Perspectives on neurological patient registries: a literature review and focus group study

Role of Registries in Medicare Coverage of New Alzheimer Disease Drugs

This Viewpoint discusses how the design of the Centers for Medicare & Medicaid Services (CMS) registry could impact Medicare’s ability to evaluate whether monoclonal antibodies are reasonable and necessary for patients with Alzheimer disease and help physicians understand when the drug is most beneficial.

A systematic review of the symptomatic management of Lhermitte's phenomenon

INTRODUCTION

Lhermitte's phenomenon (LP) is a transient shock-like sensation that radiates down the spine into the extremities, usually with neck flexion. The potential efficacy and tolerability of various symptomatic therapies in the management of LP have not been systematically reviewed previously.

METHOD

A systematic review was conducted using PubMed, EMBASE, and the Cochrane Library from inception to August 2022 for peer-reviewed articles describing the treatment of patients with Lhermitte's phenomenon. The review adheres to the PRISMA guidelines and was registered on PROSPERO.

RESULTS

This systematic review included sixty-six articles, which included 450 patients with LP. Treatment of the underlying cause varied by aetiology. Whilst LP is most commonly considered in the context of structural pathology of the cervical cord, medication-induced LP was a common theme in the literature. The most common cause of medication-induced LP was platinum-based chemotherapy agents such as cisplatin and oxaliplatin. In medication-induced LP, symptoms typically resolved with cessation of the causative agent. Non-pharmacological treatment options were associated with mild-moderate symptomatic improvement. The most commonly used agents to treat patients with LP were carbamazepine and gabapentin, which resulted in variable degrees of symptomatic benefit.

CONCLUSIONS

No randomised studies currently exist to support the use of symptomatic therapies to treat LP. Observational data suggest that some therapies may yield a symptomatic benefit in the management of LP. However, this systematic review identified a significant paucity of evidence in the literature, which suggests that further controlled studies are needed to investigate the optimal management of this common neurologic phenomenon.

Barriers and facilitators for disease registry systems: a mixed-method study

Background

A Disease Registry System (DRS) is a system that collects standard data on a specific disease with an organized method for specific purposes in a population. Barriers and facilitators for DRSs are different according to the health system of each country, and identifying these factors is necessary to improve DRSs, so the purpose of this study was to identify and prioritize these factors.

Methods

First, by conducting 13 interviews with DRS specialists, barriers and facilitators for DRSs were identified and then, a questionnaire was developed to prioritize these factors. Then, 15 experts answered the questionnaires. We prioritized these factors based on the mean of scores in four levels including first priority (3.76–5), second priority (2.51–3.75), third priority (1.26–2.50), and the fourth priority (1–1.25).

Results

At first, 139 unique codes (63 barriers and 76 facilitators) were extracted from the interviews. We classified barriers into 9 themes, including management problems (24 codes), data collection-related problems (8 codes), poor cooperation/coordination (7 codes), technological problems and lack of motivation/interest (6 codes for each), threats to ethics/data security/confidentiality (5 codes), data quality-related problems (3 codes), limited patients’ participation and lack of or non-use of standards (2 codes for each). We also classified facilitators into 9 themes including management facilitators (36 codes), improving data quality (8 codes), proper data collection and observing ethics/data security/confidentiality (7 codes for each), appropriate technology (6 codes), increasing patients’ participation, increasing motivation/interest, improving cooperation/coordination, and the use of standards (3 codes for each). The first three ranked barriers based on mean scores included poor stakeholder cooperation/coordination (4.30), lack of standards (4.26), and data quality-related problems (4.06). The first three ranked facilitators included improving data quality (4.54), increasing motivation/interest (4.48), and observing ethics/data security/confidentiality (4.36).

Conclusion

Stakeholders’ coordination, proper data management, standardization and observing ethics, security/confidentiality are the most important areas for planning and investment that managers must consider for the continuation and success of DRSs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01840-7.

Barriers and facilitators for the implementation of health condition and outcome registry systems: a systematic literature review

OBJECTIVE

Health condition and outcome registry systems (registries) are used to collect data related to diseases and other health-related outcomes in specific populations. The implementation of these programs encounters various barriers and facilitators. Therefore, the present review aimed to identify and classify these barriers and facilitators.

MATERIALS AND METHODS

Some databases, including PubMed, Embase, ISI Web of Sciences, Cochrane Library, Scopus, Ovid, ProQuest, and Google Scholar, were searched using related keywords. Thereafter, based on the inclusion and exclusion criteria, the required data were collected using a data extraction form and then analyzed by the content analysis method. The obtained data were analyzed separately for research and review studies, and the developed and developing countries were compared.

RESULTS

Forty-five studies were reviewed and 175 unique codes were identified, among which 93 barriers and 82 facilitators were identified. Afterward, these factors were classified into the following 7 categories: barriers/facilitators to management and data management, poor/improved collaborations, technological constraints/appropriateness, barriers/facilitators to legal and regulatory factors, considerations/facilitators related to diseases, and poor/improved patients' participation. Although many of these factors have been more cited in the literature related to the developing countries, they were found to be common in both developed and developing countries.

CONCLUSION

Lack of budget, poor performance of managers, low data quality, and low stakeholders' interest/motivation on one hand, and financing, providing adequate training, ensuring data quality, and appropriate data collection on the other hand were found as the most common barriers or facilitators for the success of the registry implementation.

A Descriptive Review of Global Real World Evidence Efforts to Advance Drug Discovery and Clinical Development in Amyotrophic Lateral Sclerosis

Understanding patient clinical progression is a key gateway to planning effective clinical trials and ultimately enabling bringing treatments to patients in need. In a rare disease like amyotrophic lateral sclerosis (ALS), studies of disease natural history critically depend on collaboration between clinical centers, regions, and countries to enable creation of platforms to allow patients, caregivers, clinicians, and researchers to come together and more fully understand the condition. Rare disease registries and collaborative platforms such as those developed in ALS collect real-world data (RWD) in standardized formats, including clinical and biological specimen data used to evaluate risk factors and natural history of disease, treatment patterns and clinical (ClinROs) and patient- reported outcomes (PROs) and validate novel endpoints. Importantly, these data support the development of new therapeutics by supporting the evaluation of feasibility and design of clinical trials and offer valuable information on real-world disease trajectory and outcomes outside of the clinical trial setting for comparative purposes. RWD may help to accelerate therapy development by identifying and validating outcome measures and disease subpopulations. RWD can also make potential contributions to the evaluation of the safety and effectiveness of new indications for approved products and to satisfy post-approval regulatory and market access requirements. There is a lack of amalgamated information on available registries, databases, and other sources of real-world data on ALS; thus, a global review of all available resources was warranted. This targeted review identifies and describes ALS registries, biobanks and collaborative research networks that are collecting and synthesizing RWD for the purposes of increasing patient awareness and advancing scientific knowledge with the hope of expediting future development of new therapies.

Albertans for Health Research Network: Form, Fit, and Function

The patient engagement (PE) platform staff of Alberta Strategy for Patient Oriented Research Support for People and Patient Oriented Research Trials Unit developed a patient-powered PE network called Albertans for Health Research Network (AB4HR); an enhanced tool to better connect patient partners and researchers online. AB4HR was developed in response to an identified need—a user-friendly online forum for both patient partners and researchers to access, so that they can better work together, as partners, in health research. We codesigned AB4HR and identified ways to improve the form, fit, and function of an existing registry through discussion groups with patient partners and researchers. We found 3 main themes derived from the perspective shared by patient partners and researchers. Patient partners and researchers agreed that the existing registry provides a forum to connect with one another in an easy, low-barrier way. However, there were opportunities for improvement with AB4HR, including possibilities for greater interaction between patient partners and researchers to promote more collaborative partnerships.

"If it helps someone, then I want to do it": Perspectives of persons living with dementia on research registry participation

Registries are an important platform to which persons with dementia and other cognitive impairments can contribute to research studies. Registries also provide an opportunity for patients to stay informed about current studies. Engaging patients in registry development can increase sustainability of a registry and patient retention in clinical registries. We sought the perspective of persons with dementia and their accompanying family members about their registry participation experiences, barriers and facilitators to participation, and potential avenues for improvement of registry processes such as recruitment, data collection, and knowledge translation. Two semi-structured focus groups with persons with dementia and their family members (n = 18) were conducted and analyzed using thematic content analysis. Participants were recruited from an existing patient registry made up of patients currently being seen in a dementia assessment clinic. The main themes identified included altruistic motives with regards to registry participation; and access to and privacy of personal health information. As electronic health records are becoming more common, understanding barriers and facilitators from the perspectives of people with dementia is essential to inform the future development of cognitive condition-related registries. The results from our focus groups identified engagement strategies and solutions to overcome perceived barriers for individuals experiencing progressive cognitive decline to participate in longitudinal registry projects.

Patient data and patient rights: Swiss healthcare stakeholders' ethical awareness regarding large patient data sets - a qualitative study

Background

There is a growing interest in aggregating more biomedical and patient data into large health data sets for research and public benefits. However, collecting and processing patient data raises new ethical issues regarding patient’s rights, social justice and trust in public institutions. The aim of this empirical study is to gain an in-depth understanding of the awareness of possible ethical risks and corresponding obligations among those who are involved in projects using patient data, i.e. healthcare professionals, regulators and policy makers.

Methods

We used a qualitative design to examine Swiss healthcare stakeholders’ experiences and perceptions of ethical challenges with regard to patient data in real-life settings where clinical registries are sponsored, created and/or used. A semi-structured interview was carried out with 22 participants (11 physicians, 7 policy-makers, 4 ethical committee members) between July 2014 and January 2015. The interviews were audio-recorded, transcribed, coded and analysed using a thematic method derived from Grounded Theory.

Results

All interviewees were concerned as a matter of priority with the needs of legal and operating norms for the collection and use of data, whereas less interest was shown in issues regarding patient agency, the need for reciprocity, and shared governance in the management and use of clinical registries’ patient data. This observed asymmetry highlights a possible tension between public and research interests on the one hand, and the recognition of patients’ rights and citizens’ involvement on the other.

Conclusions

The advocation of further health-related data sharing on the grounds of research and public interest, without due regard for the perspective of patients and donors, could run the risk of fostering distrust towards healthcare data collections. Ultimately, this could diminish the expected social benefits. However, rather than setting patient rights against public interest, new ethical approaches could strengthen both concurrently. On a normative level, this study thus provides material from which to develop further ethical reflection towards a more cooperative approach involving patients and citizens in the governance of their health-related big data.

Electronic supplementary material

The online version of this article (10.1186/s12910-018-0261-x) contains supplementary material, which is available to authorized users.

Addressing the Data Linking Challenges

BACKGROUND

PARENT JA (cross-border Patient Registries iNiTiative Joint Action), a joint EU and Member States project, has conducted a research among EU patient registries aimed at gathering information on the registries' interoperability readiness. Leaning on the information and data collected through the previous PARENT JA research, this study aims to provide more detailed view into the registry holders' practical challenges with data linking. Since the studies which dealt with patient data exchange have often neglected the registry holders' performance of data exchange, we wanted to put a spotlight on various EU registry holders' practices and operations, aiming to detect their needs and concerns in the process of running an interoperable registry. The focus of this study was identifying the main practices and challenges in patient registries interoperability improvement.

METHODS

The basis for this analysis were the data collected in the series of structured interviews. The size of the interview sample was 13 patient registries, each from a different EU country. The structured interview consisted of nine questions and was conducted in two parts: oral and written. The answers were analysed using open coding.

RESULTS

Results are interpreted in the context of the six main themes that emerged through a comprehensive analysis. (1) Examples of data exchange: The most common reported data exchange practices were seen only as a way to achieve the most immediate needs and interests of the individual registries. (2) Awareness and use of international standards: International data and clinical standards were not widely used by the interviewed registries. (3) Use of data models and formats: In the area of data models and formats there is no universally used practice. (4) Data request protocols and procedures: Procedures and protocols varied, mostly depending on the national legal systems in which the patient registries operated. (5) Data security and integrity: Security of personal data was a universal concern for all registry holders that were interviewed; identifiable individual data was shared only in one case. (6) Opportunities and challenges of registry interoperability: most registry holders responded that their registries were well prepared for interoperability practices and that data exchange has never been their primary operative concern.

CONCLUSIONS

Most of the difficulties regarding data linking were not necessarily associated with technical issues, which registry holders listed outright. Our analysis showed that the lack of interoperability came as a result of organizational or legal constraints that made the registries unable to process and conduct data linking quickly and effectively with other sources.

Participation in Clinical Research Registries: A Focus Group Study Examining Views From Patients With Arthritis and Other Chronic Illnesses

OBJECTIVE

Patient registries have contributed substantially to progress in clinical research in rheumatic diseases. However, not much is known about how to optimize the patient experience in such registries. We assessed patient views, motivations, and potential barriers towards participation in registry research to better understand how registries can be improved to maximize patient engagement.

METHODS

Focus groups were held with 23 patients (mean ± SD age 59 ± 13 years) from the Boston area and led by a bilingual moderator trained in focus group methodology, using a semistructured moderator guide. Three separate focus groups were conducted to thematic saturation: patients with rheumatoid arthritis (RA) who had registry experience, patients with any chronic illness, and Spanish-speaking patients with RA or osteoarthritis. Patients in the latter 2 groups had no prior registry experience. Focus groups were audiotaped and transcribed. Four researchers independently analyzed transcripts using open data coding to identify themes. A normative group process was used to consolidate and refine themes.

RESULTS

Seven major themes were identified, including personalization/convenience of data collection, trust and confidentiality, camaraderie, learning about yourself and your disease, altruism, material motivators, and capturing mental health and other elements of the lived experience. We observed distinct differences in the discussion content of the Spanish-speaking patients compared to the English-speaking patients.

CONCLUSION

This study identified patient attitudes towards registry research among those with and without prior experience in a registry. The results provide insight into strategies for registry design to maximize patient engagement, which can lead to more robust registry data.

A Good Idea May Not Be Good Enough: Stakeholder Buy In to QuitConnect, a National Smokers' Registry

PURPOSE

To examine interest and concerns among those who fund and operate state-run smoking cessation helplines (quitlines) about the concept of creating a centralized smokers' registry that could be used to reengage smokers after they receive initial quitline support services.

DESIGN

We conducted 3, hour-long focus groups with stakeholders, covering the perceived benefits and barriers to creating a smokers' registry.

SETTING

The focus groups were conducted via telephone.

PARTICIPANTS

Three groups participated: quitline service providers (n = 14), quitline funders (n = 9), and national quitline partners (n = 8).

METHOD

Data collection: Focus groups were recorded, transcribed, and coded for major relevant themes. Analysis Strategies: We used a grounded theory approach.

RESULTS

Stakeholders were generally positive about the concept of a centralized smokers' registry (ie, QuitConnect), especially with its potential to link relapsed smokers to ongoing research studies designed to help smokers achieve abstinence from tobacco. However, stakeholders expressed concern about QuitConnect duplicating services already offered by state quitlines.

CONCLUSION

Despite a common goal, many state quitline stakeholders had strong reservations about the creation of a centralized smokers' registry unless they could see clear evidence that the registry added value and was not duplicative of their existing services.

A survey of patient perspectives on the research use of health information and biospecimens

BACKGROUND

Personal health information and biospecimens are valuable research resources essential for the advancement of medicine and protected by national standards and provincial statutes. Research ethics and privacy standards attempt to balance individual interests with societal interests. However these standards may not reflect public opinion or preferences. The purpose of this study was to assess the opinions and preferences of patients with kidney disease about the use of their health information and biospecimens for medical research.

METHODS

A 45-item survey was distributed to a convenience sample of patients at an outpatient clinic in a large urban centre. The survey briefly addressed sociodemographic and illness characteristics. Opinions were sought on the research use of health information and biospecimens including consent preferences.

RESULTS

Two hundred eleven of 400 distributed surveys were completed (response rate 52.8 %). Respondents were generally supportive of medical research and trusting of researchers. Many respondents supported the use of their information and biospecimens for health research and also preferred consent be sought for use of health information and biospecimens. Some supported the use of their information and biospecimens for research without consent. There were significant differences in the opinions people offered regarding the research use of biospecimens compared to health information. Some respondent perspectives about consent were at odds with current regulatory and legal standards.

CONCLUSIONS

Clinical health data and biospecimens are valuable research resources, critical to the advancement of medicine. Use of these data for research requires balancing respect for individual autonomy, privacy and the societal interest in the greater good. Incongruence between some respondent perspectives and the regulatory standards suggest both a need for public education and review of legislation to increase understanding and ensure the public's trust is maintained.