Refusal to participate in clinical nursing research

Recruitment strategies and rates of a multi-site behavioral intervention for adolescents and young adults with cancer

INTRODUCTION

To provide an overview of factors related to recruitment of adolescents and young adults (AYA) into research and recruitment rates and reasons for refusal from a multicenter study entitled "Stories and Music for Adolescent/Young Adult Resilience during Transplant" (SMART).

METHODS

A randomized clinical trial study design was used. The settings included 9 hospitals. The sample included AYAs (aged 11-24 years) who were undergoing a stem cell transplant. Several instruments were used to measure symptom distress, coping, resilience, and quality of life in AYA with cancer.

RESULTS

A total of 113 AYA were recruited (50%) for this study. Strategies were refined as the study continued to address challenges related to recruitment. We provide a description of recruitment strategies and an evaluation of our planning, implementing, and monitoring of recruitment rates for the SMART study.

DISCUSSION

When designing a study, careful consideration must be given to factors influencing recruitment as well as special considerations for unique populations. Dissemination of strategies specific to unique populations will be helpful to the design of future research studies.

Monitoring child and parent refusals to enrol in clinical research protocols

AIMS

The aim of this paper is to report the rates and reasons for refusal given by 817 eligible participants from 10 completed and ongoing nursing and behavioural medicine studies in paediatric oncology from 1994 to 2004.

BACKGROUND

Eligible participants have the right to accept or decline participation in research studies. Information about rates of refusal and reasons for refusal could be useful in determining participant-perceived burden related to study participation, in accurately estimating the time needed to accrue an adequate number of participants to achieve the study aims, and in interpreting study findings from certain groups of participants.

METHODS

A 13-item survey form about study characteristics was completed prospectively for each study included in this report; categories of reasons for refusal were inductively identified and defined using a semantic content analytic technique.

RESULTS

The overall rate of refusal was 23.6% (range: 6.7-46.7%). The studies that involved blood sampling or end-of-life decision-making had the highest refusal rates and an instrumentation study had the lowest. Eligible male participants had consistently higher rates of refusal than did females across the 10 studies. Nine categories of refusal were inductively identified, with the most commonly reported reason being the burden of the research methods.

CONCLUSION

A careful informed consent process will still result in some refusals. The refusal rates reported here can be used to help future researchers more accurately estimate accrual periods for studies involving blood sampling or investigating sensitive topics in paediatric oncology.

Shifting perspectives: adolescent-focused oncology nursing research

PURPOSE/OBJECTIVES

To describe contextual features of the experience of adolescents with cancer in the United States; to relate these features to a different theoretical perspective, the Shifting Perspectives Model of Chronic Illness; and to derive implications from that model for conducting research with adolescents who have cancer.

DATA SOURCES

64 qualitative and quantitative studies and clinical anecdotes.

DATA SYNTHESIS

Unique features of adolescents with cancer related to person, disease, and treatment indicate that existing theories on adolescence do not adequately guide research efforts with this patient population, nor do they adequately assist in explaining study findings.

CONCLUSIONS

The Shifting Perspectives Model of Chronic Illness is useful in generating potentially important hypotheses about adolescents and their experiences with cancer and has the promise of guiding research design and method selection for studies involving adolescents with cancer. The model also highlights a moral responsibility for researchers who conduct studies with this patient population.

IMPLICATIONS FOR NURSING

Nurse researchers who use this model to guide their research will create a purposeful balance in methods that allows adolescents with cancer to choose the amount of time and detail they will give to illness-related or to wellness-related responses in studies, particularly those that rely on self-report methods.

Collaborative Clinical Research on End-of-Life Care in Pediatric Oncology

OBJECTIVES

To present an overview of research into end-of-life (EoL) care for pediatric patients with cancer and to describe research completed by a newly formed collaboration of researchers.

DATA SOURCES

Professional group position papers and guidelines; research studies.

CONCLUSION

Studies to date in pediatric EoL care used retrospective, descriptive, or pilot intervention designs, have been conducted in single-institution settings, and have included small numbers of patients. Most studies have explored perspectives of parents and health care professionals but have omitted the perspective of the dying child.

IMPLICATIONS FOR NURSING PRACTICE

Advancing the science of EoL care will depend on intervention-based clinical trials that include the perspective of the dying child in addi tion to parents and health care professionals.

Testing a theory of decision-making derived from King's systems framework in women eligible for a cancer clinical trial

The purpose of this study was to test an explanatory theory of decision-making in women eligible for a cancer clinical trial. The theory derived from King's framework proposed that the concepts of uncertainty, role functioning, and social support relate to emotional health (hope and mood state), which in turn relates to the treatment decision. A correlational study design was used to test the theory in a sample of 40 women. Findings provided empirical evidence of the adequacy of King's framework and supported, in part, theorized relationships among the critical factors. However, these factors did not illuminate the treatment decision.

Informed consent and the limits of confidentiality

Investigators encounter many legal and ethical issues when they conduct research on partner abuse. Balancing abused women's rights to privacy with legally mandated reporting requirements involves considerable thought and planning. Failure to protect participants may result in escalation of abuse as well as loss of children to protective services. Various perspectives on maintaining participant privacy while conforming to legal mandates to report child abuse, homicidality, and suicidality are discussed. The role of confidentiality certificates in providing legal immunity for researchers and the method of obtaining the certificates are presented. In addition, the authors describe the strategies for participant protection that are implemented in a federally funded study of abuse, women's self-care, and pregnancy outcomes. The decision to clearly and specifically inform abused women of the limits of confidentiality allows participants to make informed decisions about disclosures, but may result in diminished recruitment.