PMID: 30802997 DOI: 10.1111/joor.12781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Quantification of dentin hypersensitivity (DH) is challenging and requires standardised, graded stimulation by natural-like stimuli. OBJECTIVE The present study aimed at identifying DH subjects and longitudinally monitoring their pain thresholds by cold air quantitative sensory testing (QST). METHODS Subject recruitment started with an online DH questionnaire. Respondents were screened by dental air stimulation. Sensitising and habituating subjects were excluded. A recently developed stimulation device was employed for cold air QST. Single tooth DH was verified by applying an equi-intense stimulus to a control tooth. Descriptive statistics were applied for subject characteristics. Mean values were calculated for the stimulation parameters temperature and air flow. Reliability of temperatures for detecting pain and for evoking moderate pain over multiple time points within a 3-week period was analysed by two-way random single- and average-measure intra-class correlation coefficients. RESULTS A total of 353 persons completed the online DH questionnaire of which 117 were screened. Forty-four passed the screening, yet 15 were excluded for various reasons. Twenty-nine subjects were monitored by QST across 3 weeks. Results revealed a high intra-individual stability of the temperature inducing moderate to strong pain intensity (MPI) (single-measure ICC of TMPI 0.83, P < 0.001). Mean TMPI was -13.69°C, yet it highly varied among the 29 subjects (SD ± 10.04°C). CONCLUSIONS Using a novel approach, namely dental QST based on cold air stimuli, we present evidence for temporally stable DH perceptions over a 3-week period. The method fulfils international guideline requirements and is recommendable for obtaining valid results when testing various interventions for DH management.
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Affiliation(s)
- Ben V E Brönnimann
- Ambulatory Center for Psychiatry and Psychotherapy, Psychiatric Services of District Aargau, Aargau, Switzerland
| | - Mei-Yin Hou
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Anja Zembic
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Zahnmedizin Zurich Nord, Zurich, Switzerland
| | | | - Michael L Meier
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Balgrist University Hospital, Zurich, Switzerland
| | - Dominik A Ettlin
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Healthy Volunteers for Clinical Trials in Resource-Poor Settings: National Registries Can Address Ethical and Safety Concerns. Camb Q Healthc Ethics 2018. [PMCID: PMC6317110 DOI: 10.1017/s0963180118000476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Healthy volunteers (HVs) who participate in clinical trials are a vulnerable group that deserves specific protection. We assessed the number and types of studies that involve HVs around the world and outline the methodological barriers to their analysis. We found that tens of thousands of HVs are involved every year in clinical trials in a large variety of countries and that the overwhelming majority of studies are not “first-in-human” but pharmacokinetic studies. The two cornerstones for both ethical and safe participation of HVs in clinical trials are properly obtained informed consent and a minimization of exposure to risk, in particular by avoiding concealed participation in multiple trials. To minimize the risk of exploitation of HVs and their exposure to risk, we propose ways to ensure genuine informed consent, and advocate setting up national healthy volunteer registries as established in France and the U.K.
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van der Zande ISE, van der Graaf R, Hooft L, van Delden JJM. Facilitators and barriers to pregnant women's participation in research: A systematic review. Women Birth 2018; 31:350-361. [PMID: 29373261 DOI: 10.1016/j.wombi.2017.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/01/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although there is consensus among many that exclusion of pregnant women from clinical research should be justified, there is uncertainty as to whether and why pregnant women themselves would be willing to participate even if they were found to be eligible. The objective was to identify the reasons why pregnant women participate in clinical research and thereby to distinguish between facilitators and barriers. METHODS We conducted a systematic review of articles regarding pregnant women's reasons for participation in clinical research. We used the PubMed/MEDLINE, EMBASE, PsycINFO and CINAHL databases and retrieved additional articles through manually searching the reference lists. We included all articles that reported on pregnant women's reasons for participation in clinical research. We accumulated all reasons that were mentioned in the total of articles and collated them to themes, classifying these themes as a facilitator or a barrier. RESULTS The search identified thirty articles that met the inclusion criteria. Themes classified as facilitators: aspirational benefits, collateral benefits, direct benefits, third party influence and lack of inconvenience. Themes classified as barriers: inconveniences, risks, randomisation, lack of trust in research enterprise, medical reasons and third party influence. CONCLUSIONS Pregnant women report mostly altruistic and personal reasons for their willingness to participate in clinical research, while barriers primarily relate to inconveniences. It appears that pregnant women's described reasoning is similar to the described reasoning of non-pregnant research subjects. Enhancing the facilitators and overcoming the barriers is the next step to increase the evidence-base underlying maternal and foetal health.
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Affiliation(s)
- Indira S E van der Zande
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
| | - Rieke van der Graaf
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Epidemiology, Utrecht, The Netherlands.
| | - Johannes J M van Delden
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Medical Humanities, Utrecht, The Netherlands.
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Pieper D, Kotte N, Ober P. The effect of a voucher incentive on a survey response rate in the clinical setting: a quasi-randomized controlled trial. BMC Med Res Methodol 2018; 18:86. [PMID: 30115037 PMCID: PMC6097316 DOI: 10.1186/s12874-018-0544-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 07/24/2018] [Indexed: 11/16/2022] Open
Abstract
Background Financial rewards have been shown to be an important motivator to include normal healthy volunteers in trials. Less emphasis has been put on non-healthy volunteers. No previous study has investigated the impact of a voucher incentive for participants in a cross-sectional study in a clinical setting. The objective of this study was to examine the impact of a small voucher incentive on a survey response rate in a clinical setting at the point-of-care in a quasi-randomized controlled trial (q-RCT). Methods This was an ancillary study to a survey of patients subsequent to their appointment with a physician investigating physician-patient communication. We randomized participants to receive or not receive a voucher for a coffee (costs: 1 €) enclosed in the survey package. Alternation of groups was performed on a weekly basis. The exact Chi-square test was used to compare response rates between study arms. Results In total, 472 participants received the survey package. Among them, 249 participants were quasi-randomized to the voucher arm and 223 to the control group. The total response rate was 46%. The response rates were 48% in the voucher arm and 44% in the control group. The corresponding risk ratio was 1.09 (95% CI: 0.89, 1.32). Conclusions A small voucher incentive to increase the response rate in a survey investigating physician-patient communication was unlikely to have an impact. It can be speculated whether the magnitude of the voucher was too low to generate an impact. This should be further investigated in future real-world studies.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str, 200 51109, Cologne, Germany.
| | - Nina Kotte
- Institute for Research in Operative Medicine, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str, 200 51109, Cologne, Germany
| | - Peggy Ober
- Institute for Research in Operative Medicine, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str, 200 51109, Cologne, Germany
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Craig SR, Lahey T, Dixit A, Fordham von Reyn C. Altruism, Scepticism, and collective decision-making in foreign-born U.S. residents in a tuberculosis vaccine trial. BMC Public Health 2018; 18:535. [PMID: 29685114 PMCID: PMC5914029 DOI: 10.1186/s12889-018-5460-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current vaccine against tuberculosis, BCG, is effective when given in most TB-endemic countries at birth but has diminished efficacy against pulmonary TB after 15-20 years. As a result, new booster vaccines for adolescents and adults are being developed to realize the World Health Organization target of global elimination of TB by 2035. Multiple TB candidates thus are in active clinical development. METHODS One of these, DAR-901, is advancing in human clinical trials. These clinical trials are conducted in BCG immunized adults with and without HIV infection in order to assess safety and efficacy among the people most in need of a new vaccine. A Phase I dose escalation trial of DAR-901 in BCG-immunized adults with or without HIV infection was conducted between 2014 and 2016. This offered an unusual opportunity to qualitatively examine why foreign-born adults living in the United States - a poorly studied population - decide to participate, or not, in clinical trials. RESULTS We conducted a qualitative study of individuals who were recruited to participate in this Phase I vaccine trial, interviewing those who agreed and declined to participate. We found diverse motivations for participation or refusal; varied understandings of tuberculosis and vaccines; and complex views about how 'informed consent' can be at odds with cultural understandings of power, authority, and medical decision-making. These dynamics included: knowledge (direct or indirect) of tuberculosis, a desire to be altruistic and simultaneous hopes for personal gain as well as concerns over what remuneration for participation could mean, the importance of personal relationships with care providers in shaping volunteerism, concerns over privacy, and evidence of how culture and history shape medical decision-making. CONCLUSIONS This US-based trial, aimed at addressing a crucible global health issue, raises productive questions about the interface between altruism and scepticism regarding clinical research participation. TRIAL REGISTRATION NCT02063555 .
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Affiliation(s)
- Sienna R Craig
- Department of Anthropology, Dartmouth College, 6047 Silsby Hall, Hanover, NH, 03755, USA.
| | - Timothy Lahey
- Geisel School of Medicine, Dartmouth College, Hanover, USA
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First-Year University Students Who Self-Select into Health Studies Have More Desirable Health Measures and Behaviors at Baseline but Experience Similar Changes Compared to Non-Self-Selected Students. Nutrients 2018; 10:nu10030362. [PMID: 29547538 PMCID: PMC5872780 DOI: 10.3390/nu10030362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022] Open
Abstract
Studies demonstrate that first-year university students are at high risk for weight gain. These reports typically rely on self-selected participants. The purpose of this study was to explore if students who chose to participate in a health-based research study had more desirable health measures and behaviors than students who completed health assessments as part of a first-year seminar course. Health measures included blood pressure (BP), body mass index (BMI), and percent body fat. Health behaviors included dietary patterns (Starting the Conversation questionnaire) and alcohol use (Alcohol Use Disorders Identification Test-Consumption). A total of 191 (77% female) participants completed testing in the self-selected “Health Study” group, whereas 73 of the 91 students (80%, 55% female) enrolled in the “Seminar” allowed their data to be used for research purposes. Baseline measures favored Health Study participants, including but not limited to fewer participants with undesirable BMI (≥25.0 kg/m2; males and females) and a smaller percentage of participants with undesirable BP (systolic ≥120 mmHg and/or diastolic ≥80 mmHg; females only). Differences in dietary behaviors at baseline were inconsistent, but Seminar students engaged in more problematic alcohol-use behaviors. While both groups experienced undesirable changes in health measures over time, the degree of change did not differ between groups. Changes in health behaviors over time typically resulted in undesirable changes in the Seminar group, but the magnitude of change over time did not differ between groups. Thus, results from first-year university students who self-select into health studies likely underestimate the seriousness of undesirable health measures and behaviors but may accurately reflect the degree of change over time.
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Chen SC, Sinaii N, Bedarida G, Gregorio MA, Emanuel E, Grady C. Phase 1 healthy volunteer willingness to participate and enrollment preferences. Clin Trials 2017; 14:537-546. [PMID: 28766409 DOI: 10.1177/1740774517722131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Healthy volunteers in phase 1 clinical trials contribute to the development of safe drugs and other biologics and accept risks and burdens without anticipated health benefits from participation. Although emerging data have shown that healthy volunteers are influenced by risk, some still worry that financial incentives lead them to take on unreasonable risk. Yet little is known about healthy volunteers' preferences and how they make choices about enrolling in research studies. METHODS We surveyed 654 healthy volunteers at the end of their participation in a phase 1 Pfizer trial in the United States, Belgium, and Singapore to examine their reported willingness to enroll in studies of different types, with various procedures, and with possible side-effects. RESULTS The majority of respondents were willing to join many kinds of studies, but fewer were willing to participate in first-in-human vaccine studies or studies of psychiatric drugs than in other study types. With regard to procedures, a substantial proportion were unwilling to participate in studies that involved invasive procedures, such as a lumbar puncture (45.4%) and bone marrow biopsy (42.3%), but willing to participate in studies with less invasive procedures such as a computed tomography scan of the heart (86.8%), magnetic resonance imaging (87.4%), and skin allergy testing (86.8%). Although there was some variation by gender and region, the majority were willing to participate in studies with side-effects like pain (80%) or nausea and vomiting (64%), but only a minority were willing to join if the research drug would result in their having a one in a million chance of death (34.4%), a small chance of kidney damage (16.7%), or influence how their mind works (23.2%; Figure 4). CONCLUSION Our results suggest that healthy volunteers are willing to participate in a wide range of types of phase 1 clinical trials, and express preferences for low risk and familiar studies and study procedures, preferences which are partially affected by offers of payment.
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Affiliation(s)
- Stephanie C Chen
- 1 Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ninet Sinaii
- 2 Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Ezekiel Emanuel
- 4 Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Christine Grady
- 1 Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Mucka LE, Dayton CJ, Lawler J, Kirk R, Alfafara E, Schuster MM, Miller N, Ribaudo J, Rosenblum KL, Muzik M. MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM. Infant Ment Health J 2017; 38:536-550. [PMID: 28665536 DOI: 10.1002/imhj.21652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.
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Acharya Y, Norton EC, Lumeng JC. The Effect of Financial Compensation on Willingness to Supply a Child's Blood Sample: A Randomized Controlled Trial. Eval Health Prof 2017; 40:359-371. [PMID: 28730884 DOI: 10.1177/0163278717709563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medical researchers frequently need to collect blood samples from study participants. The determination of whether and how much compensation to provide to the participants is challenging. Institutional review boards typically allow researchers to provide a compensation that reimburses participants for their time and effort but is not so large as to be coercive. Using a randomized controlled trial, we estimate parents' responsiveness to financial compensation in terms of their willingness to provide their child's blood sample. We find that an additional dollar of compensation raises the willingness to provide a child's blood sample by about 0.5 percentage point at a base of 65%. This corresponds to an elasticity of .33. Using the findings, we provide general guidance on how compensation can be structured to strike a balance between appropriate compensation for participation and coercion.
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Affiliation(s)
- Yubraj Acharya
- 1 College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Edward C Norton
- 2 University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI, USA.,3 National Bureau of Economic Research, Cambridge, MA, USA.,4 Department of Economics, University of Michigan, Ann Arbor, MI, USA
| | - Julie C Lumeng
- 2 University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI, USA.,5 University of Michigan Medical School, Ann Arbor, MI, USA
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Roberts LW, Kim JP. Healthy individuals' perspectives on clinical research protocols and influences on enrollment decisions. AJOB Empir Bioeth 2016; 8:89-98. [PMID: 28949845 DOI: 10.1080/23294515.2016.1271062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Understanding the perspectives of healthy individuals is important ethically and for the advancement of science. We assessed perceptions of risk associated with research procedures, comparing views of healthy individuals with and without experience in clinical research, and the respondents' reported willingness to volunteer. METHODS Semistructured interviews and written surveys were conducted. Study participants were healthy individuals, half of whom were currently enrolled in clinical research and half of whom had no prior experience in clinical research. Participants were queried regarding seven "minimal risk" or "greater than minimal risk" protocol vignettes with procedures of three types: routine diagnostic tests, more burdensome (i.e., more effort or potential harm) diagnostic tests, and pharmacologic interventions. Views of influences on enrollment decisions were also assessed. RESULTS Most healthy individuals indicated that protocols with more burdensome or pharmacologic interventions were very risky (59%, 58%), as opposed to routine diagnostic test procedures (32%). Respondents' willingness to enroll in protocols varied by type of protocol (p value < .001) and was inversely correlated with risk assessments (regression coefficients from GEE = -0.4; -0.5; -0.7). The odds of healthy individuals with research experience expressing strong willingness to enroll in the depicted protocols were twice the odds of healthy individuals without research experience expressing the same level of willingness (OR = 2.0 95% CI: [1.1, 3.9]). Respondents did not assign risk categories as institutional review boards (IRBs) would, as indicated by low agreement (26%) between respondent and expert opinion on minimal risk protocols. CONCLUSIONS Perceptions of procedure risk appear to influence healthy individuals' willingness to enroll in protocols. Participants with experience in clinical research were far more likely to express willingness to enroll, a finding with important scientific and ethical implications. The lack of alignment between healthy individuals' views of protocol risk and IRB categorization warrants further study.
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Affiliation(s)
- Laura Weiss Roberts
- a Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine
| | - Jane Paik Kim
- a Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine
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Dainesi SM, Goldbaum M. Reasons behind the participation in biomedical research: a brief review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 17:842-51. [PMID: 25388485 DOI: 10.1590/1809-4503201400040004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/18/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Clinical research is essential for the advancement of Medicine, especially regarding the development of new drugs. Understanding the reasons behind patients' decision of participating in these studies is critical for the recruitment and retention in the research. OBJECTIVES To examine the decision-making of participants in biomedical research, taking into account different settings and environments where clinical research is performed. METHODS A critical review of the literature was performed through several databases using the keywords: "motivation", "decision", "reason", "biomedical research", "clinical research", "recruitment", "enrollment", "participation", "benefits", "altruism", "decline", "vulnerability" and "ethics", between August and November 2013, in English and in Portuguese. RESULTS The review pointed out that the reasons can be different according to some characteristics such as the disease being treated, study phase, prognoses and socioeconomic and cultural environment. Access to better health care, personal benefits, financial rewards and altruism are mentioned depending on the circumstances. CONCLUSION Finding out more about individuals' reasons for taking part in the research will allow clinical investigators to design studies of greater benefit for the community and will probably help to remove undesirable barriers imposed to participation. Improving the information to health care professionals and patients on the benefits and risks of clinical trials is certainly a good start.
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Affiliation(s)
| | - Moisés Goldbaum
- School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
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Koonrungsesomboon N, Laothavorn J, Karbwang J. Ethical considerations and challenges in first-in-human research. Transl Res 2016; 177:6-18. [PMID: 27337526 DOI: 10.1016/j.trsl.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
Abstract
First-in-human (FIH) research is a translational process to move a new potential therapy from bench to bedside. Major ethical challenges of an FIH trial arise because of the indeterminate nature of the risks involved and the controversial risk-benefit justification. Severe adverse events and death of subjects who participated in FIH research in the past have led to an increased attention on ethical considerations in the design and conduct of such research. Furthermore, novel therapies in the current decade, such as molecular-targeted, gene transfer, and pluripotent stem cells therapies, have led to numerous emerging ethical challenges or different ethical assessment and justification frameworks for FIH research. This article presents, discusses, and interlinks ethical considerations and challenges in FIH research through a review of related ethical principles and their application to each ethical issue with given examples. Possible solutions to address each ethical challenge are presented. The scope of this article focuses on 4 major ethical issues in FIH research: risk-benefit assessment and justification for the conduct of research, selection of a suitable target population, informed consent, and conflict of interest.
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Affiliation(s)
- Nut Koonrungsesomboon
- Department of Clinical Product Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Leading Program, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Junjira Laothavorn
- Chulabhon International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Juntra Karbwang
- Department of Clinical Product Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
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Fry CL, Hall W, Ritter A, Jenkinson R. The Ethics of Paying Drug Users Who Participate in Research: A Review and Practical Recommendations. J Empir Res Hum Res Ethics 2016; 1:21-36. [DOI: 10.1525/jer.2006.1.4.21] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The payment of research participants raises ethical and empirical questions that have special importance in addictions research involving drug-dependent participants. Despite a now large literature on human subjects payment, what is still needed is practical guidance for investigators and ethics committees. This paper reviews the literature on: Current payment practices and guidelines; defining features of undue and due incentives and fair reimbursement; and the significance of risks and harms that may arise from paying drug using participants. We conclude that research payments are ethically acceptable in most circumstances of addictions research, but should be closely scrutinized in situations where these may exacerbate existing harms or create additional risks for participants and investigators. General principles, key questions and procedural options are highlighted for an applied approach to ethical research payments. Future research directions are identified.
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Affiliation(s)
- Craig L. Fry
- Senior Research Fellow, Turning Point Alcohol and Drug Centre Inc., and Fellow, Department of Public Health, University of Melbourne
| | - Wayne Hall
- Professor of Public Health Policy, School of Population Health, University of Queensland
| | - Alison Ritter
- Associate Professor, National Drug and Alcohol Research Centre
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Zhang MW, Ho RC. Ethical Considerations for Clinical Research and Off-label Use of Ketamine to Treat Mood Disorders: The Balance Between Risks and Benefits. ETHICS & BEHAVIOR 2016. [DOI: 10.1080/10508422.2016.1189333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Melvyn W. Zhang
- Biomedical Global Institute of Healthcare Research and Technology (BIGHEART), National University of Singapore
| | - Roger C. Ho
- Department of Psychological Medicine, National University of Singapore
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Aasa U, Lundell S, Barnekow-Bergkvist M, Jansson E, Westerståhl M. The Swedish physical activity and fitness cohort born in 1958 - dropout analysis and overview at 36-year follow-up. Scand J Med Sci Sports 2016; 27:418-429. [DOI: 10.1111/sms.12665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- U. Aasa
- Department of Community Medicine and Rehabilitation; Umeå University; Umeå Sweden
| | - S. Lundell
- Department of Community Medicine and Rehabilitation; Umeå University; Umeå Sweden
| | | | - E. Jansson
- Department of Laboratory Medicine; Clinical Physiology Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital; SE-141 86 Stockholm Sweden
| | - M. Westerståhl
- Department of Laboratory Medicine; Clinical Physiology Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital; SE-141 86 Stockholm Sweden
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Factors Influencing the Research Participation of Adults with Autism Spectrum Disorders. J Autism Dev Disord 2016; 46:1793-805. [DOI: 10.1007/s10803-016-2708-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Guillemin M, Gillam L, Barnard E, Stewart P, Walker H, Rosenthal D. "We're checking them out": Indigenous and non-Indigenous research participants' accounts of deciding to be involved in research. Int J Equity Health 2016; 15:8. [PMID: 26772174 PMCID: PMC4715344 DOI: 10.1186/s12939-016-0301-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is important for researchers to understand the motivations and decision-making processes of participants who take part in their research. This enables robust informed consent and promotes research that meets the needs and expectations of the community. It is particularly vital when working with Indigenous communities, where there is a history of exploitative research practices. In this paper, we examine the accounts of Australian Indigenous and non-Indigenous research participants in terms of how and why they agree to take part in research. METHODS A qualitative research approach was employed to undertake individual interviews with 36 research participants in Victoria, Australia. Eight participants identified as Indigenous and 28 were non-Indigenous. Thematic analysis was used to interpret the data. RESULTS There were stark differences between Indigenous and non-Indigenous research participants in terms of why and how they decided to participate in research. For Indigenous participants, taking part in research was primarily to benefit their communities rather than for personal interests. Indigenous participants often started from a position of caution, and showed a considered and deliberate process of decision making. In weighing up their decision to participate, some Indigenous participants clearly articulated what was valued in conducting research with Indigenous communities, for example, honesty, reciprocity, and respect; these values were explicitly used to assist their decision whether or not to participate. This was in contrast to non-Indigenous participants who took researchers' claims on face value, and for whom deciding to participate in research was relatively straightforward. The motivations to participate of non-Indigenous participants were due to personal interests, a desire to help others, or trust in the medical practitioner who recruited them for the research project. CONCLUSION Understanding research participants' motivations about taking part in research is important. This is particularly relevant for Indigenous communities where there is a reported history of research abuse leading to mistrust. This understanding can lead to research practice that is more respectful and responsive to the needs of Indigenous communities and abides by the values of Indigenous communities. Moreover it can lead to more ethical and respectful research practice for all.
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Affiliation(s)
- Marilys Guillemin
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Lynn Gillam
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Emma Barnard
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Paul Stewart
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Hannah Walker
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Doreen Rosenthal
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
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Mngadi KT, Frohlich J, Montague C, Singh J, Nkomonde N, Mvandaba N, Ntombeka F, Luthuli L, Abdool Karim Q, Mansoor L. Challenges with participant reimbursement: experiences from a post-trial access study. JOURNAL OF MEDICAL ETHICS 2015; 41:909-913. [PMID: 26392172 DOI: 10.1136/medethics-2013-101899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 08/30/2015] [Indexed: 06/05/2023]
Abstract
Reimbursement of trial participants remains a frequently debated issue, with specific guidance lacking. Trials combining post-trial access and implementation science may necessitate new strategies and models. CAPRISA 008, a post-trial access study testing the feasibility of using family planning services to rollout a prelicensure HIV prevention intervention, tried to balance the real-life scenario of no reimbursement for attendance at public sector clinics with that of a trial including some visits that focused on research procedures and others that focused on standard of care procedures. A reduced reimbursement was offered for 'standard of care' visits, meant primarily to cover transport costs to and from the clinic only. This impacted negatively on accrual, retention and participant morale, primarily due to the protracted delay in regulatory approval, during which time, the costs of living, including travel costs had increased. Relevant guidelines were reviewed and institutional policy was updated to incorporate the South African National Health Research Ethics Committee guidelines on reimbursement (taking into account participant time, travel and inconvenience). The reimbursement amount for 'standard of care' visits was increased accordingly. The question remains whether a trial that combines post-trial access with implementation science, with clear benefits for the participants and the provision of above standard medical care, should have reimbursement rates that approach those of a proof-of-concept trial, for 'standard of care' visits.
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Affiliation(s)
- Kathryn Therese Mngadi
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa School of Laboratory Medicine and Medical Sciences, University of Kwazulu Natal, South Africa
| | - Janet Frohlich
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa
| | - Carl Montague
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa
| | - Jerome Singh
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa Department of HIV Prevention, Dalla Lana School of Public Health and Joint Centre for Bioethics, University of Toronto, Toronto, Alberta, Canada
| | - Nelisiwe Nkomonde
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa
| | - Nomzamo Mvandaba
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa
| | - Fanelesibonge Ntombeka
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa
| | - Londiwe Luthuli
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa
| | - Quarraisha Abdool Karim
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa Department if Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Leila Mansoor
- Department of HIV Prevention, Centre for the AIDS Program of Research in South Africa, University of Kwazulu Natal, Durban, Kwazulu Natal, South Africa
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Picillo M, Kou N, Barone P, Fasano A. Recruitment strategies and patient selection in clinical trials for Parkinson's disease: Going viral and keeping science and ethics at the highest standards. Parkinsonism Relat Disord 2015; 21:1041-8. [PMID: 26228079 DOI: 10.1016/j.parkreldis.2015.07.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/16/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Enrollment of an adequate number of suitable candidates is a critical component of good quality randomized controlled trials (RCTs). Parkinson's disease (PD) is a highly heterogeneous disease and recruiting a large and homogeneous sample of patients is often challenging. Further, PD patients are often elderly, cognitively impaired and disabled, thus requiring the assistance from their caregivers for participation in RCTs. Only a limited number of studies have explored the effectiveness of recruitment strategies and PD patient selection in clinical trials. We aim to review the four crucial recruitment components of RCTs (i.e. infrastructure, nature of the research, recruiter characteristics and participant characteristics) with particular implications in PD, and to explore strategies to improve recruitment and patient selection in RCTs in PD. CONCLUSION Movement disorders centers have a key role in managing recruitment and patient selection in RCTs in PD. Key recommendations within the infrastructure component are to improve trust and communication between patient and participant, and to consider the diversity, perceived disadvantages, and health care accessibility of the participants. Further, study designs that involve participant's opinions and considers placebo and lessebo effects are highly recommended for the nature of the research component of RCTs. Finally, a team-based approach with recruiters and participants that establishes relationships between researchers and the community and addresses ethical considerations are encouraged as part of the recruiters and participants components. Finally, we envisage a greater usage of internet-based strategies for clinical trials recruitment in PD with the goal of 'going viral' with the recruitment.
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Affiliation(s)
- Marina Picillo
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, ON, Canada; Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nancy Kou
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Paolo Barone
- Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, ON, Canada.
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Gunasekera RC, Moss J, Crank H, Mitchell PA, Nawaz S, Tew GA. Patient recruitment and experiences in a randomised trial of supervised exercise training for individuals with abdominal aortic aneurysm. JOURNAL OF VASCULAR NURSING 2015; 32:4-9. [PMID: 24534082 DOI: 10.1016/j.jvn.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/14/2013] [Accepted: 05/21/2013] [Indexed: 11/17/2022]
Abstract
We sought to describe patient recruitment and experiences in a randomised controlled trial of a 12-week (thrice weekly) supervised exercise program for patients with small abdominal aortic aneurysm (AAA). Potential patients were identified via AAA surveillance lists and vascular clinics and invited to participate in the study. Upon completion of baseline assessments, patients were randomly allocated 1:1 to exercise or usual care. Patients completing the exercise arm were invited to attend a focus group session to explore experiences of diagnosis, management of condition, trial recruitment, and expectations and experiences of the exercise program. Between January 2010 and September 2011, 545 patients were identified. The response rate to postal invitation was 81.7% (445/545), with 108 patients responding as "interested." Only 28 of these patients were eligible and recruited (46.7% of recruitment target), yielding an overall recruitment rate of 5.1%. However, the estimated recruitment rate among eligible patients was 23.7%. Twenty-five patients (89.3%) completed the study, and compliance to the exercise program was 94%. Participants attending the focus group session indicated that the exercise program was manageable, beneficial, and enjoyable. The feasibility of supervised exercise training in individuals with small AAA remains unclear. Our study revealed a poorer than expected recruitment rate, but good compliance to, and feedback for, the exercise intervention. We present potential explanations for these findings and suggestions for future trials involving similar populations.
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Affiliation(s)
- Roshan C Gunasekera
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
| | - James Moss
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
| | - Helen Crank
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
| | - Pauline A Mitchell
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
| | - Shah Nawaz
- Sheffield Vascular Institute, Northern General Hospital, Sheffield, United Kingdom
| | - Garry A Tew
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom.
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Jennings CG, MacDonald TM, Wei L, Brown MJ, McConnachie L, Mackenzie IS. Does offering an incentive payment improve recruitment to clinical trials and increase the proportion of socially deprived and elderly participants? Trials 2015; 16:80. [PMID: 25888477 PMCID: PMC4364332 DOI: 10.1186/s13063-015-0582-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/26/2015] [Indexed: 11/24/2022] Open
Abstract
Background Patient recruitment into clinical trials is a major challenge, and the elderly, socially deprived and those with multiple comorbidities are often underrepresented. The idea of paying patients an incentive to participate in research is controversial, and evidence is needed to evaluate this as a recruitment strategy. Method In this study, we sought to assess the impact on clinical trial recruitment of a £100 incentive payment and whether the offer of this payment attracted more elderly and socially deprived patients. A total of 1,015 potential patients for five clinical trials (SCOT, FAST and PATHWAY 1, 2 and 3) were randomised to receive either a standard trial invitation letter or a trial invitation letter containing an incentive offer of £100. To receive payment, patients had to attend a screening visit and consent to be screened (that is, sign a consent form). To maintain equality, eventually all patients who signed a consent form were paid £100. Results The £100 incentive offer increased positive response to the first invitation letter from 24.7% to 31.6%, an increase of 6.9% (P < 0.05). The incentive offer increased the number of patients signing a consent form by 5.1% (P < 0.05). The mean age of patients who responded positively to the invitation letter was 66.5 ± 8.7 years, whereas those who responded negatively were significantly older, with a mean age of 68.9 ± 9.0 years. The incentive offer did not influence the age of patients responding. The incentive offer did not improve response in the most socially deprived areas, and the response from patients in these areas was significantly lower overall. Conclusion A £100 incentive payment offer led to small but significant improvements in both patient response to a clinical trial invitation letter and in the number of patients who consented to be screened. The incentive payment did not attract elderly or more socially deprived patients. Trial registrations Standard care versus Celecoxib Outcome Trial (SCOT) (ClinicalTrials.gov identifier: NCT00447759). Febuxostat versus Allopurinol Streamlined Trial (FAST) (EudraCT number: 2011-001883-23). Prevention and Treatment of Hypertension with Algorithm Guided Therapy (British Heart Foundation funded trials) (PATHWAY) 1: Monotherapy versus dual therapy for initiating treatment (EudraCT number: 2008-007749-29). PATHWAY 2: Optimal treatment of drug-resistant hypertension (EudraCT number: 2008-007149-30). PATHWAY 3: Comparison of single and combination diuretics in low-renin hypertension (EudraCT number: 2009-010068-41). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0582-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudine G Jennings
- Medicines Monitoring Unit (MEMO), University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Thomas M MacDonald
- Medicines Monitoring Unit (MEMO), University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Li Wei
- School of Pharmacy, University College London, London, WC1E 6BT, UK.
| | - Morris J Brown
- University of Cambridge, Addenbrookes Centre for Clinical Investigation (ACCI), Addenbrookes Hospital, Cambridge, CB2 2QQ, UK.
| | - Lewis McConnachie
- Medicines Monitoring Unit (MEMO), University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Isla S Mackenzie
- Medicines Monitoring Unit (MEMO), University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
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Luzurier Q, Damm C, Lion F, Daniel C, Pellerin L, Tavolacci MP. Strategy for recruitment and factors associated with motivation and satisfaction in a randomized trial with 210 healthy volunteers without financial compensation. BMC Med Res Methodol 2015; 15:2. [PMID: 25559410 PMCID: PMC4293827 DOI: 10.1186/1471-2288-15-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/23/2014] [Indexed: 11/22/2022] Open
Abstract
Background The aim was to describe a strategy for recruitment of healthy volunteers (HV) to a randomized trial that assessed the efficacy of different telephone techniques to assist HV in performing cardiac massage for vital emergency. Participation in the randomized trial was not financially compensated, however HV were offered emergency first-aid training. We also studied factors associated with HV motivation and satisfaction regarding participation in the trial. Methods Strategy for recruitment of 210 HV aged 18 to 60 years was based on: (1) the updated records of all telephone number since January 2000 of HV registered in the Rouen Clinical Investigation Centre HV database, (2) a communication campaign for the general public focussing on posters and media advertisements. Data on the recruitment, socio-demographics, motivation and satisfaction of the 210 HV were collected by anonymous self-administered questionnaire. Results Of the 210 HV included, 63.3% (n = 133) were recruited from the HV database and 36.7% (n = 77) by the communication campaign. On the one hand, the HV database enabled screening of 1315 HV, 54.8% (n = 721) of whom were reached by phone, 55.2% (n = 398) of these latter accepted to participate in the study and 10.1% of the initial screening (n = 133) were finally included. One the other hand, for the 77 HV not recruited from the HV database, word-of-mouth (56.1%) was the main means of recruitment. The male/female ratio of the 210 HV was 0.5 and mean age 43.5 years (Standard Deviation = 12.4). The main motivations given for participating in the trial were to support research (87.6%) and receive emergency first-aid training (85.7%). Overall satisfaction with the welcome process was significantly higher for older HV (46–60 years) (adjusted odds ratio (AOR): 3.44; 95% confidence interval (95% CI): 1.48-7.99), and for HV in management jobs (AOR: 4.26; 95% CI: 1.22-14.87). Satisfaction with protocol management was higher for women (AOR: 2.33; 95% CI: 1.18-4.60) and for older HV (46–60 years) (AOR: 4.76; 95% CI: 1.97-11.52). Conclusions Recruitment of non-compensated HV required broad screening with a primary HV database alongside word-of-mouth communication which seemed more efficient than media advertising. To enhance HV recruitment to randomized trials without financial compensation it seems crucial to provide them not only with a direct interest but also to ensure their satisfaction.
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Affiliation(s)
| | | | | | | | | | - Marie-Pierre Tavolacci
- Rouen University Hospital, Clinical Investigation Centre - Biological Resource Centre, CIC-CRB, Inserm 1404, 1 rue de Germont, F 76031 Rouen Cedex, France.
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Schembri N, Hernandez-Jover M, Toribio JALML, Holyoake PK. On-farm characteristics and biosecurity protocols for small-scale swine producers in eastern Australia. Prev Vet Med 2014; 118:104-16. [PMID: 25433716 DOI: 10.1016/j.prevetmed.2014.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 11/08/2014] [Accepted: 11/10/2014] [Indexed: 11/25/2022]
Abstract
Pigs are considered high risk for the introduction and spread of foot and mouth disease (FMD) in Australia. Facilities where animals from different origins are commingled, such as saleyards, pose a high risk for disease spread. Sound on-farm management practices and biosecurity protocols are the first line of defence against a potential on-farm disease outbreak. This study evaluated the practices of 104 producers (vendors who sold pigs and purchasers of live pigs for grow-out) who traded pigs at 6 peri-urban and rural saleyards in eastern Australia. Specifically, management and on-farm biosecurity practices were assessed using an in-depth questionnaire. Univariable and multivariable logistic regression analyses were used to investigate (1) producer associations: producer type, State, motivation to keep pigs, farm type, gender, years having owned pigs, and the acquisition of formal livestock qualifications; and (2) pig associations: herd size, housing, management (husbandry and feeding) practices and biosecurity (including pig movement) practices. Backyard operations (<20 sows) were undertaken by 60.6% of participants, followed by small-scale pig operations (28.8%; 21-100 sows). Few producers (16.3%) reported residing in close proximity (<5 km) to commercial operations; however, less rural producers had neighbouring hobby pig operations within 5 km of their property (P=0.033). Motivation for keeping pigs was significantly associated with a number of biosecurity practices. Producers who kept pigs for primary income were more likely to provide footwear precautions (P=0.007) and ask visitors about prior pig contacts (P=0.004). Approximately 40% of backyard and small-scale producers reported not having any quarantine practices in place for incoming pigs, compared to only 9.1% among larger producers. The main reasons cited for not adopting on-farm biosecurity practices in this study included having no need on their property (43.1%) and a lack of information and support (by the industry and/or authorities; 18.5%). Up to three-quarters of all producers maintained an open breeding herd, regularly introducing new pigs to the main herd. Saleyards are an important source of income for backyard and small-scale producers as well as an important risk factor for the introduction and dissemination of endemic and emerging animal diseases. Differing management and biosecurity practices as well as the motivations of these producers keeping pigs in small numbers and trading pigs at saleyards need to be taken into account in the development of successful biosecurity extension programmes for this sector of the Australian pork industry.
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Affiliation(s)
- N Schembri
- The University of Sydney, Farm Animal and Veterinary Public Health, 425 Werombi Road, Camden, NSW 2570, Australia.
| | - M Hernandez-Jover
- The University of Sydney, Farm Animal and Veterinary Public Health, 425 Werombi Road, Camden, NSW 2570, Australia; Graham Centre for Agricultural Innovation (NSW Department of Primary Industries and Charles Sturt University), School of Animal and Veterinary Sciences, Locked Bag 588, Wagga Wagga, NSW 2678, Australia
| | - J-A L M L Toribio
- The University of Sydney, Farm Animal and Veterinary Public Health, 425 Werombi Road, Camden, NSW 2570, Australia
| | - P K Holyoake
- The University of Sydney, Farm Animal and Veterinary Public Health, 425 Werombi Road, Camden, NSW 2570, Australia; Victorian Department of Primary Industries, Pig Health and Research Unit, Epsom, VIC 3551, Australia
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Valera P, Cook S, Macklin R, Chang Y. Conducting Health Disparities Research with Criminal Justice Populations: Examining Research, Ethics, and Participation. ETHICS & BEHAVIOR 2014; 24:164-174. [PMID: 25045243 PMCID: PMC4101906 DOI: 10.1080/10508422.2013.826581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study explored the challenges of informed consent and understanding of the research process among Black and Latino men under community supervision (e.g., parole and/or probation). Between February and October 2012, we conducted cognitive face-to-face interviews using open-ended questions on the significant areas of research participation (i.e., the informed consent process, confidentiality, compensation, what is meant by human subject and clinical trials) among 259 men aged 35 to 67 under community supervision in Bronx, New York. Content analysis of the open-ended questions revealed limited knowledge concerning the understanding of research participation. The study participants appeared to generally understand concepts such as compensation after research participation and confidentiality. Participants demonstrated a lack of understanding of certain aspects of the research process-informed consent, human subject, Institutional Review Board, and clinical trials. These findings are informative to researchers conducting studies with criminal justice populations and Institutional Review Boards reviewing research studies.
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Affiliation(s)
- Pamela Valera
- Department of Sociomedical Sciences Columbia University Mailman School of Public Health
| | - Stephanie Cook
- Department of Health Behavior and Health Education University of Michigan School of Public Health
| | - Ruth Macklin
- Department of Epidemiology & Population Health Albert Einstein School of Medicine
| | - Yvonne Chang
- Department of Sociomedical Sciences Columbia University Mailman School of Public Health
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Wright MS, Robertson CT. Heterogeneity in IRB policies with regard to disclosures about payment for participation in recruitment materials. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2014; 42:375-382. [PMID: 25264094 DOI: 10.1111/jlme.12153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although the Federal Common Rule requires that informed consent documents include all material information, it does not specify the content of materials used to recruit human subjects. In particular, there is no federal regulation relating to how payment for research participation is to be advertised. Rather, the FDA has issued guidance, advising researchers not to emphasize payment information. In order to determine how IRBs have interpreted this guidance, we coded the policies of the top 100 institutions by receipt of NIH funding, in order to determine whether they require, permit, or forbid researchers to disclose the amount of compensation in their recruitment materials. We found that the vast majority of institutions implicitly or explicitly permit such disclosures; however, there are a significant number of IRBs at each extreme, some discouraging or forbidding with others encouraging or mandating such disclosures. Such heterogeneity in local regulations suggests that IRB discretion may be imposing costs on human subjects and the scientific enterprise that outweigh the benefits. We suggest that this heterogeneity should be resolved towards a national consensus on permissibility.
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Affiliation(s)
- Megan S Wright
- J.D. candidate (2016) at Yale Law School in New Haven, CT
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Townsend A, Cox SM. Accessing health services through the back door: a qualitative interview study investigating reasons why people participate in health research in Canada. BMC Med Ethics 2013; 14:40. [PMID: 24119203 PMCID: PMC3853104 DOI: 10.1186/1472-6939-14-40] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is extensive information about why people participate in clinical trials, studies are largely based on quantitative evidence and typically focus on single conditions. Over the last decade investigations into why people volunteer for health research have become increasingly prominent across diverse research settings, offering variable based explanations of participation patterns driven primarily by recruitment concerns. Therapeutic misconception and altruism have emerged as predominant themes in this literature on motivations to participate in health research. This paper contributes to more recent qualitative approaches to understanding how and why people come to participate in various types of health research. We focus on the experience of participating and the meanings research participation has for people within the context of their lives and their health and illness biographies. METHODS This is a qualitative exploratory study informed by grounded theory strategies. Thirty-nine participants recruited in British Columbia and Manitoba, Canada, who had taken part in a diverse range of health research studies participated in semi-structured interviews. Participants described their experiences of health research participation including motivations for volunteering. Interviews were recorded, transcribed, and analyzed using constant comparisons. Coding and data management was supported by Nvivo-7. RESULTS A predominant theme to emerge was 'participation in health research to access health services.' Participants described research as ways of accessing: (1) Medications that offered (hope of) relief; (2) better care; (3) technologies for monitoring health or illness. Participants perceived standard medical care to be a "trial and error" process akin to research, which further blurred the boundaries between research and treatment. CONCLUSIONS Our findings have implications for recruitment, informed consent, and the dichotomizing of medical/health procedures as either research or treatment. Those with low health status may be more vulnerable to potential coercion, suggesting the need for a more cautious approach to obtaining consent. Our findings also indicate the need for boundary work in order to better differentiate treatment and research. It is important however to acknowledge a categorical ambiguity; it is not always the case that people are misinformed about the possible benefits of research procedures (i.e., therapeutic misconception); our participants were aware that the primary purpose of research is to gain new knowledge yet they also identified a range of actual health benefits arising from their participation.
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Affiliation(s)
- Anne Townsend
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
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Doshi MS, Kulkarni SP, Ghia CJ, Gogtay NJ, Thatte UM. Evaluation of factors that motivate participants to consent for non-therapeutic trials in India. JOURNAL OF MEDICAL ETHICS 2013; 39:391-396. [PMID: 23475804 DOI: 10.1136/medethics-2012-100755] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND RATIONALE Several factors that motivate individuals to participate in non-therapeutic studies have been identified. This study was conducted as limited data is available regarding these motivations from developing countries. METHODS This was a single-centre study conducted over 4 months in which a questionnaire was administered to 102 healthy participants and 16 patient participants who had earlier taken part in non-therapeutic studies at our centre. Descriptive statistics and univariate analysis were used to analyse data. RESULTS The most common motivation among healthy participants was financial reward (65%) followed by altruism, free medical check up, curiosity and personal health benefit. Patient participants, however, most commonly said they consented to take part in the trial as they were 'invited to participate by the treating physician' (88%). In comparison with the patient participants, healthy participants were more likely to be satisfied with the financial reward (p=0.02), and recommend participation in studies to friends or relatives (p=0.0013). CONCLUSIONS The most common motivating factor to participate in non-therapeutic studies appears to be different for healthy participants (financial reward) and patient participants (invitation to participate by the physician). Participants also felt that adequate information and care was given to them during the trial, and that they would participate in future clinical studies, and would also recommend such studies to their friends.
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Affiliation(s)
- Maulik Sumantbhai Doshi
- Department of Clinical Pharmacology, 1st Floor, MSB, Seth GS Medical College and KEM Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra 400012, India.
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The use of students as participants in a study of eating disorders in a developing country: case study in the ethics of mental health research. J Nerv Ment Dis 2012; 200:265-70. [PMID: 22373768 DOI: 10.1097/nmd.0b013e318247d262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes the ethical analysis of an eating disorder study in which a university-based researcher in South Africa set out to establish the cross-cultural validity of the Eating Disorders Inventory. The following ethical issues are considered in the analysis: study design, social value, study population, risks and benefits, oversight, informed consent, and posttrial obligations. The ethics analysis is based on an adaptation of the structured framework proposed by Emanuel et al. (The Oxford textbook of clinical research ethics; pp. 123-133, 2008) for ethical research in developing countries. The analysis reveals that research that, on superficial analysis, seems to be low risk and noninterventional can result in adverse psychosocial effects and complexities for research participants and researchers alike. The study underlines the need for special ethics scrutiny of mental health-related research proposals involving students as research participants, especially when conducted by their own teachers.
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Fisher JA, Kalbaugh CA. Challenging assumptions about minority participation in US clinical research. Am J Public Health 2011; 101:2217-22. [PMID: 22021285 DOI: 10.2105/ajph.2011.300279] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Although extensive research addresses minorities' low participation in clinical research, most focuses almost exclusively on therapeutic trials. The existing literature might mask important issues concerning minorities' participation in clinical trials, and minorities might actually be overrepresented in phase I safety studies that require the participation of healthy volunteers. It is critical to consider the entire spectrum of clinical research when discussing the participation of disenfranchised groups; the literature on minorities' distrust, poor access, and other barriers to trial participation needs reexamination. Minority participation in clinical trials is an important topic in public health discussions because this representation touches on issues of equality and the elimination of disparities, which are core values of the field.
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Affiliation(s)
- Jill A Fisher
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN 37203, USA.
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Abstract
Despite federal initiatives to increase research and expand data about the effectiveness and safety of medications in children, data are still limited for this population. One of the most salient barriers to conducting pediatric clinical trials involves participant recruitment. In this article, we summarize recruitment challenges including a lack of research infrastructure, the need to properly define appropriate use of incentives and payments, and inconsistencies in the current use of payments and incentives. We also searched the Centerwatch.com and ClinicalTrials.gov databases for updated data on current practices in pediatric participant compensation/payment. We provide recommendations for tackling current barriers to recruiting and retaining children and families in clinical trials.
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Affiliation(s)
- Carl L Tishler
- Department of Psychology, Ohio State University, 1776 E Broad St, Columbus, OH 43203, USA.
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