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Rubovits E, Yedavalli A, Sadruddin S, Lavari K, Mudar R, Leung V, Cothran FA, Raj M. Engaging Asian American Family Caregivers in Clinical Trials: Awareness, Preferences, and Concerns. J Appl Gerontol 2024:7334648241271354. [PMID: 39101877 DOI: 10.1177/07334648241271354] [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: 08/06/2024] Open
Abstract
The purpose of this study was to evaluate Asian American caregivers' experiences and concerns related to clinical trials and the types of information they trust, use, and prefer before enrolling their older relative in a clinical trial. We conducted an online, cross-sectional survey with Asian American family caregivers between July 2022 and April 2023. Of all respondents (n = 98), 62.2% reported knowing only a little about clinical trials. Respondents expressed wanting information about (a) the purpose, design, and components of the trial; (b) trial research ethics and safety; and (c) their responsibilities as the caregiver. Greater engagement between clinicians and family caregivers of culturally diverse older adults could help minimize sociocultural barriers to participation in clinical trials. Providing key information to family caregivers in a comprehensive and accessible way without adding burden could help caregivers understand their responsibilities through the clinical trial process.
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Affiliation(s)
- Eve Rubovits
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Anjali Yedavalli
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Sabeen Sadruddin
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Kavin Lavari
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Raksha Mudar
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Vania Leung
- Department of Geriatric Medicine, University of Illinois Chicago, Chicago, IL, USA
| | | | - Minakshi Raj
- College of Applied Health Sciences, University of Illinois Urbana Champaign, Champaign, IL, USA
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Graber N, Canova N, Bryant‐Lukosius D, Robert G, Navarro‐Rodrigo B, Trueb L, Coukos G, Eicher M, Corbière T, Colomer‐Lahiguera S. Reflections on the opportunities and challenges of applying experience-based co-design (EBCD) to phase 1 clinical trials in oncology. Health Expect 2024; 27:e14068. [PMID: 38937953 PMCID: PMC11211206 DOI: 10.1111/hex.14068] [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: 12/21/2023] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Experience-Based Co-Design (EBCD) is a multi-stage participatory action research process which was developed originally to increase patient involvement in service improvement initiatives. This viewpoint article serves as a reflection on the researchers' experiences, focusing on the application and feasibility of participatory approaches, particularly co-design, in the specific context of early-phase clinical trials. METHODS We reflect on the opportunities and challenges of applying EBCD in a new context of early-phase clinical trials in oncology where experimental treatments are increasingly perceived as a therapeutic option and, in certain instances, their efficacy may lead to accelerated approval facilitating a swifter integration into standard care. RESULTS We propose that the opportunity of applying EBCD in such trials lies in improving the delivery of person-centered care, care coordination, and support during the transition from experimental to standard care. Three potential challenges when applying EBCD in early-phase clinical trials are discussed related to: the need for standardization in trial processes; planning EBCD in a context of high uncertainty; and vulnerability of patient populations. CONCLUSION Integrating EBCD into early-phase oncology trials presents an opportunity to enhance person-centered care and can lead to simultaneous improvements in care processes and therapeutic development. PATIENT OR PUBLIC CONTRIBUTION This article has been developed with the collaboration of a patient partner who serves on the advisory board of our ongoing EBCD study in early clinical trials.
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Affiliation(s)
- Nils Graber
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and MedicineUniversity of Lausanne (UNIL)LausanneSwitzerland
| | - Nina Canova
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and MedicineUniversity of Lausanne (UNIL)LausanneSwitzerland
| | | | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | | | - Lionel Trueb
- Department of OncologyLausanne University Hospital (CHUV)LausanneSwitzerland
| | - George Coukos
- Department of OncologyLausanne University Hospital (CHUV)LausanneSwitzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and MedicineUniversity of Lausanne (UNIL)LausanneSwitzerland
- Department of OncologyLausanne University Hospital (CHUV)LausanneSwitzerland
| | - Tourane Corbière
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and MedicineUniversity of Lausanne (UNIL)LausanneSwitzerland
| | - Sara Colomer‐Lahiguera
- Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and MedicineUniversity of Lausanne (UNIL)LausanneSwitzerland
- Department of OncologyLausanne University Hospital (CHUV)LausanneSwitzerland
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Foxwell AM, LaRochelle LM, Ulrich CM. Rhetoric of research: a call for renaming the clinical research partnership. BMJ Open 2024; 14:e080137. [PMID: 38772594 PMCID: PMC11112157 DOI: 10.1136/bmjopen-2023-080137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/04/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE Research cannot advance without the voluntary participation of human participants. SUMMARY OF ARGUMENTS Full participation of research participants is often restrained by the traditional research framework, which relegates them to a predefined participant role and allows them only quasi-scripted opportunities to contribute to research processes and outcomes. Terms commonly used to refer to research participants do not reflect their significant role or send a clear message about their value. The authors propose a shift from 'patient participant' to 'participant partner.' Recognition of the true partnership between the participant and the research team, from the consent process to the trial's end, will encourage and enable fuller participation. CONCLUSION Changing the rhetoric of research in the labelling of research participants will require dialogue. 'Respect for persons' demands it, and the research process will be better for it.
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Affiliation(s)
- Anessa M Foxwell
- Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lillie M LaRochelle
- Georgetown University School of Nursing, Washington, District of Columbia, USA
| | - Connie M Ulrich
- Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sawyer CS, Taylor S, Carter L, Stanworth M, Davies M, Thistlethwaite F, Taylor J, Eastwood C, Yorke J. Development and validation of a patient reported experience measure for experimental cancer medicines (PREM-ECM) and their carers (PREM-ECM-Carer). BMC Cancer 2024; 24:500. [PMID: 38641809 PMCID: PMC11031988 DOI: 10.1186/s12885-024-11963-x] [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: 01/13/2023] [Accepted: 02/05/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Our aim was to develop a validated Patient Reported Experience Measure (PREM) to capture patient and carer experience during participation in experimental cancer medicine trials (ECM): called PREM-ECM. METHODS Mixed method design, consisting of four stages. Questionnaire items were produced for both patients and carers using interviews, focus groups, and cognitive interviews with patients and carers separately. For both patient and carer PREMs, a cross-sectional questionnaire study was conducted to identify final items for inclusion using hierarchical item reduction and Rasch analysis. Questionnaire validity and reliability were assessed, including administration feasibility. RESULTS Initial interview participants suggested the need for three PREMs, two specific to patients: (i) a 'prior' questionnaire that captured experiences of trial introduction, screening, consenting, and early trial experience (< 6 weeks post consent); and (ii) 'on-trial' that captured experiences of ongoing consent and trial participation; and (iii) a PREM specific for carers. The draft 25-item 'prior' questionnaire was completed by 162 patients and 162 patients completed the draft 35-item 'on-trial' questionnaire. Hierarchical and Rasch analysis produced a 14-item 'prior' list and a 15-item list for 'on-trial'. Both patient PREM's demonstrated a good fit to the Rasch model following Bonferroni correction (X2p = 0.008). The carer 34-draft item questionnaire was completed by 102 participants. Hierarchical and Rasch analysis produced a 13-item list for PREM-ECM-Carer, with good fit to the Rasch model ( X2p = 0.62). The pilot testing demonstrated the feasibility of all the PREMs in capturing patient and caregiver experiences in routine clinical settings. CONCLUSIONS The three PREM-ECM questionnaires will be the first validated experience measures for ECM trial patients and their carers. These questionnaires may be used to assess patients' and their carers' experiences of ECM and enable robust comparisons across cancer trial units highlighting areas for service improvement.
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Affiliation(s)
- Chelsea S Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, Manchester, UK
| | - Sally Taylor
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | - Louise Carter
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | - Melissa Stanworth
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, Manchester, UK
| | - Michelle Davies
- NIHR Manchester Clinical Research Facility, The Christie NHS Foundation Trust, Manchester, UK
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Fiona Thistlethwaite
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Jo Taylor
- The Christie NHS Foundation Trust, Manchester, UK
| | - Charlotte Eastwood
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- Christie Patient Centred Research (CPCR), The Christie NHS Foundation Trust, Manchester, UK.
- Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK.
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
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Thomson MD, Van Houtven CH, Xu R, Siminoff LA. The many "costs" of transportation: Examining what cancer caregivers experience as transportation obstacles. Cancer Med 2023; 12:17356-17364. [PMID: 37485648 PMCID: PMC10501274 DOI: 10.1002/cam4.6351] [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: 04/12/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Transportation has been identified as a specific source of burden for cancer caregivers. This study examined cancer caregivers' subjective experiences and objectives costs associated with transportation over a 6-month period of providing end-of-life care to a family member or friend. METHODS This was a multi-site longitudinal, prospective cohort study that followed 223 caregiver-patient dyads. Data were collected using biweekly, semi-structured interviews for up to 6 months and collection of all caregiving related receipts. Interviews were coded and analyzed using a comparative, iterative analysis and actual out of pockets costs were described using descriptive statistics. RESULTS Over the 6-month study period most caregivers (n = 143; 74%) discussed transportation at one or more timepoints. Average biweekly transportations costs to caregivers were $43.6. Caregivers described (n = 56; 39%) multiple direct and indirect costs of transportation, and 58% (n = 84) discussed the need for transportations services or assistance at the institutional level. CONCLUSIONS Caregivers described the multifaceted costs of transportation they experienced which are in line with previous work. Alongside descriptions of direct costs, caregivers described key opportunity costs, such as personal and work time forgone to transporting patients. Caregivers also made suggestions for institutional and/or civic based solutions to facilitate reliable modes of transportation, rather than individual-level intervention.
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Affiliation(s)
- Maria D. Thomson
- Department of Health Behavior and PolicyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Courtney Harold Van Houtven
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Durham ADAPT, Durham Veterans Affairs Medical CenterDurhamNorth CarolinaUSA
| | - Rebecca Xu
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Laura A. Siminoff
- Department of Social and Behavioral SciencesTemple UniversityPhiladelphiaPennsylvaniaUSA
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Mokhnatkin JV, Bae M, Dale W, Tiwari A, Patanapirom J, Sedrak MS. Facilitators and Barriers to Older Adult Participation in Cancer Trials: A Qualitative Study Exploring Patient-Caregiver Dyad Congruence. JCO Oncol Pract 2023; 19:484-492. [PMID: 37079865 PMCID: PMC10337716 DOI: 10.1200/op.22.00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 04/22/2023] Open
Abstract
PURPOSE Family caregivers play an integral role in caring for older adults with cancer. Few studies have examined older adults with cancer and their family caregivers as a unit in a relationship or a dyad. Dyad congruence, or consistency in perspective, is relevant to numerous aspects of living with cancer, including the decision to enroll in a cancer clinical trial. METHODS Semistructured interviews of 32 older women (age ≥ 70 years) with breast cancer and their family caregivers (16 dyads) were conducted at both academic and community settings from December 2019 to March 2021 to explore perceived facilitators and barriers to cancer trials. Dyad congruence was defined as aligned (matching) perspectives, and incongruence was defined as misaligned (nonmatching) perspectives. RESULTS Five (31%) of 16 patients were age ≥80 years, 11 (69%) had nonmetastatic breast cancer, and 14 (88%) were treated in an academic setting. Six (38%) of 16 caregivers were in the 50-59 age group, 10 (63%) were female, and seven (44%) were daughters. Dyad congruence centered on the clinical benefit of trials and physician recommendation. However, compared with caregivers, patients were more motivated to contribute to science. Patients and caregivers also differed on the perceived extent to which the caregiver influenced enrollment. CONCLUSION Older patients with cancer and their caregivers generally agree about the facilitators and barriers to cancer trial enrollment, but some perceptions are misaligned. Further research is needed to understand whether misaligned perspectives between patients and caregivers influence clinical trial participation of older adults with cancer.
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