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Hinze V, Henshall C, Smith T, Littlejohns J, Collett Z, Jones H, Maughan D, Ede R, Moll D, Marlowe K, Broughton N, Geddes J, Cipriani A. Count Me In: an inclusive approach towards patient recruitment for clinical research studies in the NHS. BMJ MENTAL HEALTH 2023; 26:e300774. [PMID: 37879674 PMCID: PMC10603415 DOI: 10.1136/bmjment-2023-300774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Participation in clinical research is associated with better patient outcomes and higher staff retention and satisfaction rates. Nevertheless, patient recruitment to mental health studies is challenging due to a reliance on clinician or patient referrals (standard approach). To empower patients and make healthcare research more equitable, we explored a novel researcher-led approach, called 'Count Me In' (CMI). OBJECTIVE To evaluate a 12-month implementation of CMI in a routine clinical setting. METHODS CMI was launched in August 2021 in a mental health National Health Service (NHS) Trust in England. Patients (aged 18+) learnt about CMI at their initial clinical appointment. Unless they opted out, they became contactable for research (via research informatics searches). FINDINGS After 12 months, 368 patients opted out and 22 741 became contactable through CMI, including 2716 through the standard approach and 20 025 through electronic searches (637% increase). Of those identified via electronic searches, 738 were contacted about specific studies and 270 consented to participate. Five themes were identified based on patient and staff experiences of CMI: 'level of awareness and accessibility of CMI', 'perceptions of research and perceived engagement with CMI', 'inclusive research practice', 'engagement and incentives for research participation', and 'relationships between clinical and research settings'. CONCLUSIONS CMI (vs standard) led to a larger and diverse patient cohort and was favoured by patients and staff. Yet a shift in the NHS research culture is needed to ensure that this diversity translates to actual research participation. CLINICAL IMPLICATIONS Through collaboration with other NHS Trusts and services, key funders (National Institute for Health and Care Research) and new national initiatives (Office for Life Sciences Mental Health Mission), CMI has the potential to address recruitment challenges through rapid patient recruitment into time-sensitive country-wide studies.
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Affiliation(s)
- Verena Hinze
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Catherine Henshall
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University Faculty of Health and Life Sciences, Oxford, UK
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | - Zoe Collett
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Helen Jones
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Daniel Maughan
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Roger Ede
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Deborah Moll
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Karl Marlowe
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nick Broughton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Effa C, Al Onazi MM, Spencer N, Pritchard L, Fletcher I, McNeely ML. Exploring the validity of the body image scale with survivors of breast cancer: A cognitive interview approach. Eur J Cancer Care (Engl) 2022; 31:e13717. [PMID: 36168095 DOI: 10.1111/ecc.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 07/24/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study is to explore the construct validity of the Body Image Scale for Cancer Questionnaire (BIS) using cognitive interviews. METHODS Twelve breast cancer survivors participated in a cognitive interview while completing the BIS. Each participant was asked to think-out-loud while answering items, and an interviewer asked probing questions relating to the participants' comprehension, example retrieval, certainty of answer and other decision-making factors. Interviews were audio recorded and transcribed, and the data were analysed deductively and inductively. RESULTS The participants' interpretations of the questions varied significantly. Several participants perceived the phrasing of some questions to be leading. The participants were able to provide examples of how their physical, physiological and body function affected their body image. The participants expressed positive attitudes towards, and gratitude for their body, which was not captured by the questionnaire. At times, the participants felt uncertain in how to respond appropriately to specific items, and the participants found some items challenging to answer. Finally, the BIS included sensitive questions that elicited emotional reactions and discomfort for some participants. CONCLUSION The findings of this study provide insight into, and suggestions for potential questionnaire revisions that may enhance the validity and relevance of the BIS for use with breast cancer survivors.
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Affiliation(s)
- Corrie Effa
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Mona M Al Onazi
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Nancy Spencer
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Lesley Pritchard
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Ian Fletcher
- Clinical Psychology, Division of Health Research, Lancaster University, Lancaster, UK
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.,Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
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Hagström J, Woodford J, von Essen A, Lähteenmäki P, von Essen L. Opt-out rates and reasons for non-participation in a single-arm feasibility trial (ENGAGE) of a guided internet-administered CBT-based intervention for parents of children treated for cancer: a nested cross-sectional survey. BMJ Open 2022; 12:e056758. [PMID: 35365530 PMCID: PMC8977820 DOI: 10.1136/bmjopen-2021-056758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Difficulties with recruitment into clinical trials are common. An opt-out recruitment strategy, whereby potential participants can decline further contact about a study (opt-out), and non-responders are contacted, may facilitate participation. Primary objectives examined opt-out and consent rates, mode and time point of opt-out, and sociodemographic characteristics of those who opted out versus those who chose to participate in a single-arm feasibility trial (ENGAGE) of a guided, internet-administered, cognitive-behavioural therapy-based intervention for parents of children treated for cancer. Secondary objectives examined reasons for non-participation. DESIGN A cross-sectional survey nested within the ENGAGE feasibility trial. SETTING The intervention was delivered from Uppsala University, with parents located throughout Sweden. PARTICIPANTS Potential participants were recruited 3 months-5 years following their child ending treatment for cancer and were identified via their personal identification number (via the Swedish Childhood Cancer Registry and Swedish Tax Agency) and invited via postal invitation packs and could opt out via post, online, telephone or email. Those who did not opt out or consent, within 4 weeks, received up to five telephone calls and/or one postal reminder. RESULTS Of 509 invited, 164 (32.2%) opted out, 78 (47.6%) via post, 53 (32.3%) via telephone, 24 (14.6%) online, and 6 (3.7%) via email, 88 (53.7%) opted out after at least one telephone call and/or postal reminder. There was a trend for parents with lower educational levels to opt out. No need of psychological support, lack of time, and no interest in internet-administered self-help were frequently reported reasons for non-participation. CONCLUSIONS Results emphasise the importance of using different opt-out modes and suggest future research should consider how to widen study participation for parents with lower education levels. Self-identifying a need for psychological support and the acceptability of internet-administered self-help are important factors for participation and should be considered in future research to increase recruitment. TRIAL REGISTRATION NUMBER ISRCTN57233429.
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Affiliation(s)
- Josefin Hagström
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Agnes von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Päivi Lähteenmäki
- Department of Paediatrics and Adolescent Medicine, TYKS Turku University Hospital, Turku, Finland
- Pediatric Oncology and Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Linton MJ, Biddle L, Bennet J, Gunnell D, Purdy S, Kidger J. Barriers to students opting-in to universities notifying emergency contacts when serious mental health concerns emerge: A UK mixed methods analysis of policy preferences. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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OUP accepted manuscript. Health Promot Int 2022:6556290. [DOI: 10.1093/heapro/daac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Long JC, Pomare C, Ellis LA, Churruca K, Braithwaite J. The pace of hospital life: A mixed methods study. PLoS One 2021; 16:e0255775. [PMID: 34407092 PMCID: PMC8372908 DOI: 10.1371/journal.pone.0255775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
The pace-of-life hypothesis is a socio-psychological theory postulating that citizens of different cities transact the business of life at varying paces, and this pace is associated with a number of population level variables. Here we apply the pace-of-life hypothesis to a hospital context to empirically test the association between pace and patient and staff outcomes. As pressure on hospitals grow and pace increases to keep up with demand, is there empirical evidence of a trade-off between a rapid pace and poorer outcomes? We collected data from four large Australian hospitals, inviting all staff (clinical and non-clinical) to complete a survey, and conducted a series of observations of hospital staff's walking pace and transactional pace. From these data we constructed three measures of pace: staff perception of pace, transactional pace, and walking pace. Outcome measures included: hospital culture, perceived patient safety, and staff well-being outcomes of job satisfaction and burnout. Overall, participants reported experiencing a "fast-paced" "hurried" and "rapid" pace-of-life working in the Australian hospital sector. We found a significant difference in perceived pace across four hospital sites, similar to trends observed for transactional pace. This provides support that the pace-of-life hypothesis may apply to the hospital context. We tested associations between faster perceived pace, hospital culture, staff well-being and patient safety. Results revealed perceived faster pace significantly predicted negative perceptions of organizational culture, greater burnout and lower job satisfaction. However, perceived pace did not predict perceptions of patient safety. Different perceptions of hospital pace-of-life were found between different clinical settings and the type of care delivered; staff working in emergency departments reported significantly "faster-paced" work environments than staff working in palliative, aged care, or rehabilitation wards.
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Affiliation(s)
- Janet C. Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A. Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Snow AL, Loup J, Morgan RO, Richards K, Parmelee PA, Baier RR, McCreedy E, Frank B, Brady C, Fry L, McCullough M, Hartmann CW. Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program. BMC Geriatr 2021; 21:281. [PMID: 33906631 PMCID: PMC8076882 DOI: 10.1186/s12877-021-02189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability. Discussion This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. Trial registration NCT04533815, ClinicalTrials.gov, August 20, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02189-8.
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Affiliation(s)
- A Lynn Snow
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA. .,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA.
| | - Julia Loup
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA.,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, USA
| | - Kathy Richards
- School of Nursing, The University of Texas at Austin, Austin, TX, 78701-1412, USA
| | - Patricia A Parmelee
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA
| | - Rosa R Baier
- Brown University School of Public Health, Providence, RI, 02912, USA
| | - Ellen McCreedy
- Brown University School of Public Health, Providence, RI, 02912, USA
| | | | | | - Liam Fry
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Megan McCullough
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Christine W Hartmann
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
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Abstract
BACKGROUND Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment OBJECTIVE: The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. METHODS A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. RESULTS Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. CONCLUSIONS While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. IMPLICATIONS FOR PRACTICE Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.
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Morris SE, Nayak MM, Block SD. Insights from Bereaved Family Members about End-of-Life Care and Bereavement. J Palliat Med 2020; 23:1030-1037. [DOI: 10.1089/jpm.2019.0467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sue E. Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Children's Hospital and Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Manan M. Nayak
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Susan D. Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Departments of Psychiatry and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Aoun SM, Kissane DW, Cafarella PA, Rumbold B, Hogden A, Jiang L, Bear N. Grief, depression, and anxiety in bereaved caregivers of people with motor neurone disease: a population-based national study. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:593-605. [DOI: 10.1080/21678421.2020.1790610] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Samar M Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - David W Kissane
- Palliative Medicine Research, The University of Notre Dame Australia, and The Cunningham Centre for Palliative Care Research, St Vincent's Hospital, Sydney, NSW, Australia
- Cabrini Psycho-Oncology and Supportive Care Research Unit, Monash University, Melbourne, VIC, Australia
| | - Paul A. Cafarella
- Department of Respiratory Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- College of Nursing and Health Sciences & College of Medicine and Public Health, Flinders University of South Australia, Bedford Park, SA, Australia
| | - Bruce Rumbold
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, NSW, Australia and
| | - Leanne Jiang
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Natasha Bear
- Institute of Health Research, Fremantle Campus, University of Notre Dame Australia, Fremantle, WA, Australia
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Nordfalk F, Hoeyer K. The rise and fall of an opt-out system. Scand J Public Health 2020; 48:400-404. [PMID: 29207930 PMCID: PMC7263030 DOI: 10.1177/1403494817745189] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/21/2017] [Accepted: 10/24/2017] [Indexed: 11/18/2022]
Abstract
Introduction: In Denmark, citizens participate in register-based research without the possibility of opting out. However, in 1995 it was made possible for Danish citizens to register an opt-out called 'researcher protection' [forskerbeskyttelse], which implied that researchers could not contact people to invite them to participate in research projects, such as clinical trials or questionnaries, based on their registrations in national registers. Data already registered could still be used for research. In 2014, this possibility of opt-out was revoked by law. Aims: The aims of this paper are to understand how the Danish researcher protection system came about, why it was terminated and what we can we learn from this example. Methods: We conducted a descriptive analysis of a copy of the former researcher protection register along with policies and media debate surrounding the rise and revocation of the researcher protection system. Results: Our results show how both the inception and the abolishment of researcher protection appear to be ad hoc and without specified criteria of success. An examination of the recorded entries in the researcher protection registry could have led to changes in its administration as an alternative to its total abolition. Conclusions: In future opt-out systems, there should be focus on monitoring register practices and the purpose and criteria for evaluation must be defined prior to implementation.
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Affiliation(s)
- Francisca Nordfalk
- Center for Medical Science and Technology Studies, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Klaus Hoeyer
- Center for Medical Science and Technology Studies, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
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Callahan DG, Garabedian LF, Harney KF, DiVasta AD. Will it Hurt? The Intrauterine Device Insertion Experience and Long-Term Acceptability Among Adolescents and Young Women. J Pediatr Adolesc Gynecol 2019; 32:615-621. [PMID: 31401254 DOI: 10.1016/j.jpag.2019.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/15/2019] [Accepted: 08/05/2019] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE To examine how the intrauterine device (IUD) insertion experience affects long-term IUD acceptability among adolescents. DESIGN Text to Web survey study. SETTING Boston Children's Hospital and Cambridge Health Alliance in Massachusetts. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES Nulliparous adolescents aged 13-21 years who received an IUD or etonogestrel implant between January 2012 and May 2018. RESULTS We received survey responses from 95 adolescents (n = 46 IUD; n = 49 implant; response rate = 95/1098 (9%)). Mean current age (20.8 years) and time since device insertion (2.4 years) were similar between groups. Although a large proportion of both groups (64%) experienced moderate to severe preprocedural anxiety, IUD users expected more insertional pain compared with implant users (55.6 vs 39.6; P = .01). Compared with implant users, more IUD users experienced moderate to severe insertional pain (80% vs 18%; P < .0001), recalled that the procedure hurt more than expected (52% vs 4%; P < .0001), and endorsed lower rates of pain management satisfaction (72.4 vs 85.6; P = .04). Most respondents would recommend their method to a friend (75%) or consider getting the same device in the future (63%). When explicitly asked, more IUD users reported that dislike of the insertion procedure might or would probably prevent them from getting the same device in the future (41% vs 14%; P = .005). CONCLUSION Compared with implant users, IUD users reported more negative insertion experiences, although preprocedural anxiety was prevalent in both groups. Dislike of the insertion experience might negatively affect adolescents' willingness to continue using an IUD in the future. Findings should encourage multimodal interventions to holistically improve the IUD insertion experience.
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Affiliation(s)
- Dana G Callahan
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Laura F Garabedian
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Kathleen F Harney
- Department of Obstetrics and Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Amy D DiVasta
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
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Aoun SM, Lowe J, Christian KM, Rumbold B. Is there a role for the funeral service provider in bereavement support within the context of compassionate communities? DEATH STUDIES 2018; 43:619-628. [PMID: 30265833 DOI: 10.1080/07481187.2018.1506835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
This is the first study to explore bereaved individuals' experiences of funeral service providers using these services' databases. A total of 839 Australians participated in a postal survey, 6-24 months into their bereavement. Funeral providers were reported to be the third most prevalent form of bereavement support after friends and family. Analysis found six themes related to perceived helpful or unhelpful support: instrumental support, professionalism, informational support, financial tension, communication, and emotional support. Funeral providers could improve their support by adopting a proactive approach to bereavement needs and offering personalized and ongoing support. We develop these suggestions by exploring their potential contributions to building community capacity around death, dying and bereavement.
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Affiliation(s)
- Samar M Aoun
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University , Melbourne , Victoria , Australia
- Institute for Health Research, Notre Dame University , Fremantle , Western Australia , Australia
| | - Jennifer Lowe
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University , Melbourne , Victoria , Australia
| | - Kim M Christian
- School of Psychology, Faculty of Health Sciences, Curtin University , Perth , Western Australia , Australia
| | - Bruce Rumbold
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University , Melbourne , Victoria , Australia
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Aoun SM, Breen LJ, White I, Rumbold B, Kellehear A. What sources of bereavement support are perceived helpful by bereaved people and why? Empirical evidence for the compassionate communities approach. Palliat Med 2018; 32:1378-1388. [PMID: 29754514 PMCID: PMC6088515 DOI: 10.1177/0269216318774995] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care. DESIGN A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis. SETTING AND PARTICIPANTS Bereaved people were recruited from databases of funeral providers in Australia via an anonymous postal survey (2013-2014). RESULTS In total, 678 bereaved people responded to the survey. The most frequently used sources of support were in the informal category such as family, friends and funeral providers. While the professional category sources were the least used, they had the highest proportions of perceived unhelpfulness whereas the lowest proportions of unhelpfulness were in the informal category. The functional types of helpful support were Attachment, Reliable Alliance, Social Integration and Guidance. The five themes for least helpful support were: Insensitivity, Absence of Anticipated Support, Poor Advice, Lack of Empathy and Systemic Hindrance. CONCLUSION A public health approach, as exemplified by compassionate communities policies and practices, should be adopted to support the majority of bereaved people as much of this support is already provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. This study has provided further support for the need to strengthen the compassionate communities approach, not only for end of life care for dying patients but also along the continuum of bereavement support.
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Affiliation(s)
- Samar M Aoun
- 1 Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,2 Institute for Health Research, Notre Dame University, Fremantle, WA, Australia
| | - Lauren J Breen
- 3 School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Ishta White
- 3 School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Bruce Rumbold
- 1 Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Allan Kellehear
- 4 School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
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Cheney AM, Koenig CJ, Miller CJ, Zamora K, Wright P, Stanley R, Fortney J, Burgess JF, Pyne JM. Veteran-centered barriers to VA mental healthcare services use. BMC Health Serv Res 2018; 18:591. [PMID: 30064427 PMCID: PMC6069794 DOI: 10.1186/s12913-018-3346-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 07/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans' experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to using mental healthcare services among a diverse sample of US rural and urban veterans. We sought to identify veteran-centric barriers to mental healthcare to increase initial engagement and continuation with VA mental healthcare services. METHODS Cultural Domain Analysis, incorporated in a mixed methods approach, generated a cognitive map of veterans' barriers to care. The method involved: 1) free lists of barriers categorized through participant pile sorting; 2) multi-dimensional scaling and cluster analysis for item clusters in spatial dimensions; and 3) participant review, explanation, and interpretation for dimensions of the cultural domain. Item relations were synthesized within and across domain dimensions to contextualize mental health help-seeking behavior. RESULTS Participants determined five dimensions of barriers to VA mental healthcare services: concern about what others think; financial, personal, and physical obstacles; confidence in the VA healthcare system; navigating VA benefits and healthcare services; and privacy, security, and abuse of services. CONCLUSIONS These findings demonstrate the value of participatory methods in eliciting meaningful cultural insight into barriers of mental health utilization informed by military veteran culture. They also reinforce the importance of collaborations between the VA and Department of Defense to address the role of military institutional norms and stigmatizing attitudes in veterans' mental health-seeking behaviors.
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Affiliation(s)
- Ann M. Cheney
- Department of Social Medicine, Population, and Public Health, Center for Healthy Communities, School of Medicine, University of California, Riverside, 900 University Avenue, Riverside, CA 92521 USA
| | - Christopher J. Koenig
- Department of Communication Studies, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132 USA
| | - Christopher J. Miller
- The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130 USA
- Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215 USA
| | - Kara Zamora
- San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121 USA
| | - Patricia Wright
- School of Nursing, University of Arkansas for Medical Sciences, 220 Campus Dr, Little Rock, AR 72205 USA
| | - Regina Stanley
- HSR&D Center of Innovation, Central Arkansas VA Health Care System, 2200 Ft. Roots Drive Bldg. 58 152/NLR, North Little Rock, AR 72114 USA
| | - John Fortney
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108 USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-6560 USA
| | - James F. Burgess
- The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130 USA
| | - Jeffrey M. Pyne
- HSR&D Center of Innovation, Central Arkansas VA Health Care System, 2200 Ft. Roots Drive Bldg. 58 152/NLR, North Little Rock, AR 72114 USA
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR 72205 USA
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16
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Breen LJ, Karangoda MD, Kane RT, Howting DA, Aoun SM. Differences in meanings made according to prolonged grief symptomatology. DEATH STUDIES 2018; 42:69-78. [PMID: 28489494 DOI: 10.1080/07481187.2017.1328467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study investigated differences in specific meanings made following bereavement, according to participants' prolonged grief symptomatology. A survey of 580 bereaved adults (Mage = 61.6 years, 70.7% female) showed 13 meanings predicted symptomatology, with the largest differences between the two lower symptomatology groups and the high symptomatology group; the latter was more likely to report no meaning. The results provide further support for empirically distinct groups within the bereaved population, not only in terms of symptoms, etiology, outcomes, courses, and treatment responses, but also in their meanings made, and may assist in advancing meaning reconstruction interventions.
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Affiliation(s)
- Lauren J Breen
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Michelle D Karangoda
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Robert T Kane
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Denise A Howting
- b School of Nursing, Midwifery and Paramedicine , Curtin University , Perth , Australia
| | - Samar M Aoun
- b School of Nursing, Midwifery and Paramedicine , Curtin University , Perth , Australia
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Hunt KJ, Richardson A, Darlington ASE, Addington-Hall JM. Developing the methods and questionnaire (VOICES-SF) for a national retrospective mortality follow-back survey of palliative and end-of-life care in England. BMJ Support Palliat Care 2017; 9:e5. [PMID: 29101120 DOI: 10.1136/bmjspcare-2016-001288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 07/31/2017] [Accepted: 09/15/2017] [Indexed: 11/04/2022]
Abstract
The National Survey of Bereaved People was conducted by the Office for National Statistics on behalf of NHS England for the first time in 2011, and repeated annually thereafter. It is thought to be the first time that nationally representative data have been collected annually on the experiences of all people who have died, regardless of cause and setting, and made publicly available informing palliative and end-of-life policy, service provision and development, and practice. This paper describes the development of the questionnaire used in the survey, VOICES-SF, a short-form of the VOICES (Views Of Informal Carers-Evaluation of Services) questionnaire, adapted specifically to address the aims of the national survey. The pilot study to refine methods for the national survey is also described. The paper also reports on the development of the retrospective, after-death or mortality follow-back method in palliative and end-of-life care, and reviews its strengths and weaknesses.
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Affiliation(s)
- Katherine J Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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18
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Bereavement support for family caregivers: The gap between guidelines and practice in palliative care. PLoS One 2017; 12:e0184750. [PMID: 28977013 PMCID: PMC5627900 DOI: 10.1371/journal.pone.0184750] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022] Open
Abstract
Background Standards for bereavement care propose that support should be matched to risk and need. However, studies in many countries demonstrate that palliative care services continue to adopt a generic approach in offering support to bereaved families. Objective To identify patterns of bereavement support in palliative care services based upon the experience of bereaved people from a population based survey and in relation to clinical practice guidelines. Design An anonymous postal survey collected information from clients of six funeral providers in four Australian states (2014–15), 6 to 24 months after the death of their family member or friend, with 1,139 responding. Responses from 506 bereaved relatives of people who had terminal illnesses were analysed. Of these, 298 had used palliative care services and 208 had not. Results More people with cancer (64%) had received palliative care in comparison to other illnesses such as heart disease, dementia and organ failure (4–10%). The support for family caregivers before and after their relative’s death was not considered optimal. Only 39.4% of the bereaved reported being specifically asked about their emotional/ psychological distress pre-bereavement, and just half of the bereaved perceived they had enough support from palliative care services. Half of the bereaved had a follow up contact from the service at 3–6 weeks, and a quarter had a follow-up at 6 months. Their qualitative feedback underlined the limited helpfulness of the blanket approach to bereavement support, which was often described as “not personal” or “generic”, or “just standard practice”. Conclusions Timeliness and consistency of relationship is crucial to building rapport and trust in the service’s ability to help at post-bereavement as well as a focus on the specific rather than the generic needs of the bereaved. In light of these limitations, palliative care services might do better investing their efforts principally in assessing and supporting family caregivers during the pre-bereavement period and developing community capacity and referral pathways for bereavement care. Our findings suggest that bereavement support in Australian palliative care services has only a tenuous relationship with guidelines and assessment tools, a conclusion also drawn in studies from other countries, emphasizing the international implications of our study.
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Heerman WJ, Jackson N, Roumie CL, Harris PA, Rosenbloom ST, Pulley J, Wilkins CH, Williams NA, Crenshaw D, Leak C, Scherdin J, Muñoz D, Bachmann J, Rothman RL, Kripalani S. Recruitment methods for survey research: Findings from the Mid-South Clinical Data Research Network. Contemp Clin Trials 2017; 62:50-55. [PMID: 28823925 DOI: 10.1016/j.cct.2017.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of this study was to report survey response rates and demographic characteristics of eight recruitment approaches to determine acceptability and effectiveness of large-scale patient recruitment among various populations. METHODS We conducted a cross sectional analysis of survey data from two large cohorts. Patients were recruited from the Mid-South Clinical Data Research Network using clinic-based recruitment, research registries, and mail, phone, and email approaches. Response rates are reported as patients who consented for the survey divided by the number of eligible patients approached. RESULTS We contacted more than 90,000 patients and 13,197 patients completed surveys. Median age was 56.3years (IQR 40.9, 67.4). Racial/ethnic distribution was 84.1% White, non-Hispanic; 9.9% Black, non-Hispanic; 1.8% Hispanic; and 4.0% other, non-Hispanic. Face-to-face recruitment had the highest response rate of 94.3%, followed by participants who "opted-in" to a registry (76%). The lowest response rate was for unsolicited emails from the clinic (6.1%). Face-to-face recruitment enrolled a higher percentage of participants who self-identified as Black, non-Hispanic compared to other approaches (18.6% face-to-face vs. 8.4% for email). CONCLUSIONS Technology-enabled recruitment approaches such as registries and emails are effective for recruiting but may yield less racial/ethnic diversity compared to traditional, more time-intensive approaches.
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Affiliation(s)
- William J Heerman
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA.
| | - Natalie Jackson
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Christianne L Roumie
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA; Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, 1310 24th Ave S, Nashville, TN 37212, USA
| | - Paul A Harris
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
| | - S Trent Rosenbloom
- Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA; Department of Biomedical Informatics, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
| | - Jill Pulley
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Consuelo H Wilkins
- Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), HSR&D Center, 1310 24th Ave S, Nashville, TN 37212, USA; Meharry-Vanderbilt Alliance, 1005 Dr. D.B. Todd Jr. Blvd., Biomedical Building, Nashville, TN 37208, USA; Meharry Medical College, Department of Medicine, 1005 Dr. D.B. Todd Jr. Blvd., Biomedical Building, Nashville, TN 37208, USA
| | | | - David Crenshaw
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Cardella Leak
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Jon Scherdin
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Daniel Muñoz
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Justin Bachmann
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA
| | - Russell L Rothman
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
| | - Sunil Kripalani
- Center for Health Services Research, Institute for Medicine and Public Health, Vanderbilt University, 2525 West End Ave, Nashville, TN 37232, USA; Department of Medicine, School of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN 37232, USA
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20
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Miller CJ, Burgess JF, Fischer EP, Hodges DJ, Belanger LK, Lipschitz JM, Easley SR, Koenig CJ, Stanley RL, Pyne JM. Practical application of opt-out recruitment methods in two health services research studies. BMC Med Res Methodol 2017; 17:57. [PMID: 28410585 PMCID: PMC5391553 DOI: 10.1186/s12874-017-0333-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/28/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Participant recruitment is an ongoing challenge in health research. Recruitment may be especially difficult for studies of access to health care because, even among those who are in care, people using services least often also may be hardest to contact and recruit. Opt-out recruitment methods (in which potential participants are given the opportunity to decline further contact about the study (opt out) following an initial mailing, and are then contacted directly if they have not opted out within a specified period) can be used for such studies. However, there is a dearth of literature on the effort needed for effective opt-out recruitment. METHODS In this paper we describe opt-out recruitment procedures for two studies on access to health care within the U.S. Department of Veterans Affairs. We report resource requirements for recruitment efforts (number of opt-out packets mailed and number of phone calls made). We also compare the characteristics of study participants to potential participants via t-tests, Fisher's exact tests, and chi-squared tests. RESULTS Recruitment rates for our two studies were 12 and 21%, respectively. Across multiple study sites, we had to send between 4.3 and 9.2 opt-out packets to recruit one participant. The number of phone calls required to arrive at a final status for each potentially eligible Veteran (i.e. study participation or the termination of recruitment efforts) were 2.9 and 6.1 in the two studies, respectively. Study participants differed as expected from the population of potentially eligible Veterans based on planned oversampling of certain subpopulations. The final samples of participants did not differ statistically from those who were mailed opt-out packets, with one exception: in one of our two studies, participants had higher rates of mental health service use in the past year than did those mailed opt-out packets (64 vs. 47%). CONCLUSIONS Our results emphasize the practicality of using opt-out methods for studies of access to health care. Despite the benefits of these methods, opt-out alone may be insufficient to eliminate non-response bias on key variables. Researchers will need to balance considerations of sample representativeness and feasibility when designing studies investigating access to care.
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Affiliation(s)
- Christopher J. Miller
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Harvard Medical School Department of Psychiatry, Boston, Massachusetts USA
| | - James F. Burgess
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health, Boston, Massachusetts USA
| | - Ellen P. Fischer
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, and University of Arkansas for Medical Sciences Department of Psychiatry, Little Rock, Arkansas USA
| | - Deborah J. Hodges
- Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas USA
| | - Lindsay K. Belanger
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health, Boston, Massachusetts USA
| | - Jessica M. Lipschitz
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Harvard Medical School Department of Psychiatry, Boston, Massachusetts USA
| | - Siena R. Easley
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health, Boston, Massachusetts USA
| | - Christopher J. Koenig
- San Francisco VA Health Care System and San Francisco State University Department of Communication Studies, San Francisco, California USA
| | - Regina L. Stanley
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas USA
| | - Jeffrey M. Pyne
- Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences Department of Psychiatry, Little Rock, Arkansas USA
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21
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Corsini N, Fish J, Ramsey I, Sharplin G, Flight I, Damarell R, Wiggins B, Wilson C, Roder D, Eckert M. Cancer survivorship monitoring systems for the collection of patient-reported outcomes: a systematic narrative review of international approaches. J Cancer Surviv 2017; 11:486-497. [DOI: 10.1007/s11764-017-0607-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 02/14/2017] [Indexed: 01/23/2023]
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22
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Pratt B, Paul A, Hyder AA, Ali J. Ethics of health policy and systems research: a scoping review of the literature. Health Policy Plan 2017; 32:890-910. [DOI: 10.1093/heapol/czx003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/12/2022] Open
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McCullough MB, Janicke D, Odar Stough C, Robson S, Bolling C, Zion C, Stark L. Barriers to Recruitment in Pediatric Obesity Trials: Comparing Opt-in and Opt-out Recruitment Approaches. J Pediatr Psychol 2017; 42:174-185. [PMID: 27328916 PMCID: PMC6497420 DOI: 10.1093/jpepsy/jsw054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/16/2016] [Accepted: 05/23/2016] [Indexed: 11/14/2022] Open
Abstract
Objective To compare the efficacy of opt-in versus opt-out recruitment methods in pediatric weight management clinical trials. Methods Recruitment of preschoolers and school-age children across two obesity randomized controlled trials (RCTs) were compared using the same opt-in recruitment approach (parents contact researchers in response to mailings). Opt-in and opt-out strategies (parents send decline postcard in response to mailings if they do not want to participate) were then compared across two preschool obesity RCTs. Results Opt-in strategies yielded a significantly lower overall recruitment rate among preschoolers compared with school-age children. Among preschoolers, an opt-out strategy demonstrated a significantly higher overall recruitment rate compared with an opt-in strategy with the main advantage in the number of families initially contacted. Conclusions Opt-out recruitment strategies may be more effective in overcoming the barriers of recruitment in the preschool age-group because it does not rely on parent recognition of obesity.
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Affiliation(s)
- Mary Beth McCullough
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati
Children’s Hospital Medical Center
| | - David Janicke
- Department of Clinical and Health Psychology, University of Florida
| | - Cathleen Odar Stough
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati
Children’s Hospital Medical Center
| | - Shannon Robson
- Department of Behavioral Health and Nutrition, University of Delaware
| | | | - Cindy Zion
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati
Children’s Hospital Medical Center
| | - Lori Stark
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati
Children’s Hospital Medical Center
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24
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Green AR, Jenkins A, Masoudi FA, Magid DJ, Kutner JS, Leff B, Matlock DD. Decision-Making Experiences of Patients with Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1061-1069. [PMID: 27566614 DOI: 10.1111/pace.12943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/03/2016] [Accepted: 08/18/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND When patients are not adequately engaged in decision making, they may be at risk of decision regret. Our objective was to explore patients' perceptions of their decision-making experiences related to implantable cardioverter defibrillators (ICDs). METHODS Cross-sectional, mailed survey of 412 patients who received an ICD without cardiac resynchronization therapy for any indication between 2006 and 2009. Patients were asked about decision participation and decision regret. RESULTS A total of 295 patients with ICDs responded (72% response rate). Overall, 79% reported that they were as involved in the decision as they wanted. However, 28% reported that they were not told of the option of not getting an ICD and 37% did not remember being asked if they wanted an ICD. In total, 19% reported not wanting their ICD at the time of implantation. Those who did not want the ICD were younger (<65 years; 74% vs 43%, P < 0.001), had higher decision regret (31/100 vs 11/100, P < 0.001), and reported less participation in decision making (the doctor "totally" made the decision, 9% vs 3%; P < 0.001). CONCLUSIONS A considerable number of ICD recipients recalled not wanting their ICD at the time of implantation. While these findings may be prone to recall bias, they likely identify opportunities to improve ICD decision making.
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Affiliation(s)
- Ariel R Green
- Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Amy Jenkins
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado
| | - David J Magid
- Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jean S Kutner
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Bruce Leff
- Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Daniel D Matlock
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado
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Flint AC, Conell C, Klingman JG, Rao VA, Chan SL, Kamel H, Cullen SP, Faigeles BS, Sidney S, Johnston SC. Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention. J Am Heart Assoc 2016; 5:e003413. [PMID: 27473035 PMCID: PMC5015276 DOI: 10.1161/jaha.116.003413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Statin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization. METHODS AND RESULTS This is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an "opt-in" to "opt-out" mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time-series modeling. The EMR intervention increased both overall in-hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [Pdiff]=0.02, P=0.016) and discharge to home or rehabilitation facility (Pdiff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (Pdiff=0.17, P=0.033) and rate of discharge to home or rehabilitation (Pdiff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in-hospital (Pdiff=-0.14, P=0.026). CONCLUSIONS A simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.
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Affiliation(s)
- Alexander C Flint
- Department of Neuroscience, Kaiser Permanente, Redwood City, CA Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Carol Conell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jeff G Klingman
- Department of Neurology, Kaiser Permanente, Walnut Creek, CA
| | - Vivek A Rao
- Department of Neuroscience, Kaiser Permanente, Redwood City, CA
| | - Sheila L Chan
- Department of Neuroscience, Kaiser Permanente, Redwood City, CA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical Center, New York, NY
| | - Sean P Cullen
- Department of Neuroscience, Kaiser Permanente, Redwood City, CA
| | | | - Steve Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Breen LJ, Aoun SM, Rumbold B, McNamara B, Howting DA, Mancini V. Building Community Capacity in Bereavement Support. Am J Hosp Palliat Care 2016; 34:275-281. [DOI: 10.1177/1049909115615568] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Most bereaved people do not require specialist intervention, yet building community capacity in providing bereavement support is underdeveloped. While family caregivers indicate a need for more information about bereavement, there is little evidence to guide what this information might contain. Objective: The study’s purpose was to inform bereavement support by determining the advice people bereaved through expected deaths in palliative care have for others in that situation. Design: Four funeral providers posted a questionnaire to previous clients who had used their services 6 to 24 months prior and 678 bereaved people responded. Setting/Participants: The sample size for this study comprised 265 bereaved people whose relative used palliative care services. Measurements: The questionnaire comprised 82 questions about caregiving, bereavement support, current bereavement-related distress, and 2 open-ended questions concerning their bereavement, one of them on advice they have to other people in the same situation. Results: Family caregivers (n = 140) of people who received palliative care responded to the open-ended question about advice for others. An open content analysis yielded 3 themes—preparations for bereavement, utilizing social networks, and strategies for dealing with grief. Conclusions: Bereaved family caregivers’ experiential knowledge can be harnessed to progress the development of bereavement care strategies for the good of the community. These responses could be incorporated into information brochures, posters, and other community education avenues in order to upskill palliative care bereavement volunteers and the wider community so that bereaved family caregivers are best supported.
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Affiliation(s)
| | - Samar M. Aoun
- Curtin University, Perth, Western Australia, Australia
| | - Bruce Rumbold
- La Trobe University, Perth, Western Australia, Australia
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Ellis J, Warden J, Molassiotis A, Mackereth P, Lloyd-Williams M, Bailey C, Burns K, Yorke J. Participation in a randomised controlled feasibility study of a complex intervention for the management of the Respiratory Symptom Distress Cluster in lung cancer: patient, carer and research staff views. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27389436 PMCID: PMC5697644 DOI: 10.1111/ecc.12538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 11/28/2022]
Abstract
This paper reports finding from a nested qualitative study designed to elicit the views and perceptions of those who participated in a randomised controlled feasibility trial testing a non‐pharmacological intervention, Respiratory Distress Symptom Intervention (RDSI), for the management of the breathlessness–cough–fatigue symptom cluster in lung cancer. Semi‐structured interviews were conducted with 11 lung cancer patients, three caregivers and seven researchers involved in recruitment, consent, RDSI training and delivery and participant follow‐up. Thematic analysis identified key considerations including: the importance of informed consent emphasising commitment to completion of paperwork and raising awareness of potential sensitivities relating to content of questionnaires; ensuring screening for the presence of symptoms reflects the language used by patients; appreciation of the commitment required from participants to learn intervention techniques and embed them as part of everyday life; conduct of interviews with patients who decline to participate; and conduct of serial interviews with those receiving RDSI to further inform its routine implementation into clinical practice. This study will inform the development of a fully powered follow‐on trial testing the hypothesis that RDSI plus usual care is superior to usual care alone in the effective management of this symptom cluster in lung cancer.
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Affiliation(s)
- J Ellis
- Health Services Research, University of Liverpool, Liverpool, UK
| | - J Warden
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - A Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - P Mackereth
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - M Lloyd-Williams
- Health Services Research, University of Liverpool, Liverpool, UK
| | - C Bailey
- Health Sciences, University of Southampton, Southampton, UK
| | - K Burns
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.,Christie Hospital NHS Foundation Trust, Manchester, UK
| | - J Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.,Christie Hospital NHS Foundation Trust, Manchester, UK
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Lea NC, Nicholls J, Dobbs C, Sethi N, Cunningham J, Ainsworth J, Heaven M, Peacock T, Peacock A, Jones K, Laurie G, Kalra D. Data Safe Havens and Trust: Toward a Common Understanding of Trusted Research Platforms for Governing Secure and Ethical Health Research. JMIR Med Inform 2016; 4:e22. [PMID: 27329087 PMCID: PMC4933798 DOI: 10.2196/medinform.5571] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/19/2016] [Accepted: 06/04/2016] [Indexed: 01/23/2023] Open
Abstract
In parallel with the advances in big data-driven clinical research, the data safe haven concept has evolved over the last decade. It has led to the development of a framework to support the secure handling of health care information used for clinical research that balances compliance with legal and regulatory controls and ethical requirements while engaging with the public as a partner in its governance. We describe the evolution of 4 separately developed clinical research platforms into services throughout the United Kingdom-wide Farr Institute and their common deployment features in practice. The Farr Institute is a case study from which we propose a common definition of data safe havens as trusted platforms for clinical academic research. We use this common definition to discuss the challenges and dilemmas faced by the clinical academic research community, to help promote a consistent understanding of them and how they might best be handled in practice. We conclude by questioning whether the common definition represents a safe and trustworthy model for conducting clinical research that can stand the test of time and ongoing technical advances while paying heed to evolving public and professional concerns.
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Bray I, Noble S, Boyd A, Brown L, Hayes P, Malcolm J, Robinson R, Williams R, Burston K, Macleod J, Molloy L, Tilling K. A randomised controlled trial comparing opt-in and opt-out home visits for tracing lost participants in a prospective birth cohort study. BMC Med Res Methodol 2015. [PMID: 26202794 PMCID: PMC4512038 DOI: 10.1186/s12874-015-0041-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attrition is an important problem in cohort studies. Tracing cohort members who have moved or otherwise lost contact with the study is vital. There is some debate about the acceptability and relative effectiveness of opt-in versus opt-out methods of contacting cohort members to re-engage them in this context. We conducted a randomised controlled trial to compare the two approaches in terms of effectiveness (tracing to confirm address and consenting to continue in the study), cost-effectiveness and acceptability. METHODS Participants in this trial were individuals (young people and mothers) recruited to the Avon Longitudinal Study of Parents and Children (ALSPAC), who had not engaged with the study in the previous 5 years and for whom mail had been returned from their last known address. The sampling frame was restricted to those for whom database searching led to a potential new address being found in the Bristol area. 300 participants were randomly selected and assigned using stratified randomisation to the opt-in or opt-out arm. A tailored letter was sent to the potential new address, either asking participants to opt in to a home visit, or giving them the option to opt out of a home visit. Fieldworkers from Ipsos MORI conducted home visits to confirm address details. RESULTS The proportion who were traced was higher in the opt-out arm (77/150 = 51 %) than the opt-in arm (6/150 = 4 %), as was the proportion who consented to continue in ALSPAC (46/150 = 31 % v 4/150 = 3 %). The mean cost per participant was £8.14 in the opt-in arm and £71.93 in the opt-out arm. There was no evidence of a difference in acceptability between the opt-in and opt-out approaches. CONCLUSION Since the opt-in approach yielded very low response rates, and there were no differences in terms of acceptability, we conclude that the opt-out approach is the most effective method of tracing disengaged study members. The gains made in contacting participants must be weighed against the increase in cost using this methodology.
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Affiliation(s)
- Isabelle Bray
- Department of Health and Social Science, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, UK.
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Andy Boyd
- ALSPAC, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Lindsey Brown
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Pei Hayes
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Joanne Malcolm
- ALSPAC, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Ross Robinson
- ALSPAC, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | | | | | - John Macleod
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Lynn Molloy
- ALSPAC, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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Elkington J, Stevenson M, Haworth N, Sharwood L. Using police crash databases for injury prevention research - a comparison of opt-out and opt-in approaches to study recruitment. Aust N Z J Public Health 2015; 38:286-9. [PMID: 24890488 DOI: 10.1111/1753-6405.12237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/01/2013] [Accepted: 02/01/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The study aimed to examine the difference in response rates between opt-out and opt-in participant recruitment in a population-based study of heavy-vehicle drivers involved in a police-attended crash. METHODS Two approaches to subject recruitment were implemented in two different states over a 14-week period and response rates for the two approaches (opt-out versus opt-in recruitment) were compared. RESULTS Based on the eligible and contactable drivers, the response rates were 54% for the opt-out group and 16% for the opt-in group. CONCLUSIONS AND IMPLICATIONS The opt-in recruitment strategy (which was a consequence of one jurisdiction's interpretation of the national Privacy Act at the time) resulted in an insufficient and potentially biased sample for the purposes of conducting research into risk factors for heavy-vehicle crashes. Australia's national Privacy Act 1988 has had a long history of inconsistent practices by state and territory government departments and ethical review committees. These inconsistencies can have profound effects on the validity of research, as shown through the significantly different response rates we reported in this study. It is hoped that a more unified interpretation of the Privacy Act across the states and territories, as proposed under the soon-to-be-released Australian Privacy Principles(1) will reduce the recruitment challenges outlined in this study.
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Affiliation(s)
- Jane Elkington
- Department of Health Professions, Macquarie University, New South Wales
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31
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Aoun S, Deas K, Toye C, Ewing G, Grande G, Stajduhar K. Supporting family caregivers to identify their own needs in end-of-life care: Qualitative findings from a stepped wedge cluster trial. Palliat Med 2015; 29:508-17. [PMID: 25645667 DOI: 10.1177/0269216314566061] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Carer Support Needs Assessment Tool encompasses the physical, psychological, social, practical, financial, and spiritual support needs that government policies in many countries emphasize should be assessed and addressed for family caregivers during end-of-life care. AIM To describe the experience of family caregivers of terminally ill people of the Carer Support Needs Assessment Tool intervention in home-based palliative care. METHODS This study was conducted during 2012-2014 in Silver Chain Hospice Care Service in Western Australia. This article reports on one part of a three-part evaluation of a stepped wedge cluster trial. All 233 family caregivers receiving the Carer Support Needs Assessment Tool intervention provided feedback on their experiences via brief end-of-trial semi-structured telephone interviews. Data were subjected to a thematic analysis. RESULTS The overwhelming majority reported finding the Carer Support Needs Assessment Tool assessment process straightforward and easy. Four key themes were identified: (1) the practicality and usefulness of the systematic assessment; (2) emotional responses to caregiver reflection; (3) validation, reassurance, and empowerment; and (4) accessing support and how this was experienced. CONCLUSION Family caregivers appreciated the value of the Carer Support Needs Assessment Tool intervention in engaging them in conversations about their needs, priorities, and solutions. The Carer Support Needs Assessment Tool presented a simple, yet potentially effective intervention to help palliative care providers systematically assess and address family caregivers' needs. The Carer Support Needs Assessment Tool provided a formal structure to facilitate discussions with family caregivers to enable needs to be addressed. Such discussions can also inform an evidence base for the ongoing development of services for family caregivers, ensuring that new or improved services are designed to meet the explicit needs of family caregivers.
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Affiliation(s)
- Samar Aoun
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Kathleen Deas
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Chris Toye
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Gunn Grande
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Kelli Stajduhar
- School of Nursing and Center on Aging, University of Victoria, Victoria, BC, Canada
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Stiel S, Heckel M, Bussmann S, Weber M, Ostgathe C. End-of-life care research with bereaved informal caregivers--analysis of recruitment strategy and participation rate from a multi-centre validation study. BMC Palliat Care 2015; 14:21. [PMID: 25934560 PMCID: PMC4422133 DOI: 10.1186/s12904-015-0020-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background One essential element of research is the successful recruitment of participants. However, concerns are obvious regarding the ethical implications of involving terminally ill and even dying patients and their informal caregivers as research participants. This study aims to illustrate central issues encountered when recruiting bereaved informal caregivers for a questionnaire validation study on the quality of dying and death. Methods Between July 2012 and November 2013, informal caregivers of deceased inpatients who were treated at two palliative care units in Germany were invited to participate in a questionnaire validation study. Informal caregivers were called by a trained researcher at the end of the fourth week after death at the earliest and by the sixteenth week after death at the latest and asked to participate in a face-to-face interview in their private home. Results The overall participation rate of all eligible informal caregivers was 76.1% (226/297). The mean burden score was 2.5 (NRS from 0 = no burden to 10 = maximum burden; n = 221). Higher burden scores (≥4) were associated with emotional and burdensome memories (n = 34) being invoked throughout the interview. Severe or maximum burden scores (≥7) were stated by 13.2% of participants. The average time between the associated patient’s death and the informal caregiver’s interview was 57.3 days (range 26–176 days, median 49.5 days). 5.3% of all 226 interviews were not completed due to different reasons. Participants’ comments on the way in which the study was conducted gave insight into their motivation to take part in the study and their evaluation of the interview situation. Conclusions The recruitment strategy can be recommended to other researchers developing research with bereaved carers. The burden caused by study participation was acceptable to the researchers carrying out this research, although a small group of participants experienced high levels of burden which should be anticipated and appropriate support services offered. Family caregivers are willing to support end-of-life care research, have different motivations for participation and even reported benefits from participation. Nevertheless, study designs have to take into account and ease the potential burden of interviews for caregivers experiencing grief.
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Affiliation(s)
- Stephanie Stiel
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany. .,Comprehensive Cancer Centre, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Maria Heckel
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany. .,Comprehensive Cancer Centre, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Sonja Bussmann
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Christoph Ostgathe
- Department of Palliative Medicine, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany. .,Comprehensive Cancer Centre, CCC Erlangen - EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Boland J, Currow DC, Wilcock A, Tieman J, Hussain JA, Pitsillides C, Abernethy AP, Johnson MJ. A systematic review of strategies used to increase recruitment of people with cancer or organ failure into clinical trials: implications for palliative care research. J Pain Symptom Manage 2015; 49:762-772.e5. [PMID: 25546286 DOI: 10.1016/j.jpainsymman.2014.09.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/31/2014] [Accepted: 09/22/2014] [Indexed: 11/27/2022]
Abstract
CONTEXT The challenges of palliative care clinical trial recruitment are well documented. OBJECTIVES The aim of the study was to review tested strategies to improve recruitment to trials of people with a range of conditions who may access palliative care services but are not explicitly stated to be "palliative." METHODS This was a systematic review with narrative description. The Cochrane, Embase, PubMed, PsycINFO, and CINAHL electronic databases were searched (English; January 2002 to February 2014) for quasi-experimental and randomized controlled trials (RCTs) testing the effect of recruitment strategies on accrual to clinical trials of people with organ failure and cancer. Titles, abstracts, and retrieved articles were screened by two researchers and categorized by recruitment challenge: 1) patients with reduced cognition, 2) those requiring emergency treatment, and 3) willingness of patients and clinical staff to contribute to trials. RESULTS Of 549 articles identified, 15 were included. Thirteen reported RCTs and two papers reported three quasi-experimental studies. Five were cluster RCTs of recruiting sites/institutions. One was a randomized cluster, crossover, feasibility study. Seven studies recruited patients with cancer. Others included patients with dementia, stroke, cardiovascular disease, diabetes, frail elderly, and bereaved carers. Some interventions improved recruitment: memory aid, contact before arrival, cluster consent, "opt out" consent. Others either reduced recruitment (formal mental capacity assessment) or made no difference (advance research directive; a variety of educational, supportive, and advertising interventions). CONCLUSION Successful strategies from other disciplines could be considered by palliative care researchers. Tailored, efficient, evidence-based strategies must be developed, acknowledging that strategies with face validity are not necessarily the most effective.
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Affiliation(s)
- Jason Boland
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - David C Currow
- Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia
| | | | - Jennifer Tieman
- Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia
| | | | | | - Amy P Abernethy
- Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia; Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA
| | - Miriam J Johnson
- Hull York Medical School, University of Hull, Hull, United Kingdom.
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Aoun SM, Breen LJ, Howting DA, Rumbold B, McNamara B, Hegney D. Who needs bereavement support? A population based survey of bereavement risk and support need. PLoS One 2015; 10:e0121101. [PMID: 25811912 PMCID: PMC4374848 DOI: 10.1371/journal.pone.0121101] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/09/2015] [Indexed: 11/29/2022] Open
Abstract
This study identifies and describes the profiles of bereavement risk and support needs of a community sample in Australia and tests the fit of the data with the three-tiered public health model for bereavement support. Family members who were bereaved 6–24 months prior to the survey and who were clients of four funeral providers participated (May-July 2013). A postal survey was used to collect information about bereaved people’s experience of caring and perceived satisfaction with any bereavement support provided. The questionnaire included a validated risk assessment screening measure for Prolonged Grief Disorder (PG-13). A total of 678 bereaved people responded. The model predicted that 60% of the sample would be low risk, 30% moderate risk, and 10% high risk. Actual figures were very close at 58.4%, 35.2% and 6.4% respectively. The analysis of the demographic characteristics, experience and impact of caring and bereavement, and satisfaction with support received from a variety of sources revealed differential experiences and needs that align with the expectation of low, moderate, and high bereavement support need, as articulated in the public health model. This is the first empirical test of the public health model of bereavement support. As there is a lack of clear evidence to guide development and allocation of bereavement support programs, the findings have the potential to inform the ability of services, community organizations and informal networks to prioritize care according to each level of bereavement need. This is essential to achieve cost-effective and equitable resource allocation.
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Affiliation(s)
- Samar M. Aoun
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Lauren J. Breen
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Denise A. Howting
- School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Bruce Rumbold
- Palliative Care Unit, Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Beverley McNamara
- School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia, Australia
| | - Desley Hegney
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Nursing and Midwifery, University of Southern Queensland, Brisbane, Queensland, Australia
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Hinkle LJ, Bosslet GT, Torke AM. Factors Associated With Family Satisfaction With End-of-Life Care in the ICU. Chest 2015; 147:82-93. [DOI: 10.1378/chest.14-1098] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hunt KJ, Shlomo N, Addington-Hall J. End-of-life care and achieving preferences for place of death in England: results of a population-based survey using the VOICES-SF questionnaire. Palliat Med 2014; 28:412-21. [PMID: 24292157 DOI: 10.1177/0269216313512012] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIM Health policy places emphasis on enabling patients to die in their place of choice, and increasing the proportion of home deaths. In this article, we seek to explore reported preferences for place of death and experiences of care in a population-based sample of deaths from all causes. DESIGN Self-completion post-bereavement survey. SETTING/PARTICIPANTS Census of deaths registered in two health districts between October 2009 and April 2010. Views of Informal Carers - Evaluation of Services Short Form was sent to each informant (n = 1422; usually bereaved relative) 6-12 months post-bereavement. RESULTS Response was 33%. In all, 35.7% of respondents reported that the deceased said where they wanted to die, and 49.3% of these were reported to achieve this. Whilist 73.9% of those who were reported to have a preference cited home as the preferred place, only 13.3% of the sample died at home. Cancer patients were more likely to be reported to achieve preferences than patients with other conditions (p < .01). Being reported to have a record of preferences for place of death increased the likelihood of dying at home (odds ratio = 22.10). When rating care in the last 2 days, respondents were more likely to rate 'excellent' or 'good' for nursing care (p < .01), relief of pain (p < .01) and other symptoms (p < .01), emotional support (p < .01) and privacy of patient's environment (p < .01) if their relative died in their preferred place. CONCLUSIONS More work is needed to encourage people to talk about their preferences at the end of life: this should not be restricted to those known to be dying. Increasing knowledge and achievement of preferences for place of death may also improve end-of-life care.
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Affiliation(s)
- Katherine J Hunt
- 1Faculty of Health Sciences, University of Southampton, Southampton, UK
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Hunt KJ, Shlomo N, Addington-Hall J. End-of-life care and preferences for place of death among the oldest old: results of a population-based survey using VOICES-Short Form. J Palliat Med 2014; 17:176-82. [PMID: 24438096 DOI: 10.1089/jpm.2013.0385] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND End-of-life care (EOLC) is a key component in care of older people. However, evidence suggests that the oldest old (>85 years) are less likely to access specialist EOLC. OBJECTIVE The study's objective was to explore experiences of EOLC among the oldest old and determine their reported preference for place of death. DESIGN The study involved a self-completion postbereavement survey. METHODS A census was taken of deaths registered between October 2009 and April 2010 in two health districts, identified from death certificates. Views of Informal Carers-Evalution of Service (VOICES)-Short Form was sent to each informant (n=1422, usually bereaved relative) 6 to 12 months after the death. RESULTS Of 473 (33%) who responded, 48% of decedents were age 85 or over. There were no age differences in reported care quality in the last three months, but in the last two days the oldest old were reported to receive poorer relief of nonpain symptoms and less emotional and spiritual support. Compared to people under age 85, the over 85s were less likely to be reported to know they were dying, to have a record of their preferences for place of death, to die in their preferred place, to have enough choice about place of death-and more likely to be reported to have had unwanted treatment decisions. Being over 85 years was associated with a reduction in the odds of home death (OR=0.36); failure to ascertain and record preference for place of death contributed to this. CONCLUSIONS Age-associated disparity exists in care provided in the last two days and the realization of preferences.
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Affiliation(s)
- Katherine J Hunt
- 1 Faculty of Health Sciences, University of Southampton , Southampton, United Kingdom
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Allen J, Stapleton H, Tracy S, Kildea S. Is a randomised controlled trial of a maternity care intervention for pregnant adolescents possible? An Australian feasibility study. BMC Med Res Methodol 2013; 13:138. [PMID: 24225138 PMCID: PMC4226005 DOI: 10.1186/1471-2288-13-138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/11/2013] [Indexed: 12/02/2022] Open
Abstract
Background The way in which maternity care is provided affects perinatal outcomes for pregnant adolescents; including the likelihood of preterm birth. The study purpose was to assess the feasibility of recruiting pregnant adolescents into a randomised controlled trial, in order to inform the design of an adequately powered trial which could test the effect of caseload midwifery on preterm birth for pregnant adolescents. Methods We recruited pregnant adolescents into a feasibility study of a prospective, un-blinded, two-arm, randomised controlled trial of caseload midwifery compared to standard care. We recorded and analysed recruitment data in order to provide estimates to be used in the design of a larger study. Results The proportion of women aged 15–17 years who were eligible for the study was 34% (n=10), however the proportion who agreed to be randomised was only 11% (n = 1). Barriers to recruitment were restrictive eligibility criteria, unwillingness of hospital staff to assist with recruitment, and unwillingness of pregnant adolescents to have their choice of maternity carer removed through randomisation. Conclusions A randomised controlled trial of caseload midwifery care for pregnant adolescents would not be feasible in this setting without modifications to the research protocol. The recruitment plan should maximise opportunities for participation by increasing the upper age limit and enabling women to be recruited at a later gestation. Strategies to engage the support of hospital-employed staff are essential and would require substantial, and ongoing, work. A Zelen method of post-randomisation consent, monetary incentives and ‘peer recruiters’ could also be considered.
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Affiliation(s)
- Jyai Allen
- Midwifery Research Unit, Mater Research, Aubigny Place, Raymond Terrace, South Brisbane, Queensland, Australia.
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