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Davis HA, Hoberg AA, Jacobus LS, Nepple K, Seaman AT, Sorensen J, Weiner GJ, Gilbertson-White S. Leveraging oncology collaborative networks and biomedical informatics data resources to rapidly recruit and enroll rural residents into oncology quality of life clinical trials. J Clin Transl Sci 2024; 8:e135. [PMID: 39345703 PMCID: PMC11428118 DOI: 10.1017/cts.2024.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 10/01/2024] Open
Abstract
Purpose This study assesses the feasibility of biomedical informatics resources for efficient recruitment of rural residents with cancer to a clinical trial of a quality-of-life (QOL) mobile app. These resources have the potential to reduce costly, time-consuming, in-person recruitment methods. Methods A cohort was identified from the electronic health record data repository and cross-referenced with patients who consented to additional research contact. Rural-urban commuting area codes were computed to identify rurality. Potential participants were emailed study details, screening questions, and an e-consent link via REDCap. Consented individuals received baseline questionnaires automatically. A sample minimum of n = 80 [n = 40 care as usual (CAU) n = 40 mobile app intervention] was needed. Results N = 1298 potential participants (n = 365 CAU; n = 833 intervention) were screened for eligibility. For CAU, 68 consented, 67 completed baseline questionnaires, and 54 completed follow-up questionnaires. For intervention, 100 consented, 97 completed baseline questionnaires, and 58 completed follow-up questionnaires. The CAU/intervention reached 82.5%/122.5% of the enrollment target within 2 days. Recruitment and retention rates were 15.3% and 57.5%, respectively. The mean age was 59.5 ± 13.5 years. The sample was 65% women, 20% racial/ethnic minority, and 35% resided in rural areas. Conclusion These results demonstrate that biomedical informatics resources can be highly effective in recruiting for cancer QOL research. Precisely identifying individuals likely to meet inclusion criteria who previously indicated interest in research participation expedited recruitment. Participants completed the consent and baseline questionnaires with zero follow-up contacts from the research team. This low-touch, repeatable process may be highly effective for multisite clinical trials research seeking to include rural residents.
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Affiliation(s)
- Heath A Davis
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Carver College of Medicine IT, University of Iowa, Iowa City, IA, USA
| | - Asher A Hoberg
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Carver College of Medicine IT, University of Iowa, Iowa City, IA, USA
| | - Laura S Jacobus
- Institute for Clinical & Translational Science, University of Iowa, Iowa City, IA, USA
- Vanderbilt Institute for Clinical & Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth Nepple
- Urology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Aaron T Seaman
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Jamie Sorensen
- Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - George J Weiner
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Stephanie Gilbertson-White
- Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Community & Primary Care, College of Nursing, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
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Sönnerfors P, Jacobson PK, Andersson A, Behndig A, Bjermer L, Blomberg A, Blomqvist H, Erjefält J, Friberg M, Lamberg Lundström K, Lundborg A, Malinovschi A, Persson HL, Tufvesson E, Wheelock Å, Janson C, Sköld CM. The challenges of recruiting never-smokers with chronic obstructive pulmonary disease from the large population-based Swedish CArdiopulmonary bioImage study (SCAPIS) cohort. Eur Clin Respir J 2024; 11:2372903. [PMID: 39015382 PMCID: PMC11251440 DOI: 10.1080/20018525.2024.2372903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/22/2024] [Indexed: 07/18/2024] Open
Abstract
Background A substantial proportion of individuals with COPD have never smoked, and it is implied to be more common than previously anticipated but poorly studied. Aim To describe the process of recruitment of never-smokers with COPD from a population-based cohort (n = 30 154). Methods We recruited never-smokers with COPD, aged 50-75 years, from six University Hospitals, based on: 1) post broncho-dilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) < 0.70 and 2) FEV1 50-100% of predicted value and 3) being never-smokers (self-reported). In total 862 SCAPIS participants were identified, of which 652 were reachable and agreed to a first screening by telephone. Altogether 128 (20%) were excluded due to previous smoking or declined participation. We also applied a lower limit of normal (LLN) of FEV1/FVC (z-score<-1.64) according to the Global Lung Initiative to ensure a stricter definition of airflow obstruction. Results Data on respiratory symptoms, health status, and medical history were collected from 492 individuals, since 32 were excluded at a second data review (declined or previous smoking), prior to the first visit. Due to not matching the required lung function criteria at a second spirometry, an additional 334 (68%) were excluded. These exclusions were by reason of: FEV1/FVC ≥0.7 (49%), FEV1 > 100% of predicted (26%) or z-score ≥ -1,64 (24%). Finally, 154 never-smokers with COPD were included: 56 (36%) women, (mean) age 60 years, FEV1 84% of predicted, FEV1/FVC: 0.6, z-score: -2.2, Oxygen saturation: 97% and BMI: 26.8 kg/m2. Conclusions The challenges of a recruitment process of never-smokers with COPD were shown, including the importance of correct spirometry testing and strict inclusion criteria. Our findings highlight the importance of repeated spirometry assessments for improved accuracy in diagnosing COPD.
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Affiliation(s)
- Pernilla Sönnerfors
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women´s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petra Kristina Jacobson
- Department of Respiratory Medicine in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Andersson
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- COPD Center Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Behndig
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Leif Bjermer
- Department of Clinical Sciences, Respiratory medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Heléne Blomqvist
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Erjefält
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Lund, Sweden
| | - Maria Friberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kristina Lamberg Lundström
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anna Lundborg
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hans Lennart Persson
- Department of Respiratory Medicine in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ellen Tufvesson
- Department of Clinical Sciences, Respiratory medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Åsa Wheelock
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Carl Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
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Zhang J, Peng M, Li J, Li L, Bai X, Thabane L, Yh Lip G, Van Spall HG, Li G. Enrollment of Black, Indigenous and People of Color (BIPOC) and female participants in the US diabetes trials spanning 2000 to 2020: A chronological survey. Diabetes Metab Syndr 2024; 18:103074. [PMID: 39033649 DOI: 10.1016/j.dsx.2024.103074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
AIMS Little is known about the enrollment practice of both Black, Indigenous and People of Color (BIPOC) and females in the US diabetes trials. We aimed to perform a chronological survey to evaluate the enrollment of BIPOC and female participants in the US diabetes randomized controlled trials (RCTs) over the past two decades. METHODS We searched databases to systematically include the US diabetes RCTs from 2000 January 1st to 2020 December 31st. Primary outcome was the adequate enrollment of both BIPOC and females, defined by the participation to prevalence ratio (PPR) > 0.8. We tested the temporal trend in adequate enrollment over time and used logistic regression analysis to explore the relationship between adequate enrollment and trial characteristics. RESULTS A total of 69 US diabetes trials were included for analyses, with a median BIPOC and female enrollment percentage of 29.0 % and 45.4 % respectively. There were 22 (31.9 %) trials with adequate enrollment of both BIPOC and females. No significant trend of adequate enrollment percentage of BIPOC and females over time was observed (P = 0.16). Of trial types, those with medication interventions were significantly related to decreased odds of adequate enrollment, when compared to trials with non-drug interventions (odds ratio = 0.29, 95 % confidence interval: 0.11-0.84). CONCLUSIONS Less than one third of the US diabetes trials adequately enrolled both BIPOC and females over the past two decades, and no temporal improvement in BIPOC and female participant enrollment was observed. These results highlight the need for more endeavors to mitigate inadequate representation regarding BIPOC and female enrollment in diabetes trials.
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Affiliation(s)
- Jingyi Zhang
- Center for Clinical Epidemiology and Methodology (CCEM), The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Miaoguan Peng
- Department of Endocrinology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Jianfeng Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Likang Li
- Center for Clinical Epidemiology and Methodology (CCEM), The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
| | - Xuerui Bai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Lehana Thabane
- Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Harriette Gc Van Spall
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China; Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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Rierola-Fochs S, Terradas-Monllor M, Varela-Vasquez LA, Ochandorena-Acha M, Minobes-Molina E, Merchán Baeza JA. Feasibility study of a home-based graded motor imagery intervention (GraMI protocol) for amputees with phantom limb pain. Physiother Theory Pract 2024:1-11. [PMID: 38708842 DOI: 10.1080/09593985.2024.2349759] [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: 12/30/2023] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Phantom limb pain affects 64% of amputees. Graded Motor Imagery comprises three consecutive application techniques designed to reorganize maladaptive changes that have occurred after the amputation. OBJECTIVE To assess the feasibility of a home-based Graded Motor Imagery intervention, the GraMI protocol, for amputee people with phantom limb pain. METHODS Twenty individuals over 18 years of age with upper or lower limb amputation, experiencing phantom limb pain, who were pharmacologically stable, and had been discharged from the hospital were recruited. The experimental group followed the GraMI protocol. Primary outcomes included study processes, such as recruitment time and rate, adherence, compliance, and the acceptability of digital technologies as a treatment tool. Secondary outcomes assessed the impact on phantom limb pain, quality of life, functionality, and depressive symptoms. RESULTS On average, seven participants were recruited monthly over a three-month period. No losses were recorded throughout the nine weeks of intervention. Treatment adherence averaged 89.32%, and all participants demonstrated familiarity with the usability of digital technologies. No significant differences were observed between groups (p = .054). However, within the experimental group, intragroup analysis revealed a significant (p = .005) and clinically relevant reduction (>2 points) with a large effect size (0.89) in phantom limb pain. CONCLUSION Conducting a multicenter study with a home-based intervention using the GraMI protocol is feasible. Future clinical trials are needed to verify its effectiveness in managing phantom limb pain.
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Affiliation(s)
- Sandra Rierola-Fochs
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Marc Terradas-Monllor
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Pain Medicine Section, Anaesthesiology Dept, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Luz Adriana Varela-Vasquez
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Tecnocampus Mataró-Maresme, Universitat Pompeu Fabra, Mataró, Spain
| | - Mirari Ochandorena-Acha
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Eduard Minobes-Molina
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Spanish Society of Geriatrics and Gerontology, Madrid, Spain
| | - Jose Antonio Merchán Baeza
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
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Godskesen T, Björk J, Juth N. Challenges regarding informed consent in recruitment to clinical research: a qualitative study of clinical research nurses' experiences. Trials 2023; 24:801. [PMID: 38082434 PMCID: PMC10712041 DOI: 10.1186/s13063-023-07844-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Clinical research nurses (CRNs) have first-hand experience with ethical challenges and play a crucial role in upholding ethical conduct and adherence to the principles of informed consent in clinical research. This study explores the ethical challenges encountered by CRNs in the process of obtaining informed consent for clinical research. METHODS A qualitative exploratory design. Semistructured interviews (n = 14) were conducted with diverse CRNs in Sweden. These CRNs covered a wide range of research fields, including pharmaceutical and academic studies, interventions, and observational research, spanning different trial phases, patient categories, and medical conditions. The interviews were analysed using inductive qualitative content analysis. RESULTS The analysis identified three main categories: (i) threats to voluntariness, (ii) measures to safeguard voluntariness, and (iii) questionable exclusion of certain groups. CRNs face challenges due to time constraints, rushed decisions, information overload, and excessive reliance on physicians' recommendations. Overestimating therapeutic benefits in stages of advanced illness emerged as a risk to voluntariness. CRNs outlined proactive solutions, such as allowing ample decision-making time and offering support, especially for terminally ill patients. Concerns were also voiced about excluding certain demographics, such as those with language barriers or cognitive impairments. CONCLUSIONS In conclusion, upholding ethical research standards requires recognising various factors affecting patient voluntariness. Researchers and CRNs should prioritise refining the informed consent process, overcoming participation challenges, and aligning scientific rigour with personalised care. Additionally, a concerted effort is vital to meet the diverse needs of patient populations, including equitable inclusion of individuals with language barriers or cognitive limitations in clinical studies. These findings have significant implications for enhancing the ethics of clinical research and advancing person-centred care.
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Affiliation(s)
- Tove Godskesen
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Joar Björk
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Stockholm, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Niklas Juth
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Stockholm, Sweden
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Fu MX, Carvalho C, Milan-Chhatrisha B, Gadi N. Stereotactic Body Radiotherapy for Management of Pulmonary Oligometastases in Stage IV Colorectal Cancer: A Perspective. Clin Colorectal Cancer 2023; 22:402-410. [PMID: 37748936 DOI: 10.1016/j.clcc.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/05/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
In pulmonary oligometastases from colorectal cancer (POM-CRC), metastasectomy is the primarily recommended treatment. Stereotactic body radiotherapy (SBRT) has been suggested as a viable alternative therapy. SBRT efficacy for POM-CRC is poorly delineated compared to selected non-CRC primaries. This perspective article aims to critically summarize the existing evidence regarding efficacy of SBRT in terms of overall survival (OS) and local control (LC), and factors modulating this, in the treatment of POM-CRC. Overall, reasonable LC and OS rates were observed. The wide range of expansions in planning target volume margins introduced variation in pretreatment protocols. Dose-fractionation schedules varied according to patient and tumor characteristics, though leverage of BED10 in select studies enabled standardization. An association between SBRT dose and improved OS and LC was observed across multiple studies. Prognostic factors that were associated with improved LC included: fewer oligometastases, absence of extra-pulmonary metastases, primary tumor histology, and smaller gross tumor volume. Differences in SBRT modality and techniques over time further confounded results. Many studies included patients receiving additional systemic therapies; preprotocol and adjuvant chemotherapies were identified as prognostic factors for LC. SBRT compared with metastasectomy showed no differences in short-term OS and LC outcomes. In conclusion, SBRT is an efficacious treatment for POM-CRC, in terms of OS and LC. Heterogeneity in study design, particularly pertaining to dose protocols, patient selection, and additional therapies should be controlled for future randomized studies to further validate SBRT efficacy.
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Affiliation(s)
- Michael X Fu
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom.
| | - Catarina Carvalho
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Bella Milan-Chhatrisha
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Nishita Gadi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Dobbins NJ, Han B, Zhou W, Lan KF, Kim HN, Harrington R, Uzuner Ö, Yetisgen M. LeafAI: query generator for clinical cohort discovery rivaling a human programmer. J Am Med Inform Assoc 2023; 30:1954-1964. [PMID: 37550244 PMCID: PMC10654856 DOI: 10.1093/jamia/ocad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE Identifying study-eligible patients within clinical databases is a critical step in clinical research. However, accurate query design typically requires extensive technical and biomedical expertise. We sought to create a system capable of generating data model-agnostic queries while also providing novel logical reasoning capabilities for complex clinical trial eligibility criteria. MATERIALS AND METHODS The task of query creation from eligibility criteria requires solving several text-processing problems, including named entity recognition and relation extraction, sequence-to-sequence transformation, normalization, and reasoning. We incorporated hybrid deep learning and rule-based modules for these, as well as a knowledge base of the Unified Medical Language System (UMLS) and linked ontologies. To enable data-model agnostic query creation, we introduce a novel method for tagging database schema elements using UMLS concepts. To evaluate our system, called LeafAI, we compared the capability of LeafAI to a human database programmer to identify patients who had been enrolled in 8 clinical trials conducted at our institution. We measured performance by the number of actual enrolled patients matched by generated queries. RESULTS LeafAI matched a mean 43% of enrolled patients with 27 225 eligible across 8 clinical trials, compared to 27% matched and 14 587 eligible in queries by a human database programmer. The human programmer spent 26 total hours crafting queries compared to several minutes by LeafAI. CONCLUSIONS Our work contributes a state-of-the-art data model-agnostic query generation system capable of conditional reasoning using a knowledge base. We demonstrate that LeafAI can rival an experienced human programmer in finding patients eligible for clinical trials.
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Affiliation(s)
- Nicholas J Dobbins
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, USA
- Department of Research IT, UW Medicine, University of Washington, Seattle, Washington, USA
| | - Bin Han
- Information School, University of Washington, Seattle, Washington, USA
| | - Weipeng Zhou
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, USA
| | - Kristine F Lan
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - H Nina Kim
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Robert Harrington
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Özlem Uzuner
- Department of Information Sciences and Technology, George Mason University, Fairfax, Virginia, USA
| | - Meliha Yetisgen
- Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, Washington, USA
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Scott K, Guy AA, Zelaya DG, Surace A, Elwy AR, Keuroghlian AS, Mayer K, Monti PM, Kahler CW. Research and engagement considerations for alcohol use telehealth services within HIV care: a qualitative exploration in federally qualified health centers. AIDS Care 2023; 35:1786-1795. [PMID: 37039068 PMCID: PMC10543395 DOI: 10.1080/09540121.2023.2197640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
The prevalence of alcohol misuse is high among people with HIV (PWH); however, access to and utilization of evidence-based alcohol misuse interventions remain limited. Telehealth is one treatment approach with the potential for enhancing substance use disorder treatment utilization for PWH served by Federally Qualified Health Centers (FQHCs). However, questions remain regarding barriers to alcohol-focused telehealth service integration and telehealth research in FQHCs. This study employed qualitative methods, guided by the Dynamic Sustainability Framework, to evaluate barriers and cultural factors impacting FQHC telehealth integration. Eighteen qualitative interviews were completed with staff and leaders across four FQHCs. Interviews were analyzed using directed content analysis, and codes were organized into a priori and emergent themes. Key themes included the presence of common workflows for referring clients to substance use disorder treatment; existing research workflows and preferences for active project staff involvement; telehealth barriers including exacerbation of healthcare disparities and high provider turnover; and the importance of cultural humility and telehealth adaptations for sexual, gender, racial and ethnic minority clients. Findings from this study will inform the development of an alcohol-focused telehealth implementation strategy for a Hybrid Type 1 implementation effectiveness trial to enhance FQHC substance use disorder treatment.Trial registration: ClinicalTrials.gov identifier: NCT02563574..
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Affiliation(s)
- Kelli Scott
- Northwestern University Feinberg School of Medicine
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Arryn A. Guy
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - David G. Zelaya
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Behavioral and Social Sciences, Brown University School of Public Health
- Harvard Medical School
| | - Anthony Surace
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - A. Rani Elwy
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System
| | | | | | - Peter M. Monti
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Christopher W. Kahler
- Alcohol Research Center on HIV, Center for Alcohol and Addiction Studies, Brown University School of Public Health
- Department of Behavioral and Social Sciences, Brown University School of Public Health
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Fylan B, Munro J, O'Hara JK, Khatoon B, Lawton R. Developing a research community within an online healthcare feedback platform. Health Expect 2023; 26:705-714. [PMID: 36661042 PMCID: PMC10010085 DOI: 10.1111/hex.13696] [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: 01/18/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Care Opinion is an online feedback platform supporting patients to author stories about their care. It is not known whether authors would be willing to be involved in improving care through research. The aims of this study were to explore the views and preferences of Care Opinion authors about joining an online research community and to pilot new research community functionality. METHODS Five hundred and nine Care Opinion authors were invited to take part in an online survey in June 2019. Survey items included questions about participants' willingness to take part in research and their preferences for supporting processes. Data were analysed descriptively. Authors were invited to consent to join a research community and were asked to participate in three pilot studies. RESULTS One hundred and sixty-three people consented to take part in the survey (32%). Participants indicated they would like to know the time commitment to the project (146, 90%), details about the organization carrying out the research (124, 76%) and safeguarding information (124, 76%). Over half indicated that they did not know how to get involved in healthcare research (87, 53%). Subsequently, 667 authors were invited to join the research community, 183 (27%) accepted, and three studies were matched to their expressed preferences for project attributes or organization type. CONCLUSION Many people who leave online feedback about their experiences of healthcare are also willing to join a research community via that platform. They have strong preferences for supporting University and NHS research. Eligibility and acceptance rates to join pilot research studies varied. Further work is needed to grow the research community, increase its diversity, and create relevant and varied opportunities to support research. PATIENT OR PUBLIC CONTRIBUTION Four members of the Safety In Numbers patient and public involvement and engagement (PPIE) group advised about survey development.
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Affiliation(s)
- Beth Fylan
- Yorkshire Quality and Safety Research Group, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - James Munro
- Care Opinion Community Interest Company, Sheffield, UK
| | - Jane K O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Binish Khatoon
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
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10
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Gilberts R, McGinnis E, Ransom M, Pynn EV, Walker B, Brown S, Trehan P, Jayasekera P, Veitch D, Hussain W, Collins J, Abbott RA, Chen KS, Nixon J. Healing of ExcisionAl wounds on Lower legs by Secondary intention (HEALS) cohort study. Part 2: feasibility data from a multicentre prospective observational cohort study to inform a future randomized controlled trial. Clin Exp Dermatol 2022; 47:1839-1847. [PMID: 35662230 PMCID: PMC9796037 DOI: 10.1111/ced.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Compression therapy is considered beneficial for postsurgical lower leg wound healing by secondary intention; however, there is a lack of supportive evidence. To plan a randomized controlled trial (RCT), suitable data are needed. AIM To determine the feasibility of recruitment and estimate recruitment rate; to understand the standard postoperative wound management pathway; to determine uptake of optional additional clinic visits for healing confirmation; and to explore patient acceptability of compression bandaging and plan a future RCT. METHODS Participant recruitment was performed from secondary care dermatology clinics, during a period of 22 months. Inclusion criteria were age ≥ 18 years, planned excision of keratinocyte cancer on the lower leg with healing by secondary intention and an ankle-brachial pressure index of ≥ 0.8. Exclusion criteria were planned primary closure/graft or flap; inability to receive, comply with or tolerate high compression; planned compression; or suspected melanoma. Patients were followed up weekly (maximum 6 months) in secondary care clinics and/or by telephone. Information was collected on healthcare resource use, unplanned compression, wound healing and an optional clinic visit to confirm healing. RESULTS This study recruited 58 patients from 9 secondary care dermatology clinics over 22 months. Mean recruitment/centre/month was 0.8 (range 0.1-2.3). Four centres had dedicated Research Nurse support. The analysis population (n = 53) had weekly follow-up assessments. Standard care clinical contacts were: general practitioner (7 visits; 1.2%), community nurse (169; 28.5%), practice nurse visits (189; 31.8%) and dermatology clinic visits (138; 23.2%). Participants whose wounds healed (34 of 45; 75.6%) attended an optional clinic visit. CONCLUSION Data were obtained to inform a future RCT. Recruitment rates were found to be higher in centres with dedicated research support. People would be willing to take part in a trial and attend a confirmation of healing visit.
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Affiliation(s)
- Rachael Gilberts
- Leeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | | | - Myka Ransom
- Leeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - Emma V. Pynn
- Aneurin Bevan University Health BoardRoyal Gwent HospitalNewportUK
| | - Benjamin Walker
- Harrogate District HospitalHarrogate and District NHS Foundation TrustHarrogateUK
| | - Sarah Brown
- Leeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - Pooja Trehan
- Broadgreen HospitalLiverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - Prativa Jayasekera
- Royal Victoria InfirmaryThe Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - David Veitch
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Walayat Hussain
- Chapel Allerton Hospital Leeds Teaching Hospitals NHS TrustLeedsUK
| | - Jemma Collins
- University Hospital of WalesCardiff and Vale University Health BoardCardiffUK
| | | | - Kun Sen Chen
- West Suffolk HospitalWest Suffolk NHS Foundation TrustBury St EdmundsUK
| | - Jane Nixon
- Leeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
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11
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Li G, Zhang J, Van Spall HGC, Douglas PS, Wang Y, Sun X, Thabane L. Exploring ethnic representativeness in diabetes clinical trial enrolment from 2000 to 2020: a chronological survey. Diabetologia 2022; 65:1461-1472. [PMID: 35705796 PMCID: PMC9200441 DOI: 10.1007/s00125-022-05736-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/07/2022] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS Ethnic representativeness of participant enrolment in diabetes RCTs involving multiple ethnicities remains unknown. The aims of this study were to evaluate the status and temporal trend of ethnic representativeness in enrolment to diabetes RCTs, and to assess under-enrolment of non-white ethnic groups and explore trial characteristics associated with under-enrolment. METHODS We conducted a chronological survey by systematically searching the literature to include eligible RCTs published between January 2000 and December 2020. We assessed temporal trends in enrolment of ethnic groups in the included trials. Univariable logistic regression was used to explore the association between trial characteristics and under-enrolment of non-white groups, using a participant to prevalence ratio of <0.8 to define under-enrolment. This study was registered in PROSPERO (CRD42021229100). RESULTS We included 405 RCTs for analysis (327 multi-country trials, 69 conducted in the USA and nine conducted in the UK). The median enrolment rate of all non-white groups was 24.0% in the overall RCTs. Trials conducted in the USA and the UK had median enrolment rates of 29.0% and 12.0% for all non-white groups, respectively. There was a temporal trend towards increased participation of non-white ethnic groups in the overall RCTs; however, no significant improvement over time was found in the US or UK trials. Non-white groups were under-enrolled in most included trials: 62.3% (43/69) in US trials and 77.8% (7/9) in UK trials. The US trials with a high female proportion were associated with lower odds of under-enrolment of all non-white groups (OR 0.22; 95% CI 0.07, 0.65), while trials receiving funding from industry showed increased odds of under-enrolment (OR 4.64; 95% CI 1.50, 14.35). Outpatient enrolment and intervention duration were significantly associated with under-enrolment of Black participants. Only a small proportion of trials reported subgroup results or explored the effect modification by ethnicity. CONCLUSIONS/INTERPRETATION A temporal trend towards increased non-white ethnic enrolment was found in diabetes RCTs globally, but not in the USA or the UK. Non-white ethnic groups were under-represented in the majority of diabetes trials conducted in the USA and the UK. Some trial characteristics may be associated with non-white under-enrolment in diabetes trials. These findings provide some evidence for non-white ethnic representativeness in diabetes trials over the past two decades, and highlight the need for more effective strategies and endeavours to alleviate under-enrolment of non-white ethnic groups.
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Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Jingyi Zhang
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pamela S Douglas
- Duke University Clinical Research Institute, Duke University, Durham, NC, USA
| | - Yaoyao Wang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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12
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Serrano-Gallardo P, Cassetti V, Boone ALD, Pisano-González MM. Recruiting Participants in Vulnerable Situations: A Qualitative Evaluation of the Recruitment Process in the EFFICHRONIC Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10765. [PMID: 36078487 PMCID: PMC9518307 DOI: 10.3390/ijerph191710765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
In recent years, stakeholder involvement in research has become a central element of responsible research. The EFFICHRONIC project reflects these principles and aims to reduce the burden of chronic diseases and increase the sustainability of the healthcare system through the implementation of an evidence-based chronic disease prevention and self-management programme. The qualitative study presented here is part of EFFICHRONIC and aims to explore and understand the recruitment strategies implemented in the participating countries (Spain, UK, Netherlands, Italy, and France). Semi-structured interviews were conducted with the country coordinators (purposive sampling of the five coordinators responsible for the recruitment strategy), and a coding and synthesis process was used to conduct a thematic analysis. The analysis resulted in five main categories: (1) Stakeholder recruitment strategies. (2) Facilitators to recruitment. (3) Barriers to recruitment. (4) Strategies developed to address recruitment challenges. (5) Lessons learned. From a collaborative approach to the co-production process, recruitment has helped to build a wide network and new relationships with local actors, explore and learn about the social world, step out of the comfort zone of health institutions, combine a wide variety of strategies, and innovate by taking into account the institutional and cultural contexts of each country.
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Affiliation(s)
- Pilar Serrano-Gallardo
- Nursing Department, Faculty of Medicine, Universidad Autonoma de Madrid, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro—Segovia de Arana, Instituto Interuniversitario “Investigación Avanzada Sobre Evaluación de la Ciencia y la Universidad”, 28029 Madrid, Spain
| | - Viola Cassetti
- Community Activities in Primary Care Programme (PACAP), 18001 Granada, Spain
| | - An L. D. Boone
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Consejería de Sanidad del Gobierno Regional de Asturias, Public Health General Directorate, Principality of Asturias, 33005 Oviedo, Spain
| | - Marta María Pisano-González
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Consejería de Sanidad del Gobierno Regional de Asturias, General Directorate of Care, Humanisation and Social Healthcare Services, Principality of Asturias, 33005 Oviedo, Spain
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13
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Fang Y, Idnay B, Sun Y, Liu H, Chen Z, Marder K, Xu H, Schnall R, Weng C. Combining human and machine intelligence for clinical trial eligibility querying. J Am Med Inform Assoc 2022; 29:1161-1171. [PMID: 35426943 PMCID: PMC9196697 DOI: 10.1093/jamia/ocac051] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To combine machine efficiency and human intelligence for converting complex clinical trial eligibility criteria text into cohort queries. MATERIALS AND METHODS Criteria2Query (C2Q) 2.0 was developed to enable real-time user intervention for criteria selection and simplification, parsing error correction, and concept mapping. The accuracy, precision, recall, and F1 score of enhanced modules for negation scope detection, temporal and value normalization were evaluated using a previously curated gold standard, the annotated eligibility criteria of 1010 COVID-19 clinical trials. The usability and usefulness were evaluated by 10 research coordinators in a task-oriented usability evaluation using 5 Alzheimer's disease trials. Data were collected by user interaction logging, a demographic questionnaire, the Health Information Technology Usability Evaluation Scale (Health-ITUES), and a feature-specific questionnaire. RESULTS The accuracies of negation scope detection, temporal and value normalization were 0.924, 0.916, and 0.966, respectively. C2Q 2.0 achieved a moderate usability score (3.84 out of 5) and a high learnability score (4.54 out of 5). On average, 9.9 modifications were made for a clinical study. Experienced researchers made more modifications than novice researchers. The most frequent modification was deletion (5.35 per study). Furthermore, the evaluators favored cohort queries resulting from modifications (score 4.1 out of 5) and the user engagement features (score 4.3 out of 5). DISCUSSION AND CONCLUSION Features to engage domain experts and to overcome the limitations in automated machine output are shown to be useful and user-friendly. We concluded that human-computer collaboration is key to improving the adoption and user-friendliness of natural language processing.
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Affiliation(s)
- Yilu Fang
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Betina Idnay
- School of Nursing, Columbia University, New York, New York, USA.,Department of Neurology, Columbia University, New York, New York, USA
| | - Yingcheng Sun
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Hao Liu
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Zhehuan Chen
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Karen Marder
- Department of Neurology, Columbia University, New York, New York, USA
| | - Hua Xu
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, USA.,Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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14
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Miller L, Jerosch-Herold C, Shepstone L. A pilot single-blind parallel randomised controlled trial comparing kinesiology tape to compression in the management of subacute hand oedema after trauma. Pilot Feasibility Stud 2022; 8:72. [PMID: 35346389 PMCID: PMC8962097 DOI: 10.1186/s40814-022-01023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hand oedema is a common consequence of hand trauma or surgery. There are numerous methods to reduce hand oedema but lack high-quality evidence to support best practice. The primary objective of this pilot trial was to assess study feasibility when comparing treatments for subacute hand oedema after trauma. Methods A parallel two-arm pilot randomised controlled trial was conducted in the hand therapy department at a regional hospital in Norfolk between October 2017 and July 2018. Patients were eligible if 18 years or over, referred to hand therapy with subacute hand oedema. Randomisation was on a 1:1 basis to treatment as usual (TAU) (compression, elevation and massage) or trial treatment (TT) (kinesiology tape, elevation and massage). One blinded assessor completed all assessments (prior to randomisation, 4 and 12 weeks later). Data on study feasibility, adherence and acceptability of treatments were collected. The primary outcome measure was hand volume (volumetry). Patient-rated severity (0–5 Likert scale), hand health profile of the Patient Evaluation Measure (PEM) and quality of life (EQ-5D-5L) were also recorded. Results Forty-five patients were screened for eligibility and 26 consented and were randomised with 13 patients in each treatment arm. Twelve participants were lost to follow-up leaving 7 participants in each group included in the analysis. Assessor blinding was maintained in 64% of participants (9/14). Total mean acceptability scores, out of 100, were higher for TAU (87.9) than TT (76.1). Health resource use results showed TT was marginally cheaper (~£2 per patient) than TAU. Individual adherence ranged between 39 and 100%, with higher levels of overall adherence seen in the TAU group. Four participants (28%) reported adverse effects (TT group n = 3, TAU group n = 1). Conclusion This pilot trial has identified that modifications are required in order to make a full-scale trial feasible. They include a formal assessment of treatment fidelity, research staff assisting with screening and recruitment of participants and multiple blinded assessors at each study site. Whilst not designed as an efficacy trial, it should be acknowledged that the small sample size and high loss to follow-up meant very small numbers were included in the final analysis resulting in wide confidence intervals and therefore low precision in parameter estimates. Trial registration International Standard Randomised Controlled Trial Number: 94083271. Date of registration 16th August 2017. Trial funding National Institute for Health Research Trainees Co-ordinating Centre (TCC); Grant Codes: CDRF-2014-05-064 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01023-1.
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Affiliation(s)
- Leanne Miller
- Therapies Department, Outpatients East Level 2, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - Christina Jerosch-Herold
- School of Health Sciences, Queen's Building, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
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15
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Jimenez-Rodriguez RM, Martín-Gutiérrez G, Jiménez-Jorge S, Rosso-Fernández CM, Tallón-Aguilar L, Roca-Oporto C, Padillo J, Luckey A, Cano A, López-Ruiz J, Gómez-Zorrilla S, Bonnín-Pascual J, Boix-Palop L, Montejo JM, Torre-Cisneros J, Cisneros JM. Factors associated with recruitment success in the phase 2a study of aztreonam-avibactam development programme: a descriptive qualitative analysis among sites in Spain. BMJ Open 2022; 12:e051187. [PMID: 35115349 PMCID: PMC8814749 DOI: 10.1136/bmjopen-2021-051187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Successful clinical trials are subject to recruitment. Recently, the REJUVENATE trial, a prospective phase 2a open-label, single-arm interventional clinical trial conducted within the Innovative Medicines Initiative-supported Combatting Bacterial Resistance in Europe-Carbapenem Resistance project, was published, with 85% of the recruitment performed in Spain. We analysed the recruitment success in this trial by establishing a model of recruitment practice. METHODS A descriptive qualitative study was performed from May 2016 to October 2017 at 10 participating Spanish centres. Data were extracted from: (1) feasibility questionnaires to assess the centre's potential for patient enrolment; (2) delegation of responsibility records; (3) pre-screening records including an anonymised list of potentially eligible and (4) screening and enrolment records. A descriptive analysis of the features was performed by the participating centre. Pearson's and Spearman's correlation coefficients were calculated to determine factors of recruitment success. RESULTS The highest recruitment rate was observed in Hospitals 3 and 6 (58.8 and 47.0 patients per month, respectively). All the study teams were multidisciplinary with a median of 15 members (range: 7-22). Only Hospitals 3, 5 and 6 had dedicated nursing staff appointed exclusively to this study. Moreover, in those three hospitals and in Hospital 9, the study coordinator performed exclusive functions as a research planner, and did not assume these functions for the other hospitals. The univariate analysis showed a significant association between recruitment success and months of recruitment (p=0.024), number of staff (p<0.001), higher number of pharmacists (p=0.005), infectious disease specialists (p<0.001), the presence of microbiologist in the research team (p=0.018) and specifically dedicated nursing staff (p=0.036). CONCLUSIONS The existence of broad multidisciplinary teams with staff dedicated exclusively to the study as well as the implementation of a well-designed local patient assessment strategy were the essential optimisation factors for recruitment success in Spain. TRIAL REGISTRATION NUMBER NCT02655419; EudraCT 2015-002726-39; analysis of pre-screened patients.
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Affiliation(s)
| | | | - Silvia Jiménez-Jorge
- Clinical Research and Clinical Trials Unit, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Clara M Rosso-Fernández
- Clinical Research and Clinical Trials Unit, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Luis Tallón-Aguilar
- Department of Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Cristina Roca-Oporto
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Javier Padillo
- Department of Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Alison Luckey
- Global Antibiotic R&D Partnership (GARDP), Geneva, Switzerland
| | - Angela Cano
- Department of Infectious Diseases, Reina Sofia University Hospital, Cordoba, Spain
| | - José López-Ruiz
- Department of Surgery, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Jaime Bonnín-Pascual
- Department of Surgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Lucía Boix-Palop
- Department of Infectious Diseases, MutuaTerrassa Group, Terrassa, Spain
| | - José Miguel Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - José Miguel Cisneros
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Eilayyan O, Thomas A, Hallé MC, Tibbles AC, Jacobs C, Ahmed S, Schneider MJ, Al Zoubi F, Lee J, Myrtos D, Long CR, Bussieres A. Promoting the use of a self-management strategy among novice chiropractors treating individuals with spine pain: A mixed methods pilot clustered-clinical trial. PLoS One 2022; 17:e0262825. [PMID: 35061845 PMCID: PMC8782363 DOI: 10.1371/journal.pone.0262825] [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: 05/21/2021] [Accepted: 01/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background The uptake of Self-Management Support (SMS) among clinicians is suboptimal. To date, few studies have tested knowledge translation (KT) interventions to increase the application of SMS in chiropractic teaching clinics. Study objective Evaluate the feasibility of implementing a KT intervention to promote the use of a SMS strategy among chiropractic interns, their supervisors, and individuals with spine pain compared to controls. Methods Mixed methods pilot clustered-clinical trial. Clusters of 16 Patient Management Teams were allocated to a complex KT intervention (online and workshop training). Primary feasibility outcomes for clinicians, interns and patients were rates of recruitment, retention, and adherence to protocol. A nominal group technique and interviews were used to seek end-users’ views on the implementation process, and generate possible solutions. Results In total, 16 (84%) clinicians, 65 (26%) interns and 42 patients agreed to participate. All clinicians in the intervention group completed all KT intervention components, 23 interns (85%) completed the online training and 14 interns (51.8%) attended the workshop training. All clinicians in the intervention and seven (78%) in the control group completed all outcome measures at baseline and 6-month follow-up, while 15 (55.6%) and 23 (60.5%) interns in the intervention and control groups completed the questionnaires at baseline and 6-month follow-up, respectively. Among patients, 10 (52.6%) and 12 (52.2%) in the intervention and control groups respectively completed the questionnaires at the end of the study. Based on interview findings, solutions to improve the feasibility of conducting a full trial include: making SMS a part of the internship, changing the time of introducing the study to the interns, and having more training on SMS. Conclusion Recruitment and retention of chiropractic interns and patients for a larger implementation trial in a single outpatient teaching clinic may be challenging.
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Affiliation(s)
- Owis Eilayyan
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Physical Therapy and Rehabilitation Department, College of Applied Medical Sciences, Jouf University, Sakaka, Jouf, Saudi Arabia
- * E-mail: ,
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | - Marie-Christine Hallé
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | | | - Craig Jacobs
- Canadian Memorial Chiropractic College, Ontario, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
| | - Michael J. Schneider
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Fadi Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Joyce Lee
- Canadian Memorial Chiropractic College, Ontario, Canada
| | - Danny Myrtos
- Canadian Memorial Chiropractic College, Ontario, Canada
| | - Cynthia R. Long
- Palmer College of Chiropractic, Davenport, Iowa, United States of America
| | - Andre Bussieres
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Quebec, Canada
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17
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AlHeresh R, Vaughan MW, Brenner IH, Keysor J. Recruitment cost and outcomes for an arthritis work disability prevention randomized clinical trial: The Work It study. Contemp Clin Trials Commun 2021; 24:100862. [PMID: 34825102 PMCID: PMC8605186 DOI: 10.1016/j.conctc.2021.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 09/28/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Despite the recommendations to increase recruitment of participants into clinical trials, investigators face costly challenges in trials investigating work disability interventions for people with arthritis and rheumatological conditions. This study aims to evaluate the recruitment costs and outcomes from a randomized controlled trial of an arthritis work disability prevention program conducted between 2011 and 2015, to inform planning and monitoring recruitment in similar studies. Methods Data were obtained from enrollment and financial records pertaining to recruitment costs for each recruitment approach employed. The cost for each recruitment method was calculated for total cost and cost per number of participants screened, eligible, and enrolled in the trial. Then the yield of each possible recruitment method was also determined based on the ratio of the number of randomized participants divided by the number of people contacted through each recruitment method. Finally, the Results Recruitment rate was lower than projected. Community advertising, specifically newspapers, was the most successful method of recruitment in terms of numbers, but social media, specifically Craigslist, was the least costly method used to recruit. Some social media approaches, including Facebook and LinkedIn, yielded few if any participants. Recruitment efforts used successfully in the past are not always effective. Conclusions Costs to recruit large numbers of people with arthritis into clinical trials are high. Investigators are encouraged to monitor recruitment efforts and evaluate the costs and outcomes of their strategies throughout the study period. Close consideration to recruitment costs should be considered as part of the research fiscal resources prior to and during the study period for long-term outcomes like work disability. Trial registration ClinicalTrials.gov Identifier: NCT01387100, date: 06/01/2011.
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Affiliation(s)
| | | | | | - Julie Keysor
- MGH Institute of Health Professions, Boston, MA, USA
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Cardenas V, Rahman A, Giulioni J, Coulourides Kogan A, Enguidanos S. Patient and physician perspectives on engaging in palliative and healthcare trials: a qualitative descriptive study. BMC Palliat Care 2021; 20:158. [PMID: 34645442 PMCID: PMC8515687 DOI: 10.1186/s12904-021-00856-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/28/2021] [Indexed: 11/12/2022] Open
Abstract
Background Researchers are encountering increasing challenges in recruiting participants for palliative and healthcare research. This paper aims to understand challenges to and methods for engaging physicians and seriously ill patients and their caregivers in research studies. Methods Between October 2019 to July 2020, we conducted qualitative interviews with 25 patients, proxies, and caregivers participants who were eligible for a randomized controlled trial of home-based palliative care and 31 physicians from participating accountable care organizations. Using thematic analysis, we analyzed participants’ responses to identify concepts and key ideas within the text. From these initial concepts, core themes around barriers to research and preferred research recruitment approaches were generated. Results Themes from patient and caregiver interviews included time constraints, privacy concerns, lack of research familiarity, disconnect with research institution, self-perceived health status, and concerns with study randomization. Physician-identified barriers focused on time constraints and study randomization. Patient and caregiver recommendations for study recruitment included in-person recruitment, recruitment at healthcare providers’ offices, recruitment via mail, additional study information, and frequent calls. Physician recommendations were related to placement of flyers at clinics, financial incentives, and formal events. Conclusions Findings demonstrated that although patients and caregivers prefer that their physicians recruit them for health-related research studies, physicians identified time constraints as a consistent barrier to research involvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00856-6.
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Affiliation(s)
- Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA
| | - Jenna Giulioni
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, 90033, USA
| | - Alexis Coulourides Kogan
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA.,Keck School of Medicine, Department of Family Medicine and Geriatrics, University of Southern California , Alhambra, CA, 91803, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., GER 208B, Los Angeles, CA, 90089, USA
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19
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Palomo-Carrión R, Lirio-Romero C, Ferri-Morales A, Jovellar-Isiegas P, Cortés-Vega MD, Romay-Barrero H. Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial. Ther Adv Chronic Dis 2021; 12:20406223211034996. [PMID: 34408823 PMCID: PMC8366120 DOI: 10.1177/20406223211034996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Children with unilateral spastic cerebral palsy (USCP) receive different treatments, including the application of modified constraint induced movement therapy (mCIMT) or bimanual intensive therapy (BIT) to increase affected upper limb functionality. The aim of this study was to compare the effectiveness of two protocols with different proportions and orders of mCIMT/BIT within combined intensive home-therapy in children with USCP (6–8 years old) with high bimanual functional performance, applied by the family. Methods: The protocols were performed on 20 children with an average age of 7.12 years [standard deviation (SD): 0.70], allocated to two different combined therapies. The protocols were designed by 100 h of dose for 10 weeks: 80 h of mCIMT followed by 20 h of BIT (mCIMT-B group) and 80 h of BIT followed by 20 h of mCIMT (BIT-mCI group). Bimanual functional performance was measured with Assisting Hand Assessment Scale (AHA) and the affected upper limb-use experience with Children’s Hand-use Experience Questionnaire (CHEQ). Parent satisfaction and expectations with therapy were measured using a specific questionnaire. There were five assessment timepoints (week 0, week 4, week 8, week 10 and week 34). Results: There were no statistically significant (p > 0.05) inter- and intra-group changes in the bimanual functional performance of both groups. The affected upper limb-use experience obtained significant changes in BIT-mCI group, with statistically significant differences in the pairwise comparisons between week 0–10 and week 4–10 (p = 0.028) for use of the affected hand and the use of the affected hand to grasp between week 4 and week 8 (p = 0.028). Grasp efficacy and discomfort acquired statistically significant differences only in the BIT-mCI group for pairwise comparisons week 0–week 10/week 4–week 10 (p = 0.035). Although task execution time compared with a typically developing child of the same age obtained statistically significant differences only in the group mCIMT-B for pairwise comparisons week 0–week 8 (p = 0.03), week 0–week 10 (p = 0.03), week 4–week 8 (p = 0.04) and week 4–week 10 (p = 0.03). Family satisfaction and expectations acquired an increase between week 0 and week 10 (p ⩽ 0.02). Conclusion: Applying 80 h of BIT for 8 weeks in children with high bimanual functional performance USCP (6–8 years old), executed at home with family involvement would be sufficient to obtain improvements in affected upper limb-use experience, without the need to use combined protocols of 100 h. However, no statistically significant increase in bimanual functional performance would be obtained, with the basal situation of the child being a factor to consider for the execution of mCIMT and BIT. Registration number and name of trial registry: [ClinicalTrials.gov identifier: NCT03465046]
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Affiliation(s)
- Rocío Palomo-Carrión
- University of Castilla-La Mancha, Toledo, Spain GIFTO, Physiotherapy Research Group of Toledo, Spain
| | - Cristina Lirio-Romero
- University of Castilla-La Mancha, Avda. Carlos III. s/n, Toledo, 45071, Spain GIFTO, Physiotherapy Research Group of Toledo, Spain
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20
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Yip KP, Gompertz S, Snelson C, Willson J, Madathil S, Huq SS, Rauf F, Salmon N, Tengende J, Tracey J, Cooper B, Filby K, Ball S, Parekh D, Dosanjh DPS. Increase in recruitment upon integration of trial into a clinical care pathway: an observational study. BMJ Open Respir Res 2021; 8:8/1/e000967. [PMID: 34230034 PMCID: PMC8261886 DOI: 10.1136/bmjresp-2021-000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/12/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Many respiratory clinical trials fail to reach their recruitment target and this problem exacerbates existing funding issues. Integration of the clinical trial recruitment process into a clinical care pathway (CCP) may represent an effective way to significantly increase recruitment numbers. Methods A respiratory support unit and a CCP for escalation of patients with severe COVID-19 were established on 11 January 2021. The recruitment process for the Randomised Evaluation of COVID-19 Therapy-Respiratory Support trial was integrated into the CCP on the same date. Recruitment data for the trial were collected before and after integration into the CCP. Results On integration of the recruitment process into a CCP, there was a significant increase in recruitment numbers. Fifty patients were recruited over 266 days before this process occurred whereas 108 patients were recruited over 49 days after this process. There was a statistically significant increase in both the proportion of recruited patients relative to the number of COVID-19 hospital admissions (change from 2.8% to 9.1%, p<0.0001) and intensive therapy unit admissions (change from 17.8% to 50.2%, p<0.001) over the same period, showing that this increase in recruitment was independent of COVID-19 prevalence. Discussion Integrating the trial recruitment process into a CCP can significantly boost recruitment numbers. This represents an innovative model that can be used to maximise recruitment without impacting on the financial and labour costs associated with the running of a respiratory clinical trial.
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Affiliation(s)
- Kay Por Yip
- University of Birmingham Institute of Inflammation and Ageing, Birmingham, West Midlands, UK .,Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Gompertz
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Birmingham Respiratory Clinical Trials Unit, Birmingham, UK
| | - Catherine Snelson
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeremy Willson
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shyam Madathil
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Birmingham Respiratory Clinical Trials Unit, Birmingham, UK
| | - Syed Sa Huq
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Farrukh Rauf
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natasha Salmon
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joyce Tengende
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Julie Tracey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Brendan Cooper
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kay Filby
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Ball
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Health Data Research UK, London, UK
| | - Dhruv Parekh
- University of Birmingham Institute of Inflammation and Ageing, Birmingham, West Midlands, UK.,Birmingham Respiratory Clinical Trials Unit, Birmingham, UK.,Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Davinder P S Dosanjh
- University of Birmingham Institute of Inflammation and Ageing, Birmingham, West Midlands, UK.,Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Birmingham Respiratory Clinical Trials Unit, Birmingham, UK
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21
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Crouse JJ, Morley KC, Buckley N, Dawson A, Seth D, Monds LA, Tickell A, Kay-Lambkin F, Chitty KM. Online interventions for people hospitalized for deliberate self-harm and problematic alcohol use: Lessons learned from the iiAIM trial. Bull Menninger Clin 2021; 85:123-142. [PMID: 34032460 DOI: 10.1521/bumc.2021.85.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Deliberate self-harm and suicide affect all age groups, sexes, and regions, and their prevention is a global health priority. Acute alcohol misuse and chronic alcohol misuse are strong, modifiable risk factors, and Internet interventions aiming to reduce alcohol misuse and comorbid mental health problems (e.g., depression) are a promising and effective treatment modality. The research team aimed to evaluate the feasibility and effectiveness of an Internet-based comorbidity intervention primarily aiming to reduce alcohol consumption, and secondarily to reduce readmission for deliberate self-harm and improve psychological outcomes among people hospitalized for deliberate self-harm who also engage in problematic alcohol use. However, due to several barriers to recruitment, the trial could not be completed and was discontinued. The authors present a "Lessons Learned" discussion and describe the Internet Intervention for Alcohol Improvement (iiAIM) trial, discuss the key barriers experienced by the research team, and recommend potential solutions that may help future trials in this area.
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Affiliation(s)
- Jacob J Crouse
- University of Sydney, Youth Mental Health and Technology Team, Brain & Mind Centre, Central Clinical School, Sydney, NSW, Australia
| | - Kirsten C Morley
- University of Sydney, Discipline of Addiction Medicine, Central Clinical School, Sydney, NSW, Australia
| | - Nicholas Buckley
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia
| | - Andrew Dawson
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
| | - Devanshi Seth
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia.,University of Sydney, Centenary Institute of Cancer Medicine and Cell Biology, Sydney, NSW, Australia, and the University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Lauren A Monds
- University of Sydney, Discipline of Addiction Medicine, Central Clinical School, Sydney, NSW, Australia
| | - Ashleigh Tickell
- University of Sydney, Youth Mental Health and Technology Team, Brain & Mind Centre, Central Clinical School, Sydney, NSW, Australia
| | - Frances Kay-Lambkin
- University of Newcastle, Centre for Brain and Mental Health Priority Research Centre, Newcastle, Australia
| | - Kate M Chitty
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia
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22
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Zahren C, Harvey S, Weekes L, Bradshaw C, Butala R, Andrews J, O'Callaghan S. Clinical trials site recruitment optimisation: Guidance from Clinical Trials: Impact and Quality. Clin Trials 2021; 18:594-605. [PMID: 34041937 PMCID: PMC8479150 DOI: 10.1177/17407745211015924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background/Aims: Participants are integral to the success of any clinical research study, yet participant recruitment into clinical trials poses ongoing and complex challenges. It is widely accepted and recognised that clinical trial sites often find it difficult to meet recruitment goals, both in terms of accrual targets and timelines. This can impact the validity of trials or cause major delays for research. There are very few frameworks available to clinical trial sites to improve recruitment. The GREET project (Guidance to Recruitment: Examining Experiences at clinical Trial sites) sought to identify barriers to recruitment and produce formal guidance to optimise recruitment outcomes. Methods: Clinical Trials: Impact and Quality, a collaborative of sector stakeholders, convened a project team with comprehensive knowledge of the Australian clinical trials sector to undertake the GREET project. The project scope included exploration of recruitment issues at a site level across all phases of clinical trials and all types of trial sites. The scope excluded upstream issues such as protocol design and general public clinical trial awareness, participant retention and elements of recruitment outside a site’s capacity to directly influence or control. The project team’s extensive knowledge and experience conducting clinical trials in Australia was used to collaboratively identify a list of 24 key barriers and 12 enablers to site recruitment which formed the basis of the project. Key stakeholder groups were surveyed to challenge project team assumptions. A national and international environmental scan and literature review was conducted to identify best-practice recruitment solutions. Results: A total of 343 people responded to a survey sent to sites, sponsors, and contract research organisations, and 162 people responded to a survey sent to consumers via consumer networks. The key barriers and enablers initially identified by the project team aligned with the key outcomes of the surveys, which in turn assisted in the development of best-practice recommendations in the form of a Clinical Trial Site Recruitment Guide. Recommendations were grouped into four key themes; conducting accurate study feasibility; proactive planning during start-up; selecting optimal recruitment methods; and participant involvement. Early intervention was identified as a key facilitator in maximising improved recruitment outcomes. The GREET Clinical Trial Site Recruitment Guide is publicly accessible on the Clinical Trials: Impact and Quality website. Conclusion: Participant recruitment challenges experienced at a site level are widespread and varied, and there is no universal recruitment solution. However, this project identified that there are interventions and assessments that can be proactively implemented and selectively applied to facilitate improved recruitment outcomes.
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Affiliation(s)
| | | | | | | | - Radhika Butala
- Clinical Trials Unit, Macquarie University, Sydney, NSW, Australia
| | - John Andrews
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Sydney, NSW, Australia
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23
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Tabriz AA, Fleming PJ, Shin Y, Resnicow K, Jones RM, Flocke SA, Shires DA, Hawley ST, Willens D, Lafata JE. Challenges and opportunities using online portals to recruit diverse patients to behavioral trials. J Am Med Inform Assoc 2021; 26:1637-1644. [PMID: 31532482 DOI: 10.1093/jamia/ocz157] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/05/2019] [Accepted: 08/10/2019] [Indexed: 12/22/2022] Open
Abstract
We describe the use of an online patient portal to recruit and enroll primary care patients in a randomized trial testing the effectiveness of a colorectal cancer (CRC) screening decision support program. We use multiple logistic regression to identify patient characteristics associated with trial recruitment, enrollment, and engagement. We found that compared to Whites, Blacks had lower odds of viewing the portal message (OR = 0.46, 95% CI = 0.37-0.57), opening the attached link containing the study material (OR = 0.75, 95% CI = 0.62-0.92), and consenting to participate in the trial (OR = 0.85, 95% CI = 0.67-0.93). We also found that compared to Whites, Asians had lower odds of viewing the portal message (OR = 0.53, 95% CI = 0.33-0.64), opening the attached link containing the study material (OR = 0.76, 95% CI = 0.54-0.97), consenting to participate in the trial (OR = 0.68, 95% CI = 0.53-0.95), and completing the trial's baseline questionnaire (OR = 0.59, 95% CI = 0.36-0.90). While portals offer an opportunity to mitigate human bias in trial invitations, because of racial disparities-not only in who has a portal account, but in how they interact with trial recruitment and enrollment material within the portal-using portals alone for trial recruitment may generate study samples that are not racially diverse.
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Affiliation(s)
- Amir Alishahi Tabriz
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Patrice Jordan Fleming
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yongyun Shin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ken Resnicow
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health and Fox Chase Cancer Center, Temple University, Philadelphia, Pennsylvania, USA
| | - Susan A Flocke
- Department of Family Medicine, Oregon Health Sciences University, Portland, Oregon, USA
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Sarah T Hawley
- Department of Medicine, Center for Health Communications Research, University of Michigan and Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | | | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Henry Ford Health System, Detroit, Michigan, USA
- UNC Lineberger Comprehensive Cancer Center, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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24
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Whitelaw S, Sullivan K, Eliya Y, Alruwayeh M, Thabane L, Yancy CW, Mehran R, Mamas MA, Van Spall HGC. Trial characteristics associated with under-enrolment of females in randomized controlled trials of heart failure with reduced ejection fraction: a systematic review. Eur J Heart Fail 2020; 23:15-24. [PMID: 33118664 DOI: 10.1002/ejhf.2034] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS To evaluate temporal trends in the enrolment of females in randomized controlled trials (RCTs) of heart failure with reduced ejection fraction (HFrEF) published in high-impact journals, and assess RCT characteristics associated with under-enrolment. METHODS AND RESULTS We searched MEDLINE, EMBASE and CINAHL for studies published from January 2000 to May 2019 in journals with impact factor ≥10. We included RCTs that recruited adults with HFrEF. We used a 20% threshold below the sex distribution of HFrEF to define under-enrolment. We used multivariable logistic regression to assess trial characteristics independently associated with under-enrolment. We included 317 RCTs. Among the 183 097 participants, mean (standard deviation) age was 63.0 (7.0) years and 25.5% were female. Females were under-enrolled in 71.6% [95% confidence interval (CI) 66.6-76.6%] of the RCTs; enrolment did not increase significantly between 2000-2019. Sex-related eligibility criteria [odds ratio (OR) 2.05, 95% CI 1.01-4.16; P = 0.046]; recruitment in ambulatory settings (OR 2.56, 95% CI 1.37-4.81; P = 0.003); trial coordination in North America (OR 4.44, 95% CI 1.09-18.07; P = 0.037), Europe (OR 6.79, 95% CI 1.63-27.39; P = 0.018) and Asia (OR 9.33, 95% CI 1.40-12.40; P = 0.033); drug (OR 1.76, 95% CI 1.96-7.36; P < 0.001) and device/surgical interventions (OR 1.69, 95% CI 1.16-9.43; P = 0.002); and men in first and last authorship position (OR 1.32, 95% CI 1.12-3.54; P = 0.047) were associated with under-enrolment of females. CONCLUSIONS Females were under-enrolled relative to disease distribution in a majority of high-impact HFrEF RCTs, with no change in temporal trends between 2000 and 2019. Trial characteristics and gender of trial leaders were associated with under-enrolment.
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Affiliation(s)
- Sera Whitelaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | | | - Yousif Eliya
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Clyde W Yancy
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Roxana Mehran
- Ican School of Medicine, Mount Sinai Hospital, NY, New York, USA
| | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK.,Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada.,ICES, McMaster University, Hamilton, Canada
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25
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Dias J, Brealey S, Cook L, Fairhurst C, Hinde S, Leighton P, Choudhary S, Costa M, Hewitt C, Hodgson S, Jefferson L, Jeyapalan K, Keding A, Northgraves M, Palmer J, Rangan A, Richardson G, Taub N, Tew G, Thompson J, Torgerson D. Surgical fixation compared with cast immobilisation for adults with a bicortical fracture of the scaphoid waist: the SWIFFT RCT. Health Technol Assess 2020; 24:1-234. [PMID: 33109331 PMCID: PMC7681317 DOI: 10.3310/hta24520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. Immediate surgical fixation of this fracture has increased. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of surgical fixation with cast treatment and early fixation in adults with scaphoid waist fractures that fail to unite. DESIGN Multicentre, pragmatic, open-label, parallel two-arm randomised controlled trial with an economic evaluation and a nested qualitative study. SETTING Orthopaedic departments of 31 hospitals in England and Wales recruited from July 2013, with final follow-up in September 2017. PARTICIPANTS Adults (aged ≥ 16 years) presenting within 2 weeks of injury with a clear, bicortical fracture of the scaphoid waist on plain radiographs. INTERVENTIONS Early surgical fixation using Conformité Européenne-marked headless compression screws. Below-elbow cast immobilisation for 6-10 weeks and urgent fixation of confirmed non-union. MAIN OUTCOME MEASURES The primary outcome and end point was the Patient-Rated Wrist Evaluation total score at 52 weeks, with a clinically relevant difference of 6 points. Secondary outcomes included Patient-Rated Wrist Evaluation pain and function subscales, Short Form questionnaire 12-items, bone union, range of movement, grip strength, complications and return to work. RESULTS The mean age of 439 participants was 33 years; 363 participants were male (83%) and 269 participants had an undisplaced fracture (61%). The primary analysis was on 408 participants with valid Patient-Rated Wrist Evaluation outcome data for at least one post-randomisation time point (surgery, n = 203 of 219; cast, n = 205 of 220). There was no clinically relevant difference in the Patient-Rated Wrist Evaluation total score at 52 weeks: the mean score in the cast group was 14.0 (95% confidence interval 11.3 to 16.6) and in the surgery group was 11.9 (95% confidence interval 9.2 to 14.5), with an adjusted mean difference of -2.1 in favour of surgery (95% confidence interval -5.8 to 1.6; p = 0.27). The non-union rate was low (surgery group, n = 1; cast group, n = 4). Eight participants in the surgery group had a total of 11 reoperations and one participant in the cast group required a reoperation for non-union. The base-case economic analysis at 52 weeks found that surgery cost £1295 per patient more (95% confidence interval £1084 to £1504) than cast treatment. The base-case analysis of a lifetime-extrapolated model confirmed that the cast treatment pathway was more cost-effective. The nested qualitative study identified patients' desire to have a 'sense of recovering', which surgeons should address at the outset. LIMITATION There were 17 participants who had initial cast treatment and surgery for confirmed non-union, which in 14 cases was within 6 months from randomisation and in three cases was after 6 months. Three of the four participants in the cast group who had a non-union at 52 weeks were not offered surgery. CONCLUSIONS Adult patients with an undisplaced or minimally displaced scaphoid waist fracture should have cast immobilisation and suspected non-unions immediately confirmed and urgently fixed. Patients should be followed up at 5 years to investigate the effect of partial union, degenerative arthritis, malunion and screw problems on their quality of life. TRIAL REGISTRATION Current Controlled Trials ISRCTN67901257. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 52. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joseph Dias
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Stephen Brealey
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Liz Cook
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | | | - Paul Leighton
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Surabhi Choudhary
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Catherine Hewitt
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Stephen Hodgson
- Department of Orthopaedic Surgery, Bolton NHS Foundation Trust, Royal Bolton Hospital, Bolton, UK
| | - Laura Jefferson
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | | | - Ada Keding
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Matthew Northgraves
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
| | - Jared Palmer
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Amar Rangan
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Nicholas Taub
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Garry Tew
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - John Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Torgerson
- Alcuin Research Resource Centre Building, Department of Health Sciences, University of York, York, UK
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26
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Gupta A, Ocker G, Chow PI. Recruiting breast cancer patients for mHealth research: Obstacles to clinic-based recruitment for a mobile phone app intervention study. Clin Trials 2020; 17:675-683. [PMID: 32660354 DOI: 10.1177/1740774520939247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nearly half of newly diagnosed breast cancer patients will report clinically significant symptoms of depression and/or anxiety within the first year of diagnosis. Research on the trajectory of distress in cancer patients suggests that targeting patients early in the diagnostic pathway could be particularly impactful. Given the recent rise of smartphone adoption, apps are a convenient and accessible platform from which to deliver mental health support; however, little research has examined their potential impact among newly diagnosed cancer patients. One reason is likely due to the obstacles associated with in-clinic recruitment of newly diagnosed cancer patients for mHealth pilot studies. METHODS This article draws from our experiences of a recently completed pilot study to test a suite of mental health apps in newly diagnosed breast cancer patients. Recruitment strategies included in-clinic pamphlets, flyers, and direct communication with clinicians. Surgical oncologists and research staff members approached eligible patients after a medical appointment. Research team members met with patients to provide informed consent and review the study schedule. RESULTS Four domains of in-clinic recruitment challenges emerged: (a) coordination with clinic staff, (b) perceived burden among breast cancer patients, (c) limitations regarding the adoption and use of technology, and (d) availability of resources. Potential solutions are provided for each challenge. CONCLUSION Recruitment of newly diagnosed cancer patients is a major challenge to conducting mobile intervention studies for researchers on a pilot-study budget. To realize the impact of mobile interventions for the most vulnerable cancer patient populations, health researchers must address barriers to in-clinic recruitment to provide vital preliminary data in proposals of large-scale research projects.
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Affiliation(s)
- Alisha Gupta
- University of Virginia, Charlottesville, VA, USA
| | | | - Philip I Chow
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
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Wilcox CS, Franceschi L, Simmons A. Layperson/Plain Language Summaries: Can Sponsors, CROs, and Sites Deliver in 2020? INNOVATIONS IN CLINICAL NEUROSCIENCE 2020; 17:41-44. [PMID: 33520403 PMCID: PMC7839658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The much-anticipated 2014 European Union (EU) Clinical Trial Regulation requiring Layperson/ Plain Language Summaries (PLS) is slated for implementation in 2020. At the 10th Annual CNS Summit Conference (Fall 2019), a panel discussion was convened with the objective of evaluating the likelihood of the PLS legislation being implemented successfully in the EU and voluntarily (e.g., pro-actively) in the rest of the world. Points of the discussion embraced the notion that this is an excellent opportunity for the entire pharmaceutical industry. Moreover, in the United States, public opinion of the pharmaceutical industry hit an all-time low in 2019, surpassing the oil industry with regard to public distrust. For decades, clinical trial participants have stated that wanting to learn, in layperson terms, the results of the study was second only to wanting to learn the treatment group into which they were assigned under double-blind conditions. Our conclusion is that while confidentiality, commercial interests, total costs, regulatory concerns, as well as some operational aspects (i.e., patient access portals) are among the hurdles, our commentary strongly advocates systematic implementation not only within the EU, but that this should be implemented globally, without further delay.
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Affiliation(s)
- Charles S Wilcox
- Dr. Wilcox is Chief Executive Officer at Praxis Research Consulting in Newport Beach, California
- Ms. Franceschi is Senior Project Director at Syneos Health in Morrisville, North Carolina
- Mr. Simmons is Director of Clinical Program Management at Alkermes Inc. in Boston, Massachusetts
| | - Leslie Franceschi
- Dr. Wilcox is Chief Executive Officer at Praxis Research Consulting in Newport Beach, California
- Ms. Franceschi is Senior Project Director at Syneos Health in Morrisville, North Carolina
- Mr. Simmons is Director of Clinical Program Management at Alkermes Inc. in Boston, Massachusetts
| | - Adam Simmons
- Dr. Wilcox is Chief Executive Officer at Praxis Research Consulting in Newport Beach, California
- Ms. Franceschi is Senior Project Director at Syneos Health in Morrisville, North Carolina
- Mr. Simmons is Director of Clinical Program Management at Alkermes Inc. in Boston, Massachusetts
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Tinkler L, Robinson L. Clinical research nursing and factors influencing success: a qualitative study describing the interplay between individual and organisational leadership influences and their impact on the delivery of clinical research in healthcare. J Res Nurs 2020; 25:361-377. [PMID: 34394647 PMCID: PMC7932384 DOI: 10.1177/1744987120904778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical research delivery is a term increasingly used to describe the work undertaken to implement studies which explore and test prevention, diagnosis and treatment in healthcare. Such studies range from multi-site clinical trials to single site observational projects. Whilst widely acknowledged as fundamental to effective healthcare, clinical research is complex to deliver and is met with challenges in the busy clinical environment. The perceptions and experiences of Clinical Research Nurses, whose work is central to this agenda, have emerged as important, yet frequently overlooked insights in relation to the potential success of research delivery. Increased understanding of these insights is essential to address the barriers and maximise facilitators to success in clinical research. AIM To better understand how the perceptions and experiences of Clinical Research Nurses relate to potential for success in research delivery. METHODS Seven focus groups and two one-to-one interviews (27 participants) were conducted in a large tertiary North East England National Health Service Foundation Trust between March and June 2017. RESULTS Clinical Research Nurses' described perceptions and experiences of working to co-ordinate and deliver a range of research as individuals, within their teams, throughout the wider organisation, and beyond. Two key elements situated within an overarching theme of leadership emerged as likely to impact on how successfully they were able to practise:• the individual (self-leadership).• the organisation (leadership culture). CONCLUSIONS The framework emerging from this study illustrates a complex interplay between personal attributes and organisational culture, mediated by national strategies and targets associated with the clinical research agenda. When situated within the concept of leadership, it broadens the potential for understanding the underlying issues and increases the range of possible support mechanisms to improve experiences for Clinical Research Nurses. Framing the challenges in this way contributes new knowledge to the dialogue surrounding clinical research delivery.
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Affiliation(s)
- Linda Tinkler
- Trust Lead, Nursing, Midwifery and AHP Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Lisa Robinson
- Consultant Allied Health Professional, Major Trauma Rehabillitation Department, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Newmark J, Gebara MA, Aizenstein H, Karp JF. Engaging in Late-Life Mental Health Research: a Narrative Review of Challenges to Participation. ACTA ACUST UNITED AC 2020; 7:317-336. [PMID: 32837830 PMCID: PMC7242610 DOI: 10.1007/s40501-020-00217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of review This narrative review seeks to ascertain the challenges older patients face with participation in mental health clinical research studies and suggests creative strategies to minimize these obstacles. Recent findings Challenges to older adults’ engagement in mental health research include practical, institutional, and collaboration-related barriers applicable to all clinical trials as well as more personal, cultural, and age-related patient barriers specific to geriatric mental health research. Universal research challenges include (1) institutional barriers of lack of funding and researchers, inter-researcher conflict, and sampling bias; (2) collaboration-related barriers involving miscommunication and clinician concerns; and (3) practical patient barriers such as scheduling issues, financial constraints, and transportation difficulties. Challenges unique to geriatric mental health research include (1) personal barriers such as no perceived need for treatment, prior negative experience, and mistrust of mental health research; (2) cultural barriers involving stigma and lack of bilingual or culturally matched staff; and (3) chronic medical issues and concerns about capacity. Summary Proposed solutions to these barriers include increased programmatic focus on and funding of geriatric psychiatry research grants, meeting with clinical staff to clarify study protocols and eligibility criteria, and offering transportation for participants. To minimize stigma and mistrust of psychiatric research, studies should devise community outreach efforts, employ culturally competent bilingual staff, and provide patient and family education about the study and general information about promoting mental health.
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Affiliation(s)
- Jordyn Newmark
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA.,Center for Interventions to Enhance Community Health, University of Pittsburgh, Pittsburgh, USA
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Pannard M, Bauquier C, Bassoleil L, Sablone L, Jacob G, Reyal F, Préau M. [Citizens who volunteer as participants for cancer research-results of the Seintinelles Barometer 2018]. Bull Cancer 2020; 107:333-343. [PMID: 32037013 DOI: 10.1016/j.bulcan.2019.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/03/2019] [Accepted: 11/16/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Health researchers often face difficulties related to participants' recruitment for their research. However, a new strategy emerges: offering patients-but also citizens who are not ill-the possibility to volunteer as participants to hasten research processes. The French platform "Seintinelles" aims to fulfill this goal and bring together citizens who volunteered to participate to cancer related research. The "Seintinelles Barometer" aims to describe these volunteers' profile. METHODS The Seintinelles Barometer data were collected through a web-based auto-questionnaire proposed to the "Seintinelles" members from June 2017 to November 2018. RESULTS The sample presents a high level of overrepresentation of women. Participants are characterized by a high level of education. About a third of the participants had suffered from cancer. Two profile of volunteers emerged: the « patients » and the « supportive citizens ». DISCUSSION The Seintinelles Barometer participants manifest a strong wish to be involved in cancer related research. Therefore, this platform seems to be a promising tool for the development of community-based research in the field of cancer.
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Affiliation(s)
- Myriam Pannard
- Université Lumière Lyon 2, groupe de recherche en psychologie sociale (GRePS), 5, avenue Pierre-Mendès-France, 69500 Bron, France.
| | - Charlotte Bauquier
- Université Lumière Lyon 2, groupe de recherche en psychologie sociale (GRePS), 5, avenue Pierre-Mendès-France, 69500 Bron, France
| | | | - Laura Sablone
- Seintinelles, 40, rue Rémy-Dumoncel, 75014 Paris, France
| | | | - Fabien Reyal
- Institut Curie, Residual Tumor & Response to Treatment Laboratory (RT2Lab), U932 Immunity and Cancer ; Inserm, 26, rue D'Ulm, 75284 Paris cedex 05, France
| | - Marie Préau
- Université Lumière Lyon 2, groupe de recherche en psychologie sociale (GRePS), 5, avenue Pierre-Mendès-France, 69500 Bron, France
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Hubbard G, Taylor C, Watson AJM, Munro J, Goodman W, Beeken RJ. A physical activity intervention to improve the quality of life of patients with a stoma: a feasibility study. Pilot Feasibility Stud 2020; 6:12. [PMID: 32042438 PMCID: PMC7001297 DOI: 10.1186/s40814-020-0560-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We hypothesise that a physical activity (PA) intervention will improve the quality of life (QoL) of people with a stoma. A feasibility study of the intervention and trial parameters is necessary to inform a future main trial. METHODS Participants received a weekly PA consultation by telephone, video conferencing, or face-to-face for 12 weeks with a PA instructor who prescribed physical activities and supported participants by addressing stoma-related concerns and using behaviour change techniques. A feasibility study of the intervention and trial parameters was conducted in three UK sites using mixed methods. RESULTS The number of eligible patients consenting to the study was 30 out of 174 (17%). Most participants were female (73%); 73% had an ileostomy and 27% a colostomy; mean time since diagnosis was 6 months. A total of 18 (64%) participants completed pre- (baseline) and post-intervention (follow-up) measures. Results show an improvement on all scales measuring QoL and disease-specific fatigue. The median PA consultation rate per participant was eight sessions. Participants reported completing 75% or more of the prescribed PA each week. Eight stoma-related themes were identified from qualitative interviews: fear of hernia, bending down, fatigue, pain, prolapse, surgical wounds, stoma appliance, and stigma. The intervention appeared to address these issues. CONCLUSION This feasibility study demonstrated that a novel manualised PA intervention for people with a stoma is safe, feasible, and acceptable, and shows promise for improving outcomes. However, difficulties with recruitment will need to be carefully considered to ensure the success of future studies in this area. TRIAL REGISTRATION ISCTN, ISRCTN58613962; Registered 14/9/2017.
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Affiliation(s)
- Gill Hubbard
- Department of Nursing and Midwifery, Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | - Claire Taylor
- St Mark’s Hospital, London North West University Healthcare NHS Trust, Harrow, Middlesex HA1 3UJ UK
| | - Angus J. M. Watson
- Department of Surgery, Raigmore Hospital, NHS Highland, Old Perth Rd, Inverness, IV2 3UJ UK
| | - Julie Munro
- Department of Nursing and Midwifery, Centre for Health Science, University of the Highlands and Islands, Old Perth Road, Inverness, IV2 3JH UK
| | - William Goodman
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Rebecca J. Beeken
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
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Identifying important barriers to recruitment of patients in randomised clinical studies using a questionnaire for study personnel. Trials 2019; 20:618. [PMID: 31666093 PMCID: PMC6822437 DOI: 10.1186/s13063-019-3737-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Many randomised controlled trials (RCT) fail to meet their recruitment goals. Study personnel play a key role in recruitment. The aim of this study was to identify successful strategies that study personnel consider to be important in patient recruitment to RCT. Methods We constructed a questionnaire based on the literature, discussions with colleagues and our own experience as trialists. The survey was named “What is Important for Making a Study Successful questionnaire” (WIMSS-q). Our target group was the study personnel in the ongoing EFFECTS study. The questionnaire was sent out electronically to all physicians and nurses (n = 148). Success factors and barriers were divided according to patient, centre and study level, respectively. Results Responses were received from 94% of the study personnel (139/148). The five most important factors at centre level for enhancing recruitment were that the research question was important (97%), a simple procedure for providing information and gaining consent (92%), a highly engaged local principal investigator and research nurse (both 87%), and that study-related follow-ups are practically feasible and possible to coordinate with the clinical follow-up (87%). The most significant barrier at the local centre was lack of time and resources devoted to research (72%). Important patient-related barriers were fear of side effects (35%) and language problems (30%). Conclusions For recruitment in an RCT to be successful, the research question must be relevant, and the protocol must be simple and easy to implement in the daily routine. Trial registration The protocol for this study was registered at the Northern Ireland Hub for trials methodology research (SWAT ID 64). The EFFECTS study has EudraCT number 2011–006130-16 and was registered 17 February 2016 at ClinicalTrials.gov number NCT02683213.
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Metse AP, Stockings E, Bailey J, Regan T, Bartlem K, Wolfenden L, Taylor G, Wiggers J, Bowman J. Rates of retention of persons with a mental health disorder in outpatient smoking cessation and reduction trials, and associated factors: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e030646. [PMID: 31488491 PMCID: PMC6731776 DOI: 10.1136/bmjopen-2019-030646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/20/2019] [Accepted: 07/31/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Smoking among persons with a mental health disorder is associated with inequitable health, social and economic burden. Randomised controlled trials (RCTs) are considered the gold standard design for the assessment of healthcare intervention efficacy/effectiveness. However, many RCTs of smoking interventions for persons with a mental health disorder lack rigour due to low participant retention. No systematic review has pooled retention rates in randomised trials of smoking interventions for persons with a mental health disorder or explored associated factors. The aims of the systematic review will therefore be to: (1) summarise overall rates of participant retention in smoking cessation and reduction trials involving persons with a mental health disorder (including for experimental and control groups separately) and (2) determine if retention rates vary according to participant, environmental, researcher and study factors. METHODS AND ANALYSIS PsycINFO, EMBASE, MEDLINE, CENTRAL and The Cochrane Tobacco Addiction Review Group Specialised Register will be searched for reports of RCTs of outpatient smoking cessation or reduction interventions for adults with a mental health disorder. The search terms will include MeSH terms and free text words, and there will be no language or date restrictions. All databases will be searched from inception to present. Data will be analysed using the Mantel-Haenszel fixed-effect model, and where substantial heterogeneity (I2 >50%) is detected, DerSimonian & Laird inverse-variance random effects model. Pooled estimates and 95% CIs will be calculated for overall participant retention rates and for intervention and control trial arms separately. Associations between participant retention and participant, environmental, researcher and study factors will be assessed via subgroup analyses and, where sufficient data are obtained, meta-regression. ETHICS AND DISSEMINATION This study does not require ethical approval. The findings of this review will be disseminated via publication in a peer-reviewed open access medical journal and presentations at international scientific meetings.
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Affiliation(s)
- Alexandra Patricia Metse
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Discipline of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Bailey
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Timothy Regan
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Bartlem
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Gemma Taylor
- Department of Psychology, University of Bath, Bath, BA2 7AY, United Kingdom
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
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Wienroth M, Pearce C, McKevitt C. Research campaigns in the UK National Health Service: patient recruitment and questions of valuation. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1444-1461. [PMID: 31119753 DOI: 10.1111/1467-9566.12957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The National Institute for Health Research (NIHR) aims to improve national 'health and wealth' by providing infrastructural support to enable clinical research in National Health Service settings in England and Wales. Cognisant of the consequences of studies' failure to achieve required numbers of participants, it also actively campaigns to promote patient awareness of research, and willingness to participate in trials. In this paper, we analyse recent NIHR campaigns and policies designed to encourage patients to participate in clinical research to interrogate how they are implicated in the national bioeconomy. In doing so we expand the notion of 'clinical labour' to include the work of patient recruitment and highlight an emergent obligation on patients to contribute to research processes. Whereas once patient knowledge and experience may have been devalued, here we draw on the concept of 'assetisation' (Birch 2012) to explore the emergent relationship between healthcare system and patient as research participant. We consider how patients' contribution goes beyond the provision of standardised objects of valuation so that patients themselves may be perceived as assets to, not only recipients of, the national healthcare system.
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Affiliation(s)
- Matthias Wienroth
- Policy, Ethics and Life Sciences Research Centre, School of Geography Politics and Sociology, Newcastle University, Newcastle upon Tyne, UK
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Caroline Pearce
- School of Population Health and Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, UK
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Bundred N, Todd C, Morris J, Keeley V, Purushotham A, Bagust A, Foden P, Bramley M, Riches K. Individualising breast cancer treatment to improve survival and minimise complications in older women: a research programme including the PLACE RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundOver 44,000 women are diagnosed with breast cancer annually in the UK. The research comprised three workstreams (WSs) focused on older women.Maximising survivalWS1 – to identify the role of older women’s and surgeons’ preferences in cancer treatment decisions and whether comorbidity or fitness for surgery has an impact on survival.Minimising complicationsWS2 – to assess multifrequency bioimpedance (BEA) compared with perometry in identifying women predisposed to develop lymphoedema after axillary node clearance (ANC) surgery. WS3 – to assess, in women at risk of lymphoedema, whether or not applying compression garments prevents the onset of lymphoedema.DesignWS1 – a prospective, consecutive cohort of surgical consultations with women aged ≥ 70 years with operable breast cancer. Interviews and questionnaire surveys of surgeons’ and women’s perceptions of responsibility for treatment decisions (Controlled Preference Score), effects related to survival and secondary outcomes. WS2 – women undergoing ANC for cancer in 21 UK centres underwent baseline and subsequent BEA, and perometer arm measurements and quality-of-life (QoL) assessments. WS3 – a randomised controlled trial testing standard versus applying graduated compression garments to the affected arm, for 1 year, in WS2 patients developing arm swelling.SettingBreast outpatient clinics in hospitals with specialist lymphoedema clinics.ParticipantsWS1 – patients aged ≥ 70 years with newly diagnosed, operable, invasive breast cancer. WS2 – women with node-positive cancer scheduled to undergo ANC. WS3 – WS2 participants developing a 4–9% increase in arm volume.InterventionsWS1 – observational study. WS2 – observational study. WS3 – application of graduated compression garments to affected arm, compared with standard management, for 1 year.OutcomesWS1 – self-report and clinically assessed health, QoL, complications and survival. WS2 – perometer and bioimpedance spectroscopy (BIS) measurements, QoL and health utility; and sensitivity and specificity of BIS for detecting lymphoedema compared with perometer arm measurements; in addition, a health economics assessment was performed. WS3 – time to the development of lymphoedema [≥ 10% relative arm-volume increase (RAVI)] from randomisation.ResultsWS1 – overall, 910 women were recruited, but numbers in the substudies differ depending on consent/eligibility. In a study of patient/surgeon choice, 83.0% [95% confidence interval (CI) 80.4% to 85.6%] had surgery. Adjusting for health and choice, only women aged > 85 years had reduced odds of surgery [odds ratio (OR) 0.18, 95%CI 0.07 to 0.44]. Patient role in treatment decisions made no difference to receipt of surgery. A qualitative study of women who did not have surgery identified three groups: ‘patient declined’, ‘patient considered’ and ‘surgeon decided’. In a survival substudy, adjusting for tumour stage, comorbidity and functional status, women undergoing surgery had one-third the hazard of dying from cancer. Serious complications from surgery were low and not predicted by older age. In a substudy of the effect of surgical decision-making on HRQoL, 59 (26%) received preferred treatment decision-making style. In multivariate analyses, change in HRQoL was associated neither with congruence (p = 0.133) nor with receipt of surgery (p = 0.841). In a substudy of receipt of chemotherapy in women aged ≥ 65 years, adjusting for tumour characteristics, health measures and choice, women aged ≥ 75 years had reduced odds of chemotherapy (OR 0.06, 95%CI 0.02 to 0.16). WS2 – lymphoedema by 24 months was detected in 21.4% of women by perometry (24.4% sleeve application) and in 39.4% by BIS. Perometer and BIS measurements correlated at 6 months (r = 0.61). Specificity for sleeve application was greater for perometry (94% CI 93% to 96%) at 24 months, as was a positive predictive value of 59% (95% CI 48% to 68%). Lymphoedema diagnosis reduced QoL scores. Sleeve application in the absence of RAVI of > 9% did not improve QoL or symptoms. A composite definition of lymphoedema was developed, comprising a 9% cut-off point for perometer and self-reported considerable swelling. Diagnostic accuracy was ≥ 94% at 6, 12 and 24 months. WS3 – the PLACE (Prevention of Lymphoedema After Clearance of External compression) trial recruited 143 patients, but recruitment was slow and closed early on the advice of the Independent Data Monitoring Committee. A qualitative substudy identified a number of barriers to recruitment.ConclusionsHalf of older patients felt that they influenced decisions about their treatment. No relationship between decision preference being fulfilled and HRQoL in elderly patients diagnosed with cancer occurred, and older age did not predict complications. Primary surgery reduced the hazard of dying of cancer by two-thirds, independent of age, health and tumour characteristics. Women aged ≥ 75 years have reduced odds of receiving chemotherapy. Lymphoedema (along with a BMI of > 30 kg/m2, cigarette smoking and chemotherapy) reduces QoL. Changes in arm volume of > 9% predicted lymphoedema requiring and benefiting from sleeve application. The PLACE trial qualitative work provides a number of insights into problems of recruitment that were specific to this trial (stigma of compression garments) but that are also generalisable to other RCTs.LimitationsBoth WS1 and WS2 were large, multicentre, UK cohort, observational studies. The WS3 PLACE trial has not reported yet but closed with approximately half of the patients originally planned.Future workResearch producing objective measures for sleeve prescription in the NHS is required.Trial registrationCurrent Controlled Trials ISRCTN48880939.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 7, No. 5. See the NIHR Journals Library website for further project information. Additional support for WS1 came from a Breast Cancer Campaign Grant and a NIHR Postdoctoral Fellowship. ImpediMed (Carslbad, CA, USA;www.impedimed.com) provided bioimpedance L-Dex®machines and electrodes for the study and Sigvaris provided the external compression garments free of charge for the (PLACE) trial.
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Affiliation(s)
- Nigel Bundred
- Department of Academic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Julie Morris
- Department of Academic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Clinical Trials Co-ordination Unit, The Christie NHS Foundation Trust, Manchester, UK
| | - Vaughan Keeley
- Department of Palliative Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | - Adrian Bagust
- Management School, University of Liverpool, Liverpool, UK
| | - Philip Foden
- Department of Academic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maria Bramley
- Oncology Research, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Katie Riches
- Department of Palliative Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
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Dhopte P, French SD, Quon JA, Owens H, Bussières A. Guideline implementation in the Canadian chiropractic setting: a pilot cluster randomized controlled trial and parallel study. Chiropr Man Therap 2019; 27:31. [PMID: 31346409 PMCID: PMC6636122 DOI: 10.1186/s12998-019-0253-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Feasibility and pilot studies are recommended prior to embarking on large-scale costly confirmatory trials. The objectives were to determine the feasibility of conducting a cluster randomized controlled trial (C-RCT) to evaluate a complex knowledge translation (KT) intervention to improve the management of people with neck pain, and to identify challenges and potential solutions to conducting a fully powered C-RCT in the chiropractic setting. Methods Pilot C-RCT involving a nationally representative sample of chiropractors and patients. We invited 400 chiropractors and 150 patients to participate. Clinicians were randomized to receive either an online theory-based KT educational and brief action plan (BAP) intervention (intervention group) or a copy of a clinical practice guideline (control group). Study-related challenges were ascertained via mid-study phone interviews and end-of-study feedback questionnaires. Analyses focused on descriptive estimates of likely recruitment, retention, and adherence rates, and documentation of potential barriers. Results In total, 47 chiropractors (12%) agreed to participate and were randomized after resampling. Fifteen withdrew from the study, leaving a total of 32 (8%) participants. Eleven chiropractors in the intervention group completed the webinars and e-learning modules, two partially completed them and three did not register. Participating chiropractors recruited a total of 29 patients. Sixty-three percent (n = 7) of intervention and 56% (n = 10) of control group patients completed all outcome measures at both baseline and 3-months follow-up, attended follow-up visits and performed home exercises. Patients in the intervention group reported significant reductions in pain (mean 1.6, 95% CI 0.26–2.94, P = 0.027) and disability scores (9.8, 95% CI 3.68–15.91, P = 0.033) from baseline to 3-month follow-up. Key barriers to participation reported by chiropractors included lack of time, difficulties in recruiting patients, problems with the administration of study questionnaires, concern that the clinician-patient relationship might be jeopardized, and lack of assistance from office staff. Over half (55%) of the respondents in the intervention group encountered some difficulty registering or completing the educational modules. Conclusion Recruitment of clinicians and patients for a trial of a complex intervention can be challenging, and retention of participants after enrolment may be low. Future trials of this nature likely require multiple recruitment strategies to achieve desired sample sizes. Moreover, time-constraint issues are perceived particularly by clinicians as a major barrier to both study enrolment before, and protocol adherence during, their actual participation in a trial. Trial registration The study was registered at, NCT02483091, on 17th June 2015. Electronic supplementary material The online version of this article (10.1186/s12998-019-0253-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prakash Dhopte
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, Montreal, Quebec H3G 1Y5 Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), 6363 chemin Hudson, bureau 061,Pavillon Lindsay de l'IURDPM, Montréal, QC H3S 1M9 Canada
| | - Simon D French
- 3Department of Chiropractic, Macquarie University, 24/1 Lakeside Rd, Eastwood NSW, 2122 Australia
| | - Jeffrey A Quon
- 4School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada.,5International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, 818 West 10th Avenue, Vancouver, BC Canada.,6Spine Program, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada.,The Cambie Chiropractic Centre, 2786 W 16th Ave suite 101, Vancouver, BC V6K 4M1 Canada
| | - Heather Owens
- 8CISSS Laval-Jewish Rehabilitation Hospital, CRIR-Feil Oberfeld Research Centre, 3205 Place Alton Goldbloom, Laval, Qc H7V 1R2 Canada
| | - André Bussières
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, Montreal, Quebec H3G 1Y5 Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), 6363 chemin Hudson, bureau 061,Pavillon Lindsay de l'IURDPM, Montréal, QC H3S 1M9 Canada.,9Département chiropratique, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, Qc G8Z 4M3 Canada
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Faulkner-Gurstein R, Jones HC, McKevitt C. "Like a nurse but not a nurse": Clinical Research Practitioners and the evolution of the clinical research delivery workforce in the NHS. Health Res Policy Syst 2019; 17:59. [PMID: 31185996 PMCID: PMC6558865 DOI: 10.1186/s12961-019-0462-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical research is increasing across the United Kingdom. Within the context of a shortage of nurses, trusts have struggled to maintain research capacity. In order to meet staffing demands, trusts have increasingly turned to Clinical Research Practitioners (CRPs) to assist in the delivery of clinical research. Initially an ad hoc workforce, the CRP role is being formalised and professionalised. This study is a close examination of the clinical research delivery workforce at one research-intensive acute trust in the United Kingdom, with a focus on the emerging CRP staff group. METHODS The study was conducted in a large inner-city teaching hospital (acute trust) in London, United Kingdom. Data were collected between September and December 2017. Twenty-five staff were interviewed across 11 different directorates. Interviews were semi-structured with an overall focus on research staff backgrounds and roles, as well as their perceptions and experiences of careers in research. The data were managed using NVivo 11 software and analysed thematically. RESULTS CRPs are drawn from a wider pool of educational and employment backgrounds than their nurse colleagues, and actively seek out work in health research. CRPs receive on-the-job training to acquire the competencies that are necessary for them to carry out their work. The CRP role, which began in an ad hoc manner, has become regularised, yet remains to be well defined, which can be a source of frustration for CRPs and those who work with them. CONCLUSIONS The professionalisation of the CRP workforce represents an opportunity for the health research system to employ research workers who possess a range of in-demand skills and to shore up research capacity in the context of the shortage of nurses.
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Affiliation(s)
- Rachel Faulkner-Gurstein
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom.
| | - Helen C Jones
- Research and Development Department, Royal Free London NHS FT, London, United Kingdom
| | - Christopher McKevitt
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
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Beckers LWME, Rameckers EAA, Smeets RJEM, van der Burg JJW, Aarts PBM, Schnackers MLAP, Janssen-Potten YJM. Barriers to recruitment of children with cerebral palsy in a trial of home-based training. Contemp Clin Trials Commun 2019; 15:100371. [PMID: 31198879 PMCID: PMC6556814 DOI: 10.1016/j.conctc.2019.100371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/27/2019] [Accepted: 04/25/2019] [Indexed: 01/28/2023] Open
Abstract
Many trials fail to include the targeted number of participants, causing scientific and ethical problems. The COAD trial of home-based training programs (HBTPs) for children with unilateral cerebral palsy (CP) encountered recruitment problems, even though the parent-delivered home-based approach complies with recent health-care developments in the Netherlands. The current project aimed to identify the barriers to recruitment in the COAD trial. This summative, multidimensional evaluation comprised informal conversational interviews in which stakeholders who had been involved reflected on the factors that impeded successful recruitment of participants into the COAD trial. Barriers to implementation and recruitment were clustered according to the constructs of the Consolidated Framework for Implementation Research (CFIR). Member checking validated the findings. A total of 41 stakeholders contributed to the evaluation. Barriers to the implementation of the HBTPs were identified within every domain of the CFIR (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process). Parent-delivered home-based training was perceived as highly complex and in conflict with the pressures on and the needs of parents. Many parents preferred the alternative center-based group interventions. The involvement of a resonance group was highly valued, and opportunities for further enhancements emerged. Additionally, the importance of research consortia was emphasized. The appropriateness of the RCT as the study design was criticized. The findings of this study are summarized in a tool which provides a dozen directions for the successful recruitment of participants in pediatric rehabilitation research.
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Affiliation(s)
- L W M E Beckers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
| | - E A A Rameckers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands.,Rehabilitation and Physical Therapy, University of Hasselt, Hasselt, Belgium
| | - R J E M Smeets
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,CIR Revalidatie, Location Eindhoven, the Netherlands
| | - J J W van der Burg
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands.,School of Pedagogical and Educational Sciences, Radboud University, Nijmegen, the Netherlands
| | - P B M Aarts
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - M L A P Schnackers
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
| | - Y J M Janssen-Potten
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, the Netherlands
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Team V, Weller CD. Randomised controlled trials as part of clinical care: A seven-step routinisation framework proposal. Int Wound J 2019; 16:442-458. [PMID: 30565877 PMCID: PMC7948918 DOI: 10.1111/iwj.13053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 12/15/2022] Open
Abstract
Evidence translation in wound care relies on the need for evidence generation. Clinical practice may generate evidence only if evidence-generating research projects, such as randomised controlled trials (RCTs), became routinised in clinical settings. The aim of this study was to identify optimal trial-related practices to routinise trial-related activities in Melbourne-located wound clinics as reported by clinicians and researchers. We conducted a secondary analysis of the available data on how to routinise RCTs in clinical care, with a focus on enablers and suggestions provided by the participants during face-to-face and telephone interviews. Data were obtained from a qualitative observational study nested within a randomised, double-blinded, placebo-controlled trial on clinical effectiveness of aspirin as an adjunct to compression therapy in healing chronic venous leg ulcers (ASPiVLU). We developed a seven-step Routinisation of Trials in Clinical Care Framework. These steps include: (1) pre-trial clinical site assessment, (2) optimising pre-recruitment arrangements, (3) developing and updating trial-related skills, (4) embedding RCT recruitment as part of routine clinical care, (5) promoting teamwork and trial-related collaboration, (6) addressing trial-related financial issues, and (7) communicating trial results to clinicians.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
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Should I stay or should I go? A qualitative study exploring participation in a urology clinical trial. Int Urogynecol J 2018; 30:9-16. [PMID: 30328486 PMCID: PMC6514084 DOI: 10.1007/s00192-018-3784-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022]
Abstract
Introduction and hypothesis The aim of this study was to identify modifiable factors to improve recruitment in a urology clinical trial of women with recurrent urinary tract infection (rUTI). An embedded qualitative study was conducted with patients and recruiting clinicians in the first 8 months of the trial. We present a matrix of factors influencing how patients make decisions about trial participation. Methods This was a qualitative study using telephone interviews. When they were first approached about the trial, women were asked to complete an expression of interest form if they wished to be contacted for an interview. Data were analysed thematically. NVivo 10 software (Qualitative data analysis software. 10th ed: QSR International Pty Ltd; 2012) was used as a management tool. Results Thirty patients and 11 clinicians were interviewed. Influences on patient participation included the impact of rUTI on quality of life (QoL), understanding of antibiotic resistance, and previous experiences with antibiotics either positive or negative. Very few women who declined the trial agreed to be interviewed. However, some of those who participated had reservations about it. These included the perceived risk of trying a new treatment, trial length, and the burden of participating. One person interviewed left the trial because of repeated infections and difficulties getting general practitioner appointments. Conclusions A combination of factors worked to influence women to decide to participate, to remain in, or to leave the trial. A better understanding of how these factors interact and work can assist in the recruitment and retention of individual trial participants.
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McCrorie AD, Chen JJ, Weller R, McGlade KJ, Donnelly C. Trial of infographics in Northern Ireland (TINI): Preliminary evaluation and results of a randomized controlled trial comparing infographics with text. COGENT MEDICINE 2018; 5:1483591. [PMID: 29938211 PMCID: PMC6002148 DOI: 10.1080/2331205x.2018.1483591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infographics represent a potential means of improving public knowledge about cancer. However, there is little experimental evidence of their efficacy. This preliminary study investigates whether infographics are superior to text for the communication of information about cancer risk in old age via a three armed randomized controlled trial. Trial involved allocation concealment and block randomization of 30 male participants aged over 50 to receive text information (control) or one of two infographics (interventions). Participants who viewed an infographic were more likely to know the correct association between cancer risk and old age compared with those viewing text information (risk ratio = 3.0, 95% confidence interval 0.82–10.90). Participants had limited understanding of the phrases “cancer incidence” and “cancer prevalence” but good understanding of the phrases “cancer risk factor” and “cancer stage.” Possession of good numerical skills appears to be a key determinant of ability to extract meaning from statistical information provided; regardless of format. Initial results suggest icon array infographics may be more effective communication mediums than text but further study with more participants and an updated infographic is necessary to confirm this finding. Trial registration number: ISRCTN33951209.
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Affiliation(s)
- Alan David McCrorie
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Jingwen Jessica Chen
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Ross Weller
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Kieran John McGlade
- Department of General Practice and Primary Care, Queen's University Belfast, Belfast, United Kingdom
| | - Conan Donnelly
- N. Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
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Wienroth M, Caffrey L, Wolfe C, McKevitt C. Patient-initiated recruitment for clinical research: Evaluation of an outpatient letter research statement. Health Expect 2018; 21:494-500. [PMID: 29164743 PMCID: PMC5867329 DOI: 10.1111/hex.12642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND UK Hospital Trusts are charged with increasing patients' research awareness and willingness to take part in research. This includes implementing strategies to encourage patient-initiated enquiries about participation. OBJECTIVES To evaluate the impact of a research statement inserted in outpatient letters in one clinical service, and to derive suggestions on potential steps towards increasing patient-initiated recruitment. SETTING A medical outpatient clinic of a research-active hospital trust, serving an inner-city multi-ethnic population across two boroughs. METHODS Pre-intervention and post-intervention questionnaires were administered face-to-face to new patients. Questionnaires included closed questions and one open comments section. Data were analysed for frequencies, with thematic coding of open-ended responses. RESULTS The response rates were 87% for the pre-intervention survey and 92% for the post-intervention survey. In the post-intervention survey, 85% of patients did not notice the research statement in the letter. More than half found the statement "a little unclear," whilst one-third considered it "clear." Three-quarters of respondents perceived the statement to be "a little helpful." Only one person enquired about participating in clinical research having read the statement in the outpatient letter. CONCLUSION The analysis suggests that simple, single-solution approaches such as including research statements in outpatient letters are unlikely to be sufficient to significantly facilitate patient-initiated recruitment. Recruitment efforts need to take into consideration the diversity of patient constituencies including the reasons they seek health care, and how patients can meaningfully access information (research literacy).
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Affiliation(s)
- Matthias Wienroth
- School of Population Health & Environmental SciencesFaculty of Life Sciences and MedicineKing's College LondonGuy's CampusLondonUK
- Policy, Ethics and Life Sciences Research CentreNewcastle UniversityNewcastle upon TyneUK
| | - Louise Caffrey
- School of Social Work and Social PolicyCollege GreenTrinity College DublinDublin 2Ireland
| | - Charles Wolfe
- School of Population Health & Environmental SciencesFaculty of Life Sciences and MedicineKing's College LondonGuy's CampusLondonUK
- NIHR Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College LondonLondonUK
| | - Christopher McKevitt
- School of Population Health & Environmental SciencesFaculty of Life Sciences and MedicineKing's College LondonGuy's CampusLondonUK
- NIHR Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College LondonLondonUK
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Kowalski C, Post S, Seufferlein T, Benz SR, Ferencz J, Wesselmann S. Barriers and Facilitating Factors for Research Involvement in Cancer Centers: A Survey of Colorectal Cancer Center Coordinators in Germany, Austria, and Switzerland. Cancer Control 2018; 25:1073274818765475. [PMID: 29592528 PMCID: PMC6852664 DOI: 10.1177/1073274818765475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Improvements in health care depend on research involving health-care providers (HCPs) and health-care organizations (HCOs). Existing research suggests that involvement in research studies is still much lower than it could be. This study investigates factors that may impede or facilitate research involvement. A standardized online questionnaire was used to carry out a survey, in 3 countries, of key informants in colorectal cancer centers that hold certification in accordance with the requirements of the German Cancer Society. A total of 184 individuals responded (response rate 65%). The respondents found it difficult to identify studies suitable for their patients (40% agreement), criticized the small overall number of studies available (48%), and found that many studies are not worthwhile financially (56%). Among respondents who were not involved in studies as the principal investigators (PIs), 66% agreed they lacked the research infrastructure needed and 81% that they did not have enough staff. Among respondents who were involved as PIs, only 22% indicated that their hospital management encouraged them to initiate and conduct clinical trials. Eighty-five percent of the respondents agreed that the general population lacks information about the importance of studies. Five recommendations for health policy makers are derived from these findings for ways of increasing the involvement of HCPs and HCOs in research, and in cancer research in particular.
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Affiliation(s)
| | - Stefan Post
- 2 University Medical Center, Mannheim, Germany
| | | | - Stefan R Benz
- 4 Klinikum Böblingen-Sindelfingen, Böblingen, Germany
| | - Julia Ferencz
- 5 OnkoZert GmbH, Certification Institute of the German Cancer Society, Neu-Ulm, Germany
| | - Simone Wesselmann
- 1 Department for Certification, German Cancer Society, Berlin, Germany
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Leighton PA, Brealey SD, Dias JJ. Interventions to improve retention in a surgical, clinical trial: A pragmatic, stakeholder-driven approach. J Evid Based Med 2018; 11:12-19. [PMID: 29356437 DOI: 10.1111/jebm.12271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/23/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To explore stakeholder perspectives upon participant retention in clinical trials, and to generate strategies to support retention in a surgical, clinical trial. STUDY DESIGN AND SETTING The SWIFFT trial is a multicenter study comparing treatments for the fracture of the waist of the scaphoid bone in adults. Here we report upon a multistage, iterative consultative process with SWIFFT stakeholders, these include workshops with members of the public, with nurses involved in data collection, and with consultant clinicians. Structured discussions were digitally recorded and transcribed, data were handled and analyzed following a framework approach to qualitative data analysis. RESULTS Removing practical barriers were identified as important factors in supporting retention. Stakeholders also identified that (i) how well a study is understood and (ii) how much it is valued are important factors in an individual's willingness to maintain their involvement. A number of strategies resulted from this consultation, these include: in-clinic data collection, co-ordinated clinical and research appointments, a SWIFFT website, and newsletter. CONCLUSION A participatory approach to trial retention might engage all relevant stakeholders in the delivery of a clinical trial, it might also support the generation of specific and contextually relevant solutions to the challenge of participant retention.
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Affiliation(s)
- Paul A Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen D Brealey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joseph J Dias
- Clinical Division of Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Daykin A, Clement C, Gamble C, Kearney A, Blazeby J, Clarke M, Lane JA, Shaw A. 'Recruitment, recruitment, recruitment' - the need for more focus on retention: a qualitative study of five trials. Trials 2018; 19:76. [PMID: 29378618 PMCID: PMC5789584 DOI: 10.1186/s13063-018-2467-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022] Open
Abstract
Background Loss to follow-up (attrition) is a frequent problem in clinical trials and can introduce bias or reduce power. So, understanding retention issues and strategies to address these are important. As part of a multi-method project, this qualitative study aimed to explore retention strategies used by trial teams and factors which may influence strategy adoption. Method A purposive sample of active trials was selected from the UK NIHR HTA portfolio of ongoing trials in 2014/2015. Semi-structured interviews with several trial team members from each trial and supplementary interviews with experienced trial managers explored strategies in collecting clinical outcome data and retaining participants. Interview data were analysed thematically using techniques of constant comparison. Results Twenty-two semi-structured interviews with trial team members including chief investigators, trial managers, nurses and research administrators revealed strategies used to enhance retention. Some were recognised methods and planned from trial outset whilst others were implemented more responsively. Interviewees placed great value on fostering positive relationships with trial participants to enhance retention. However, these strategies took time which was not always appreciated by the wider trial team or funding bodies. The national focus on recruitment targets in networks posed a challenge to staff and was deemed detrimental to retention. The ‘moral compass’ of individual researchers relied on their own beliefs and values and research experience and the factors affected their confidence to pursue participant data during follow-up. Conclusion The role of trial staff and their underlying behaviours influence retention practices and, combined with emphasis on recruitment targets, can be detrimental to motivation and retention activities. There is a need to consider how to train and support trial staff involved in retention practices and recognition of retention from funding bodies and oversight organisations.
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Affiliation(s)
- Anne Daykin
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Medical School, University of Bristol, Bristol, UK. .,Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK. .,Collaboration and innovation in Difficult and Complex randomised controlled Trials In Invasive procedures (ConDuCT II Hub), University of Bristol, Bristol, UK.
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anna Kearney
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jane Blazeby
- Bristol Medical School, University of Bristol, Bristol, UK.,Collaboration and innovation in Difficult and Complex randomised controlled Trials In Invasive procedures (ConDuCT II Hub), University of Bristol, Bristol, UK
| | - Mike Clarke
- Queen's University Belfast, Belfast, Northern Ireland
| | - J Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK.,Collaboration and innovation in Difficult and Complex randomised controlled Trials In Invasive procedures (ConDuCT II Hub), University of Bristol, Bristol, UK
| | - Alison Shaw
- Bristol Medical School, University of Bristol, Bristol, UK
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Huang GD, Bull J, Johnston McKee K, Mahon E, Harper B, Roberts JN. Clinical trials recruitment planning: A proposed framework from the Clinical Trials Transformation Initiative. Contemp Clin Trials 2018; 66:74-79. [PMID: 29330082 DOI: 10.1016/j.cct.2018.01.003] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
Abstract
Patient recruitment is widely recognized as a key determinant of success for clinical trials. Yet a substantial number of trials fail to reach recruitment goals-a situation that has important scientific, financial, ethical, and policy implications. Further, there are important effects on stakeholders who directly contribute to the trial including investigators, sponsors, and study participants. Despite efforts over multiple decades to identify and address barriers, recruitment challenges persist. To advance a more comprehensive approach to trial recruitment, the Clinical Trials Transformation Initiative (CTTI) convened a project team to examine the challenges and to issue actionable, evidence-based recommendations for improving recruitment planning that extend beyond common study-specific strategies. We describe our multi-stakeholder effort to develop a framework that delineates three areas essential to strategic recruitment planning efforts: (1) trial design and protocol development, (2) trial feasibility and site selection, and (3) communication. Our recommendations propose an upstream approach to recruitment planning that has the potential to produce greater impact and reduce downstream barriers. Additionally, we offer tools to help facilitate adoption of the recommendations. We hope that our framework and recommendations will serve as a guide for initial efforts in clinical trial recruitment planning irrespective of disease or intervention focus, provide a common basis for discussions in this area and generate targets for further analysis and continual improvement.
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Affiliation(s)
- Grant D Huang
- Cooperative Studies Program, Office of Research & Development, U.S. Department of Veterans Affairs, 810 Vermont Ave NW, Washington, DC 20420, USA.
| | - Jonca Bull
- PPDi, 929 North Front Street, Wilmington, NC 28401, USA
| | | | - Elizabeth Mahon
- Janssen Research & Development, 700 US Highway 202, Raritan, NJ 08869, USA.
| | - Beth Harper
- Association of Clinical Research Professionals, 99 Canal Center Plaza, Alexandria, VA 22314, USA.
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Kenten C, Martins A, Fern LA, Gibson F, Lea S, Ngwenya N, Whelan JS, Taylor RM. Qualitative study to understand the barriers to recruiting young people with cancer to BRIGHTLIGHT: a national cohort study in England. BMJ Open 2017; 7:e018291. [PMID: 29122799 PMCID: PMC5695486 DOI: 10.1136/bmjopen-2017-018291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES BRIGHTLIGHT is a national evaluation of cancer services for teenagers and young adults in England. Following challenges with recruitment, our aim was to understand more fully healthcare professionals' perspectives of the challenges of recruiting young people to a low-risk observational study, and to provide guidance for future recruitment processes. DESIGN Qualitative. SETTING National Health Service (NHS) hospitals in England. METHODS Semistructured telephone interviews with a convenience sample of 23 healthcare professionals. Participants included principal investigators/other staff recruiting into the BRIGHTLIGHT study. Data were analysed using framework analysis. RESULTS The emergent themes were linked to levels of research organisational management, described using the levels of social network analysis: micro-level (the individual; in this case the target population to be recruited-young people with cancer); meso-level (the organisation; refers to place of recruitment and people responsible for recruitment); and macro-level (the large-scale or global structure; refers to the wider research function of the NHS and associated policies). Study-related issues occurred across all three levels, which were influenced by the context of the study. At the meso-level, professionals' perceptions of young people and communication between professionals generated age/cancer type silos, resulting in recruitment of either children or adults, but not both by the same team, and only in the cancer type the recruiting professional was aligned to. At the macro-level the main barrier was discordant configuration of a research service with a clinical service. CONCLUSIONS This study has identified significant barriers to recruitment mainly at the meso-level and macro-level, which are more challenging for research teams to influence. We suggest that interconnected whole-system changes are required to facilitate the success of interventions designed to improve recruitment. Interventions targeted at study design/management and the micro-level only may be less successful. We offer solutions to be considered by those involved at all levels of research for this population.
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Affiliation(s)
- Charlotte Kenten
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Lea
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
| | - Nothando Ngwenya
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Cancer Division, University College Hospitals NHS Foundation Trust, London, UK
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Harrington L, Van Damme P, Vandermeulen C, Mali S. Recruitment barriers for prophylactic vaccine trials: A study in Belgium. Vaccine 2017; 35:6598-6603. [PMID: 29074202 DOI: 10.1016/j.vaccine.2017.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/18/2022]
Abstract
Recruitment of volunteers is one of the main challenges in clinical trial management, and there is little information about recruitment barriers for preventative vaccine trials. We investigated both the recruitment barriers and recruitment strategies for preventive vaccine trials in Belgium. A 10 min survey was used as well as interviews of staff at all clinical trial sites in Belgium that regularly perform vaccine trials. We observed that there are successful recruitment strategies and few recruitment issues for trials involving healthy adults and those over 65 years old. However, challenges face the recruitment of paediatric populations, pregnant women, patients and the very elderly (over 85 years old). From these results, we identified three priority areas to increase recruitment for prophylactic vaccine trials in Belgium. These are: the lack of public knowledge about infectious diseases; the lack of resources of healthcare professionals to take part in clinical trials; and the burden to potential volunteers to take part in a trial. These were discussed with stakeholders and solutions were proposed.
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Affiliation(s)
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
| | - Corinne Vandermeulen
- Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Stéphanie Mali
- Federal Agency for Medicines and Health Products (FAMHP), Belgium.
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Oduola S, Wykes T, Robotham D, Craig TKJ. What is the impact of research champions on integrating research in mental health clinical practice? A quasiexperimental study in South London, UK. BMJ Open 2017; 7:e016107. [PMID: 28899890 PMCID: PMC5595181 DOI: 10.1136/bmjopen-2017-016107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Key challenges for mental health healthcare professionals to implement research alongside clinical activity have been highlighted, such as insufficient time to apply research skills and lack of support and resources. We examined the impact of employing dedicated staff to promote research in community mental health clinical settings. DESIGN Quasiexperiment before and after study. SETTING South London and Maudsley National Health Service Foundation Trust. PARTICIPANTS 4455 patients receiving care from 15 community mental health teams between 1 December 2013 and 31 December 2014. OUTCOME MEASURES The proportion of patients approached for research participation in clinical services where research champions were present (intervention group), and where research champions were not present (comparison group). RESULTS Patients in the intervention group were nearly six times more likely to be approached for research participation (Adj. OR=5.98; 95% CI 4.96 to 7.22). CONCLUSIONS Investing in staff that promote and drive research in clinical services increases opportunities for patients to hear about and engage in clinical research studies. However, investment needs to move beyond employing short-term staff.
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Affiliation(s)
- Sherifat Oduola
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Til Wykes
- South London and Maudsley NHS Foundation Trust, NIHR Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Dan Robotham
- South London and Maudsley NHS Foundation Trust, NIHR Maudsley Biomedical Research Centre, London, UK
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Tom K J Craig
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, NIHR Maudsley Biomedical Research Centre, London, UK
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50
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Condon DL, Beck D, Kenworthy-Heinige T, Bratcher K, O'Leary M, Asghar A, Willis C, Johnson MR, Huang GD. A cross-cutting approach to enhancing clinical trial site success: The Department of Veterans Affairs' Network of Dedicated Enrollment Sites (NODES) model. Contemp Clin Trials Commun 2017; 6:78-84. [PMID: 29740639 PMCID: PMC5936861 DOI: 10.1016/j.conctc.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/04/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022] Open
Abstract
Background Recruitment into clinical trials remains a key determinant to study completion and success. While various strategies have been proposed, it is unclear how they apply across different populations, diseases, and/or study goals. The ability to effectively overcome challenges may require different approaches that more broadly focus on addressing obstacles among sites that cannot be overcome by individual studies. Methods The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) established the Network of Dedicated Enrollment Sites (NODES) as a consortium of sites to generate systematic site-level solutions to more efficiently recruit in CSP studies. Initial activities identified priorities and developed approaches through team-based efforts. Metrics were also developed to assess overall network performance. Results Network efforts produced several new strategies and best practices for common problems in CSP research. Recruitment strategies included bringing studies to patients and developing data programs using algorithms for finding eligible patients. Efficiency efforts focused on cross-training and standardizing performance reports. Conclusion NODES addressed site challenges in clinical trial recruitment and management by taking an overall approach that looked at the system rather than individual studies. Practices and operational changes were implemented for CSP research related to recruitment, staff training and research methodology. The network activities suggest that team-based development of tools and insights may help better identify targets and increase efficiencies for clinical trials recruitment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research and Development, USA
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