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Rodríguez-Torres E, González-Pérez MM, Díaz-Pérez C. Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews. Contemp Clin Trials Commun 2021; 23:100829. [PMID: 34401599 PMCID: PMC8358641 DOI: 10.1016/j.conctc.2021.100829] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The demand for clinical trial participants is today one of the highest it has ever been and continues to increase. At the same time, subject recruitment continues to be problematic and the major reason for clinical trial premature terminations. The literature on clinical trial recruitment, which spans several decades and includes hundreds of studies, has an abundance of findings that can be synthesized by way of an overview to provide a well-informed and complete picture of the factors that determine subject participation. OBJECTIVES An overview of the systematic reviews that report barriers and facilitators to clinical trial participation was conducted. The extracted data were synthesized, and a thematic framework of the factors that affect subject participation in clinical trials was developed. The overview extended across medical subjects and demographics. METHODS Thirty reviews that complied with the inclusion criteria were included. These reviews covered 753 relevant primary studies and reported 881 barriers and facilitators. The barriers and facilitators were thematically synthesized and a thematic framework of 20 themes was developed. The quality of the included reviews was assessed and reported. MAIN RESULTS Several opportunities to increase clinical trial participation, by developing interventions and changing the trial design, derived from an analysis of the thematic framework. That analysis also showed that most of the 20 themes operate mainly as a barrier or as a facilitator, and that most have an effect across medical subjects. As to the quality elements assessed, some reviews complied almost fully but most only partially.
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Affiliation(s)
| | | | - Clemente Díaz-Pérez
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, USA
- The Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico, Medical Sciences Campus, USA
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Dubé K, Perry KE, Mathur K, Lo M, Javadi SS, Patel H, Concha-Garcia S, Taylor J, Kaytes A, Dee L, Campbell D, Kanazawa J, Smith D, Gianella S, Auerbach JD, Saberi P, Sauceda JA. Altruism: Scoping review of the literature and future directions for HIV cure-related research. J Virus Erad 2020; 6:100008. [PMID: 33294210 PMCID: PMC7695811 DOI: 10.1016/j.jve.2020.100008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The question of what motivates people to participate in research is particularly salient in the HIV field. While participation in HIV research was driven by survival in the 1980's and early 1990's, access to novel therapies became the primary motivator with the advent of combination antiretroviral therapy (cART) in the late 1990s. In the HIV cure-related research context, the concept of altruism has remained insufficiently studied. METHODS We conducted a scoping review to better contextualize and understand how altruism is or could be operationalized in HIV cure-related research. We drew from the fields of altruism in general, clinical research, cancer, and HIV clinical research-including the HIV prevention, treatment, and cure-related research fields. DISCUSSION Altruism as a key motivating factor for participation in clinical research has often been intertwined with the desire for personal benefit. The cancer field informs us that reasons for participation usually are multi-faceted and complex. The HIV prevention field offers ways to organize altruism-either by the types of benefits achieved (e.g., societal versus personal), or the origin of the values that motivate research participation. The HIV treatment literature reveals the critical role of clinical interactions in fostering altruism. There remains a dearth of in-depth knowledge regarding reasons surrounding research participation and the types of altruism displayed in HIV cure-related clinical research. CONCLUSION Lessons learned from various research fields can guide questions which will inform the assessment of altruism in future HIV cure-related research.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kelly E. Perry
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kushagra Mathur
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Megan Lo
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Sogol S. Javadi
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- HIV Neurobehavioral Research Program, UCSD, San Diego, CA, USA
| | - Jeff Taylor
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- HIV + Aging Research Project – Palm Springs (HARP – PS), Palm Springs, CA, USA
| | - Andy Kaytes
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
| | - Lynda Dee
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- AIDS Action Baltimore, Baltimore, MD, CA, USA
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - David Smith
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Sara Gianella
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Judith D. Auerbach
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
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Dubé K, Hosey L, Starr K, Barr L, Evans D, Hoffman E, Campbell DM, Simoni J, Sugarman J, Sauceda J, Brown B, Diepstra KL, Godfrey C, Kuritzkes DR, Wohl DA, Gandhi R, Scully E. Participant Perspectives in an HIV Cure-Related Trial Conducted Exclusively in Women in the United States: Results from AIDS Clinical Trials Group 5366. AIDS Res Hum Retroviruses 2020; 36:268-282. [PMID: 32160755 DOI: 10.1089/aid.2019.0284] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Women remain underrepresented in HIV research. The AIDS Clinical Trials Group (ACTG) 5366 study was the first HIV cure-related trial conducted exclusively in women. Our multidisciplinary team integrated participant-centered reports into the ACTG 5366 protocol to elicit their perspectives. We nested mixed-methods surveys at the enrollment and final study visits to assess ACTG 5366 participants' perceptions and experiences. Of 31 participants enrolled in the ACTG 5366, 29 study agreed to complete the entry questionnaire and 27 completed the exit survey. The majority of study participants were nonwhite. We identified societal and personal motivators for participation, understanding of risks and benefits, and minor misconceptions among some trial participants. Stigma was pervasive for several women who joined the study, and served as a motivator for study participation. Reimbursements to defray costs of study participation were reported to facilitate involvement in the trial by about one-third of participants. Almost all respondents reported positive experiences participating in the ACTG 5366 trial. The ACTG 5366 study showed that it is possible to recruit and retain women in HIV cure-related research and to embed participant-centered outcomes at strategic time points during the study. The findings could help in the design, implementation, recruitment, and retention of women in HIV cure-related research and highlight the value of assessing psychosocial factors in HIV cure-related research participation.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Lara Hosey
- Social and Scientific Systems (S-3), Silver Spring, Maryland
| | - Kate Starr
- ACTG Community Scientific Sub-Committee, Columbus, Ohio and Baltimore, Maryland
| | - Liz Barr
- ACTG Community Scientific Sub-Committee, Columbus, Ohio and Baltimore, Maryland
- Department of Gender, Women's and Sexuality Studies, University of Maryland Baltimore County (UMBC), Baltimore, Maryland
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), New York City, New York
| | - Erin Hoffman
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jane Simoni
- Department of Global Health and University of Washington, Seattle, Washington
- Department of Psychology, University of Washington, Seattle, Washington
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland
| | - John Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California
| | - Karen L. Diepstra
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Catherine Godfrey
- HIV Research Branch, National Institute of Allergies and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, Maryland
| | | | - David A. Wohl
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rajesh Gandhi
- Massachusetts General Hospital, Boston, Massachusetts
| | - Eileen Scully
- John Hopkins University School of Medicine, Baltimore, Maryland
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Ghare MI, Chandrasekhar J, Mehran R, Ng V, Grines C, Lansky A. Sex Disparities in Cardiovascular Device Evaluations. JACC Cardiovasc Interv 2019; 12:301-308. [DOI: 10.1016/j.jcin.2018.10.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
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Browne JL, Rees CO, van Delden JJM, Agyepong I, Grobbee DE, Edwin A, Klipstein-Grobusch K, van der Graaf R. The willingness to participate in biomedical research involving human beings in low- and middle-income countries: a systematic review. Trop Med Int Health 2019; 24:264-279. [PMID: 30565381 PMCID: PMC6850431 DOI: 10.1111/tmi.13195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives To systematically review reasons for the willingness to participate in biomedical human subjects research in low‐ and middle‐income countries (LMICs). Methods Five databases were systematically searched for articles published between 2000 and 2017 containing the domain of ‘human subjects research’ in ‘LMICs’ and determinant ‘reasons for (non)participation’. Reasons mentioned were extracted, ranked and results narratively described. Results Ninety‐four articles were included, 44 qualitative and 50 mixed‐methods studies. Altruism, personal health benefits, access to health care, monetary benefit, knowledge, social support and trust were the most important reasons for participation. Primary reasons for non‐participation were safety concerns, inconvenience, stigmatisation, lack of social support, confidentiality concerns, physical pain, efficacy concerns and distrust. Stigmatisation was a major concern in relation to HIV research. Reasons were similar across different regions, gender, non‐patient or patient participants and real or hypothetical study designs. Conclusions Addressing factors that affect (non‐)participation in the planning process and during the conduct of research may enhance voluntary consent to participation and reduce barriers for potential participants.
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Affiliation(s)
- Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Connie O Rees
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene Agyepong
- Ghana Health Service, Research and Development Division, Accra, Ghana.,Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ama Edwin
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Irani E, Richmond TS. Reasons for and reservations about research participation in acutely injured adults. J Nurs Scholarsh 2015; 47:161-9. [PMID: 25599886 DOI: 10.1111/jnu.12120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to explore the reasons adult patients seeking emergency department care for minor injuries agree to participate in clinical research and to identify their reservations about participating in a research study. DESIGN AND METHODS This is a secondary analysis of data from a longitudinal cohort study of 275 adults who sought emergency department care for physical injury and were followed over 12 months. At the final interview, participants were asked open-ended short-answer questions about their perception of participating in the study. Free text responses were analyzed using conventional content analysis. FINDINGS The final sample of 214 participants was composed equally of males and females, predominantly Black (54%) and White (42%), with a mean age of 41 years. Six themes about reasons for participation emerged from free text responses: being asked, altruism, potential for personal benefit, financial gain, curiosity, and valuing or knowledge of research. Most did not report reservations. Those reservations identified included time constraints, confidentiality, and whether patients felt well suited to fulfill the study requirements. CONCLUSIONS Although injured patients are identified by the research community as vulnerable, they are willing to participate in research studies for diverse reasons, and their participation is commonly associated with positive experiences. CLINICAL RELEVANCE Understanding perceptions of participants' experiences of being in a research study after acute injury can guide researchers to improve future study protocols and recruitment strategies in order to optimize participants' experiences. Recruitment and retention into clinical research studies is essential to build nursing science to enhance the recovery of injured individuals.
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Affiliation(s)
- Elliane Irani
- Xi, Doctoral Student, University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
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Habersack M, Luschin G. Insecurities of women regarding breast cancer research: a qualitative study. PLoS One 2013; 8:e81770. [PMID: 24312584 PMCID: PMC3847121 DOI: 10.1371/journal.pone.0081770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives Only 1.2%–11% of all potential study participants participate in cancer studies. Low participation rates can result in bias or in a failure to obtain data saturation. Subject-scientific psychology assumes that reasons for acting are based on individual premises. The objective of this study was to render reproducible individual reasons of female breast cancer patients to participate or not participate in breast cancer studies using a qualitative approach. Methods Problem-based interviews were conducted with female breast cancer patients. The selection of interview partners continued until theoretical data saturation was achieved. Results As main arguments against participation emotional overload and too many medication side-effects were stated. Improvement of health-related values, long-term protection and comprehensive follow-up exams were stated as arguments for participation. Trust in the attending physician was mentioned as influencing both participation and non-participation. Conclusions A significant influential factor determining willingness to participate in studies was one's contentment with patient-physician communication. In order to guarantee an adequate patient decision-making process, keeping existing standards for patient briefings is absolutely mandatory.
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Affiliation(s)
- Marion Habersack
- Office of the Vice Rector for Teaching and Studies, Medical University Graz, Graz, Austria
- * E-mail:
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Catania C, Radice D, Spitaleri G, Adamoli L, Noberasco C, Delmonte A, Vecchio F, de Braud F, Toffalorio F, Goldhirsch A, De Pas T. The choice of whether to participate in a phase I clinical trial: increasing the awareness of patients with cancer. An exploratory study. Psychooncology 2013; 23:322-9. [DOI: 10.1002/pon.3424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/06/2013] [Accepted: 09/11/2013] [Indexed: 01/29/2023]
Affiliation(s)
- C. Catania
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - D. Radice
- Epidemiology and Biostatistics Division; European Institute of Oncology; Milan Italy
| | - G. Spitaleri
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - L. Adamoli
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - C. Noberasco
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - A. Delmonte
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - F. Vecchio
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - F. de Braud
- Medical Oncology Unit 1; Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - F. Toffalorio
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
| | - A. Goldhirsch
- Department of Medicine; European Institute of Oncology; Milan Italy
| | - T. De Pas
- Clinical Pharmacology and New Drugs Development Division, Medical Oncology Department; European Institute of Oncology; Milan Italy
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Bernhard J, Aldridge J, Butow PN, Zoller P, Brown R, Smith A, Juraskova I. Patient-doctor agreement on recall of clinical trial discussion across cultures. Ann Oncol 2013; 24:391-397. [PMID: 23019277 PMCID: PMC3551480 DOI: 10.1093/annonc/mds288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose was to investigate patient-doctor agreement on clinical trial discussion cross-culturally. METHODS In the International Breast Cancer Study Group Trial 33-03 on shared decision-making for early breast cancer in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centers, doctor and patient characteristics plus doctor stress and burnout were assessed. Within 2 weeks post-consultation about treatment options, the doctor and patient reported independently, whether a trial was discussed. Odds ratios of agreement for covariables were estimated by generalized estimating equations for each language cohort, with doctor as a random effect. RESULTS In ANZ, 21 doctors and 339 patients were eligible; in SGA, 41 doctors and 427 patients. In cases where the doctor indicated 'no trial discussed', 82% of both ANZ and SGA patients agreed; if the doctor indicated 'trial discussed', 50% of ANZ and 38% of SGA patients agreed, respectively. Factors associated with higher agreement were: low tumor grade and fewer patients recruited into clinical trials in SGA; public institution, patient born in ANZ (versus other), higher doctor depersonalization and personal accomplishment in ANZ. CONCLUSION There is discordance between oncologists and their patients regarding clinical trial discussion, particularly when the doctor indicates that a trial was discussed. Factors contributing to this agreement vary by culture.
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Affiliation(s)
- J Bernhard
- IBCSG Coordinating Center, Bern; Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - J Aldridge
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, USA
| | - P N Butow
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | | | - R Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, USA
| | - A Smith
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, Australia
| | - I Juraskova
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED)
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Dhalla S, Poole G. Motivators to participation in medical trials: the application of social and personal categorization. PSYCHOL HEALTH MED 2013; 18:664-75. [PMID: 23360313 DOI: 10.1080/13548506.2013.764604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Health Belief Model provides a framework to understand motivators for volunteering for medical research. Motivators can take the form of social and personal benefits. In this systematic review of review articles, we contrast motivators of participation in actual cancer trials to those in actual HIV vaccine trials. We retrieved eight review articles from 2000 to 2012 examining motivators to participation in actual cancer trials. Personal benefits were most often psychological in nature, such as "coping with symptoms." Social benefits included "advancing research," "helping other cancer patients," and "for their family." While specific motivators vary between considerations - cancer research and HIV vaccine trials, these motivators fall into similar categories at similar frequencies. For example, personal/psychological benefits are common in each. Participant recruitment must be mindful of these categories of motivators for both cancer and HIV vaccine research.
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Affiliation(s)
- Shayesta Dhalla
- a University of British Columbia , Vancouver , British Columbia , Canada
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