1
|
Randell RL, Hornik CP, Curtis L, Hernandez AF, Denwood T, Nebeker C, Sugarman J, Tyl B, Murakami M, Oley Wilberforce L, Pagoto S, Vedin O, Andersson T, Carrasquillo O, Dolor R, Kollins SH, Pellegrino J, Ranney ML. "Click and mortar" opportunities for digitization and consumerism in trials. Contemp Clin Trials 2023; 132:107304. [PMID: 37481202 PMCID: PMC10530120 DOI: 10.1016/j.cct.2023.107304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Digitization (using novel digital tools and strategies) and consumerism (taking a consumer-oriented approach) are increasingly commonplace in clinical trials, but the implications of these changes are not well described. METHODS We assembled a group of trial experts from academia, industry, non-profit, and government to discuss implications of this changing trial landscape and provide guidance. RESULTS Digitization and consumerism can increase the volume and diversity of trial participants and expedite recruitment. However, downstream bottlenecks, challenges with retention, and serious issues with equity, ethics, and security can result. A "click and mortar" approach, combining approaches from novel and traditional trials with the thoughtful use of technology, may optimally balance opportunities and challenges facing many trials. CONCLUSION We offer expert guidance and three "click and mortar" approaches to digital, consumer-oriented trials. More guidance and research are needed to navigate the associated opportunities and challenges.
Collapse
Affiliation(s)
- Rachel L Randell
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Christoph P Hornik
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Lesley Curtis
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Adrian F Hernandez
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Tom Denwood
- Population Health Partners LLPShort Hills, NJ, USA
| | - Camille Nebeker
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine,Johns Hopkins University, Baltimore, MD, USA
| | - Benoit Tyl
- Bayer Healthcare SAS, La Garenne Colombes, France
| | | | | | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | | | - Olveen Carrasquillo
- Division of General Internal Medicine Co-Director, Miami Clinical & Translational Science Institute (CTSI), University of Miami, Miami, FL, USA
| | - Rowena Dolor
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Scott H Kollins
- Duke University, School of Medicine, Durham, NC, USA; Akili, Inc, Boston, MA, USA
| | | | - Megan L Ranney
- School of Public Health, Yale University, New Haven, CT, USA
| |
Collapse
|
2
|
Davis MD, Lohm D, Flowers P, Whittaker A. Antibiotic assemblages and their implications for the prevention of antimicrobial resistance. Soc Sci Med 2022; 315:115550. [PMID: 36410136 DOI: 10.1016/j.socscimed.2022.115550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
Individual antibiotic use for common infections is a focus for public health efforts seeking to prevent antimicrobial resistance (AMR). These approaches employ a binary opposition of responsible and irresponsible antibiotic use with a focus on the knowledge, behaviours and intentions of the individual. To overcome these unhelpful tendencies and reveal new entry points for AMR prevention, we adopted assemblage theory to analyse personal experience narratives on individual antibiotic use in community settings. Antibiotic use was irregular, situationally diverse and shaped by factors not always under personal control. Individuals were focussed on preventing, moderating and treating infections that threatened their health. Our analysis shows that antibiotic assemblages are both cause and effect of individual efforts to manage infections. We suggest that AMR prevention needs to look beyond the antibiotic as object and the (ir)responsible use binary to engage with the antibiotic effects individuals seek in order to manage infectious diseases. This antibiotic assemblage orientation is likely to be more meaningful for individuals seeking out methods for promoting their health in the face of common infections.
Collapse
Affiliation(s)
- Mark Dm Davis
- School of Social Sciences, Monash University, Australia.
| | - Davina Lohm
- School of Social Sciences, Monash University, Australia
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, UK
| | | |
Collapse
|
3
|
Tieu M, Mudd A, Conroy T, Pinero de Plaza A, Kitson A. The trouble with personhood and person-centred care. Nurs Philos 2022; 23:e12381. [PMID: 35416420 DOI: 10.1111/nup.12381] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/04/2022] [Accepted: 02/05/2022] [Indexed: 12/30/2022]
Abstract
The phrase 'person-centred care' (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC.
Collapse
Affiliation(s)
- Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,College of Arts Humanities and Social Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Alexandra Mudd
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Alejandra Pinero de Plaza
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| |
Collapse
|
4
|
Iliffe S, Manthorpe J. Medical consumerism in the UK, from 'citizen's challenge' to the 'managed consumer'-A symbol without meaning? Health Expect 2021; 24:182-187. [PMID: 33477206 PMCID: PMC8077128 DOI: 10.1111/hex.13197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022] Open
Abstract
Background In Britain's National Health Service (NHS), medical consumerism is disliked by many doctors but managed by NHS leaders. Managed consumers have choices about treatment options, but are expected to help contain costs, improve quality of care, take part in clinical research and advocacy, and increase productivity. There are so many meanings for medical consumerism that it can be categorized, in post‐structuralist terms, as a ‘symbol without meaning’, but meanings are plentiful in the NHS. Policy expectations Choices made by discriminating consumers were expected to improve the quality of medical care for all. Extending choice to the many, and not restricting options to the few, would allow gains from choices to accumulate, so that choice would sustain social solidarity. Managed consumerism would in theory, therefore, instil reasonable choices and responsible behaviours in a moralized citizenry, across the nation. The advocates of New Labour's espousal of medical consumerism expected the accumulative effects of customer choices to challenge professional and occupational power, erode the medical model of health and illness, constrain professional judgements, and open the NHS to new ways of working. Almost all their expectations have been thwarted, so far. Conclusions Managed consumerism is far from being a meaningless symbol. This discussion paper explores the territory of managed consumerism and suggests realistic ways to make it more effective in shaping the NHS. Patient & Public Contribution We developed the arguments in this discussion paper with insights provided by a lay expert (see Acknowledgements) with experience of consumerism in both public sector management and a disease‐related charity.
Collapse
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | | |
Collapse
|
5
|
Information or Habit: What Health Policy Makers Should Know about the Drivers of Self-Medication among Romanians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020689. [PMID: 33466957 PMCID: PMC7830883 DOI: 10.3390/ijerph18020689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/09/2021] [Indexed: 02/06/2023]
Abstract
We use the Knowledge, Perceptions and Practices framework to analyze determinants of three types of self-medication practices in Romania: (1) self-medication in the case of cold/flu/viral infections; (2) taking non-prescribed medicine in general; and (3) self-medication based on recommendations by others. We analyzed 706 responses to an online survey and used a factor-based Partial Least Squares algorithm (PLSF) to estimate the relationships between each type of self-medication and possible predictors. Our results show that self–medication is strongly predicted by non-cognitive behavioral factors such as habits and similarity of symptoms, while cognitive determinants such as knowledge and understanding of potential risks are not significantly associated with self-medication behaviors. This paper identifies nonlinear relationships among self-medication practices and its predictors and discusses how our results can help policymakers calibrate interventions with better accuracy.
Collapse
|