1
|
Brown P, Hewison A, Newham R. What are research nurses' experiences of obtaining consent from or for patients participating in emergency care research? A qualitative review. J Clin Nurs 2019; 28:4155-4165. [PMID: 31241806 DOI: 10.1111/jocn.14984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION If studies are to be valid, recruitment of representative samples is essential. In 2012, 28% of UK emergency departments met the 80% standard for recruitment to trials set by the National Institute for Health Research. Research nurses play a vital role in the conduct of high-quality research, and it has been argued that dedicated research nurses are needed if clinical trials are to recruit successfully to target. REVIEW QUESTION What are research nurses' experiences of obtaining consent from or for patients participating in emergency care research? A qualitative evidence review. METHODS A qualitative integrative literature review with a narrative synthesis of the evidence. PRISMA guidelines for reporting systematic qualitative reviews (Appendix S1) were followed. A search of five electronic databases was performed in December 2018 along with a hand search which yielded 125 citations: 10 papers and one PhD thesis met the review eligibility criteria. Methodological quality of the selected studies was evaluated, and data were extracted and synthesised. RESULTS Three themes were identified: Access, Organisation and Timing. Research nurses encountered both general and specific barriers when seeking to obtain consent for participation in research. In particular, it was found there was lack of experience among staff of working in emergency research and with securing deferred consent. The distinction between nurse researchers with a clinical role and those dedicated to solely to research only is often not clear and warrants further investigation. CONCLUSION Nurse researchers with and without a clinical role can make a positive difference in recruitment to trials in emergency care. The involvement of dedicated research nurses in the consent process can increase recruitment to emergency care research. Experience of recruiting to clinical trials in nonemergency settings does not seem to help when recruiting for trials in emergency care. RELEVANCE TO CLINICAL PRACTICE There is a need for greater understanding of the experiences of dedicated research nurses in emergency care settings and in particular with regard to deferred consent.
Collapse
Affiliation(s)
| | - Alistair Hewison
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Roger Newham
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| |
Collapse
|
2
|
Furyk J, Franklin R, Watt K, Emeto T, Dalziel S, McBain-Rigg K, Stepanov N, Babl FE. Community attitudes to emergency research without prospective informed consent: A survey of the general population. Emerg Med Australas 2018; 30:547-555. [DOI: 10.1111/1742-6723.12958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jeremy Furyk
- Emergency Department; The Townsville Hospital; Townsville Queensland Australia
- School of Public Health, Tropical Medicine and Rehabilitation Sciences; James Cook University; Brisbane Queensland Australia
- Public Health and Tropical Medicine; James Cook University; Brisbane Queensland Australia
| | - Richard Franklin
- School of Public Health, Tropical Medicine and Rehabilitation Sciences; James Cook University; Brisbane Queensland Australia
| | - Kerrianne Watt
- School of Public Health, Tropical Medicine and Rehabilitation Sciences; James Cook University; Brisbane Queensland Australia
| | - Theopilus Emeto
- School of Public Health, Tropical Medicine and Rehabilitation Sciences; James Cook University; Brisbane Queensland Australia
| | - Stuart Dalziel
- Children's Emergency Department; Starship Children's Hospital; Auckland New Zealand
| | - Kris McBain-Rigg
- School of Public Health, Tropical Medicine and Rehabilitation Sciences; James Cook University; Brisbane Queensland Australia
| | - Nikola Stepanov
- Emergency Department; The Townsville Hospital; Townsville Queensland Australia
| | - Franz E Babl
- Emergency Department; Royal Children's Hospital; Melbourne Victoria Australia
| |
Collapse
|
3
|
Marshall AP, Lemieux M, Dhaliwal R, Seyler H, MacEachern KN, Heyland DK. Novel, Family-Centered Intervention to Improve Nutrition in Patients Recovering From Critical Illness: A Feasibility Study. Nutr Clin Pract 2017; 32:392-399. [PMID: 28537514 DOI: 10.1177/0884533617695241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Critically ill patients are at increased risk of developing malnutrition-related complications because of physiological changes, suboptimal delivery, and reduced intake. Strategies to improve nutrition during critical illness recovery are required to prevent iatrogenic underfeeding and risk of malnutrition. The purpose of this study was to assess the feasibility and acceptability of a novel family-centered intervention to improve nutrition in critically ill patients. MATERIALS AND METHODS A 3-phase, prospective cohort feasibility study was conducted in 4 intensive care units (ICUs) across 2 countries. Intervention feasibility was determined by patient eligibility, recruitment, and retention rates. The acceptability of the intervention was assessed by participant perspectives collected through surveys. Participants included family members of the critically ill patients and ICU and ward healthcare professionals (HCPs). RESULTS A total of 75 patients and family members, as well as 56 HCPs, were enrolled. The consent rate was 66.4%, and 63 of 75 (84%) of family participants completed the study. Most family members (53/55; 98.1%) would recommend the nutrition education program to others and reported improved ability to ask questions about nutrition (16/20; 80.0%). Family members viewed nutrition care more positively in the ICU. HCPs agreed that families should partner with HCPs to achieve optimal nutrition in the ICU and the wards. Health literacy was identified as a potential barrier to family participation. CONCLUSION The intervention was feasible and acceptable to families of critically ill patients and HCPs. Further research to evaluate intervention impact on nutrition intake and patient-centered outcomes is required.
Collapse
Affiliation(s)
- Andrea P Marshall
- 1 National Health and Medical Research Council Centre for Research Excellence in Nursing Interventions for Hospitalised Patients, School of Nursing and Midwifery, Menzies Health Institute, Griffith University and Gold Coast Health, Southport, Queensland, Australia
| | - Margot Lemieux
- 2 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Rupinder Dhaliwal
- 2 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.,3 Metabolic Syndrome Canada, Kingston, Ontario, Canada
| | - Hilda Seyler
- 4 Clinical Nutrition and Food Services, Halton Healthcare, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Kristen N MacEachern
- 5 Clinical Nutrition and Critical Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Daren K Heyland
- 6 Department of Critical Care Medicine, Queen's University and Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| |
Collapse
|
4
|
Brienza AM, Sylvester R, Ryan CM, Repine M, DiFiore S, Barone J, Callaway CW. Success Rates for Notification of Enrollment in Exception From Informed Consent Clinical Trials. Acad Emerg Med 2016; 23:772-5. [PMID: 27005490 DOI: 10.1111/acem.12969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/19/2016] [Accepted: 02/20/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Exception from informed consent (EFIC) for research in emergency settings requires investigators to notify enrolled subjects, family members, or legally authorized representatives about inclusion in the study. We examined the success rate of a notification strategy including mail services for subjects enrolled in EFIC trials. METHODS We describe notification attempts for subjects in three out-of-hospital cardiac arrest clinical trials in both urban and rural areas around Pittsburgh, Pennsylvania, between the years 2000 and 2014. We examined the time required to notify subjects and the success of contacting subjects or their representatives when notified in person (if alive), by mail (if alive and unable to reach in person), or by mail (if the subject was deceased). We characterized comments received from subjects or their representatives as positive, neutral, or negative. RESULTS We attempted notification on a total of 1,912 subjects, 1,762 by mail, and 163 in person. Of these, 1,767 (92%) notification forms were successfully delivered, and 431 (24%) were signed and returned. Only 16 subjects or representatives (0.91%) requested to withdraw from the study. In-person notifications were more likely to be signed than mailed notifications (69% vs. 20%; p < 0.001). A total of 3.2% of recipients contacted investigators by phone or letter in response to notifications, but only five recipients expressed negative attitudes toward the trial. Ninety percent of subjects were notified within 35 days of the incident. Time to notification was shorter for in person (median = 5 days, interquartile range [IQR] = 2 to 10 days) than for deceased and mailed (11 days, IQR = 8 to 14 days) or alive and mailed (20 days, IQR = 14 to 29 days). CONCLUSIONS It is possible to successfully notify recipients of enrollment in a study using EFIC over 90% of the time within 35 days, although only 24% of recipients will sign and return a form. Fewer than 1% of subjects withdraw from the study, and fewer than 5% contact investigators, usually for neutral reasons.
Collapse
Affiliation(s)
- Ashley M. Brienza
- Department of Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Raeanne Sylvester
- Department of Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Christopher M. Ryan
- Human Research Protection Program; University of California at San Francisco; San Francisco CA
| | - Melissa Repine
- Department of Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Sara DiFiore
- Department of Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Jean Barone
- Human Research Protection Office; University of Pittsburgh; Pittsburgh PA
| | - Clifton W. Callaway
- Department of Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
| |
Collapse
|
5
|
Abstract
OBJECTIVES To analyze barriers to recruitment encountered during a prospective study in the PICU and evaluate strategies implemented to improve recruitment. DESIGN Prospective observational study of continuous electroencephalogram monitoring in comatose children. SETTING PICUs at four North American institutions. PATIENTS Patients with a Glasgow Coma Scale score of less than or equal to 8 for at least an hour. INTERVENTIONS Four strategies to increase recruitment were sequentially implemented. MEASUREMENTS AND MAIN RESULTS The baseline enrollment rate was 2.1 subjects/mo, which increased following the single-site introduction of real-time patient screening using an online dashboard (4.5 subjects/mo), deferred consenting (5.2 subjects/mo), and weekend screening (6.1 subjects/mo). However, the subsequent addition of three new study sites was the greatest accelerator of enrollment (21 subjects/mo), representing a 10-fold increase from baseline (p < 0.0001). CONCLUSIONS Identifying barriers to recruitment and implementing creative strategies to increase recruitment can successfully increase enrollment rates in the challenging ICU environment.
Collapse
|
6
|
Hicks R. Ethical and regulatory considerations in the design of traumatic brain injury clinical studies. HANDBOOK OF CLINICAL NEUROLOGY 2015; 128:743-59. [PMID: 25701918 DOI: 10.1016/b978-0-444-63521-1.00046-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Research is essential for improving outcomes after traumatic brain injury (TBI). However, the ubiquity, variability, and nature of TBI create many ethical issues and accompanying regulations for research. To capture the complexity and importance of designing and conducting TBI research within the framework of key ethical principles, a few highly relevant topics are highlighted. The selected topics are: (1) research conducted in emergency settings; (2) maintaining equipoise in TBI clinical trials; (3) TBI research on vulnerable populations; and (4) ethical considerations for sharing data. The topics aim to demonstrate the dynamic and multifaceted challenges of TBI research, and also to stress the value of addressing these challenges with the key ethical principles of respect, beneficence, and justice. Much has been accomplished to ensure that TBI research meets the highest ethical standards and has fair and enforceable regulations, but important challenges remain and continued efforts are needed by all members of the TBI research community.
Collapse
Affiliation(s)
- Ramona Hicks
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
| |
Collapse
|
7
|
Limkakeng AT, de Oliveira LLH, Moreira T, Phadtare A, Garcia Rodrigues C, Hocker MB, McKinney R, Voils CI, Pietrobon R. Systematic review and metasummary of attitudes toward research in emergency medical conditions. JOURNAL OF MEDICAL ETHICS 2014; 40:401-408. [PMID: 23665997 DOI: 10.1136/medethics-2012-101147] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Emergency departments are challenging research settings, where truly informed consent can be difficult to obtain. A deeper understanding of emergency medical patients' opinions about research is needed. We conducted a systematic review and meta-summary of quantitative and qualitative studies on which values, attitudes, or beliefs of emergent medical research participants influence research participation. We included studies of adults that investigated opinions toward emergency medicine research participation. We excluded studies focused on the association between demographics or consent document features and participation and those focused on non-emergency research. In August 2011, we searched the following databases: MEDLINE, EMBASE, Google Scholar, Scirus, PsycINFO, AgeLine and Global Health. Titles, abstracts and then full manuscripts were independently evaluated by two reviewers. Disagreements were resolved by consensus and adjudicated by a third author. Studies were evaluated for bias using standardised scores. We report themes associated with participation or refusal. Our initial search produced over 1800 articles. A total of 44 articles were extracted for full-manuscript analysis, and 14 were retained based on our eligibility criteria. Among factors favouring participation, altruism and personal health benefit had the highest frequency. Mistrust of researchers, feeling like a 'guinea pig' and risk were leading factors favouring refusal. Many studies noted limitations of informed consent processes in emergent conditions. We conclude that highlighting the benefits to the participant and society, mitigating risk and increasing public trust may increase research participation in emergency medical research. New methods for conducting informed consent in such studies are needed.
Collapse
Affiliation(s)
- Alexander T Limkakeng
- Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA
| | | | - Tais Moreira
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Amruta Phadtare
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | | | - Michael B Hocker
- Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Ross McKinney
- Department of Pediatrics, Trent Center for Bioethics, Humanities, and Medical History, Duke University, Durham, North Carolina, USA
| | - Corrine I Voils
- Department of Medicine, Durham Veterans Affairs Medical Center, Duke University, Durham, North Carolina, USA
| | | |
Collapse
|
8
|
Burns KEA, Zubrinich C, Tan W, Raptis S, Xiong W, Smith O, McDonald E, Marshall JC, Saginur R, Heslegrave R, Rubenfeld G, Cook DJ. Research Recruitment Practices and Critically Ill Patients. A Multicenter, Cross-Sectional Study (The Consent Study). Am J Respir Crit Care Med 2013; 187:1212-8. [DOI: 10.1164/rccm.201208-1537oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
9
|
Abstract
Clinical trials in traumatic brain injury have shown little success in providing an evidence base for the introduction of successful new therapies into clinical practice. In addition to the problems that are common to all such studies in critical illness, trials in traumatic brain injury are complicated by the extremely short temporal window for intervention, failure of many candidate drugs to cross the blood-brain barrier, ethical and regulatory obstacles associated with research in subjects who cannot provide consent, the tendency to use small sample sizes in anticipation of unrealistic treatment benefits, and difficulty in translating experimental success into clinical practice. This article reviews the potential causes of these problems and suggests some solutions. These include the changes in regulatory frameworks that are making waived consent an acceptable strategy once more, and an increasing trend toward appropriately large trials. Other encouraging developments include the increasing use of human experimental medicine strategies before phase III trials to assess blood-brain barrier penetration and dose ranging, and provide proof of concept and proof of mechanism. Novel approaches to trial design, such as sliding dichotomy, coupled with robust outcome prediction models, can increase statistical power and improve trial design.
Collapse
|