Nurses’ Perceptions of Phase I Clinical Trials in Pediatric Oncology: A Review of the Literature

The attitudes of oncology physicians and nurses toward phase I, II, and III cancer clinical trials

OBJECTIVE

This study aimed to assess the attitudes of oncology physicians and nurses toward phase I, II, and III cancer clinical trials.

METHODS

A questionnaire was administered to 358 oncology physicians and nurses.

RESULTS

The effective response rate was 79.3%. Of the respondents, 67.6%, 95.1%, and 98.6% reported that cancer patients would benefit from phase I, II, and III trials, respectively. Respondents would also recommend that their patients participate in phase I (64.4%), II (88.4%), and III trials (95.1%). When asked to assume the role of cancer patients, the respondents themselves were willing to participate in phase I (48.2%), II (72.9%), and III trials (89.8%). Respondents who admitted having little or no understanding of cancer clinical trials were not willing to recommend participation in phase I clinical trials to their patients (OR 0.187, 95% CI 0.110-0.319, p<0.001). No factor was significantly associated with respondents' willingness to recommend that their patients participate in phase II or III clinical trials.

CONCLUSION

Most physicians and nurses hold positive attitudes toward clinical trials, especially phases II and III. The number of medical staff who approved of clinical trials was positively associated with the stage of the phase trial.

Ethical Considerations in Pediatric Oncology Phase I Clinical Trials According to The Belmont Report

Whether to suggest enrollment of pediatric oncology patients with advanced or refractory disease into a Phase I clinical trial may present a significant ethical dilemma for health care professionals. Phase I trials are experimental and unpredictable by nature, yet health care professionals must ensure the trial's therapeutic intent as well as address the many vulnerabilities of the child with terminal cancer. After reviewing the role and phases of clinical research in pediatric oncology, this article discusses ethical considerations in Phase I clinical trials according to The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects in Research and discusses specific applications of these key ethical principles.

An exploratory survey of nurses' perceptions of phase I clinical trials in pediatric oncology

This study suggests that nurses' perceptions of pediatric oncology phase I clinical trials are diverse and mixed but are more likely to be positive than negative. Improving future treatments, medical benefit, improved quality of life, and hope were cited as potential benefits of phase I clinical trials, but nurses felt that families were hoping for a cure. Toxicities, false hope, and decreased quality of life were perceived as potential negative outcomes. Acting as a patient advocate was viewed as the most important nursing role, and providing information was identified to be the most important purpose of informed consent. Although not statistically significant, data suggest that age, experience, and practice setting may influence nurses' perceptions. Younger or less experienced nurses were more likely to report either positive or negative perceptions, whereas older or more experienced nurses expressed mixed or moderate perceptions. Inpatient nurses reported more negative perceptions compared with outpatient nurses. The respondents report that caring for patients on phase I had both positive and negative effects on their quality of nursing work life.