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Weemering DN, Beelen A, Kliest T, van Leeuwen LAG, van den Berg LH, van Eijk RPA. Trial Participation in Neurodegenerative Diseases: Barriers and Facilitators: A Systematic Review and Meta-Analysis. Neurology 2024; 103:e209503. [PMID: 38830181 DOI: 10.1212/wnl.0000000000209503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Clinical trials in neurodegenerative diseases often encounter selective enrollment and under-representation of certain patient populations. This delays drug development and substantially limits the generalizability of clinical trial results. To inform recruitment and retention strategies, and to better understand the generalizability of clinical trial populations, we investigated which factors drive participation. METHODS We reviewed the literature systematically to identify barriers to and facilitators of trial participation in 4 major neurodegenerative disease areas: Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis, and Huntington disease. Inclusion criteria included original research articles published in a peer-reviewed journal and evaluating barriers to and/or facilitators of participation in a clinical trial with a drug therapy (either symptomatic or disease-modifying). The Critical Appraisal Skills Program checklist for qualitative studies was used to assess and ensure the quality of the studies. Qualitative thematic analyses were employed to identify key enablers of trial participation. Subsequently, we pooled quantitative data of each enabler using meta-analytical models. RESULTS Overall, we identified 36 studies, enrolling a cumulative sample size of 5,269 patients, caregivers, and health care professionals. In total, the thematic analysis resulted in 31 unique enablers of trial participation; the key factors were patient-related (own health benefit and altruism), study-related (treatment and study burden), and health care professional-related (information availability and patient-physician relationship). When meta-analyzed across studies, responders reported that the reason to participate was mainly driven by (1) the relationship with clinical staff (70% of the respondents; 95% CI 53%-83%), (2) the availability of study information (67%, 95% CI 38%-87%), and (3) the use or absence of a placebo or sham-control arm (53% 95% CI 32%-72%). There was, however, significant heterogeneity between studies (all p < 0.001). DISCUSSION We have provided a comprehensive list of reasons why patients participate in clinical trials for neurodegenerative diseases. These results may help to increase participation rates, better inform patients, and facilitate patient-centric approaches, thereby potentially reducing selection mechanisms and improving generalizability of trial results.
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Affiliation(s)
- Daphne N Weemering
- From the Department of Neurology (D.N.W., T.K., L.A.G.v.L., L.H.v.d.B., R.P.A.v.E.), Department of Rehabilitation, Physical Therapy Science & Sports (A.B.), and Center of Excellence for Rehabilitation Medicine (A.B.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (A.B.), Utrecht; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Anita Beelen
- From the Department of Neurology (D.N.W., T.K., L.A.G.v.L., L.H.v.d.B., R.P.A.v.E.), Department of Rehabilitation, Physical Therapy Science & Sports (A.B.), and Center of Excellence for Rehabilitation Medicine (A.B.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (A.B.), Utrecht; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Tessa Kliest
- From the Department of Neurology (D.N.W., T.K., L.A.G.v.L., L.H.v.d.B., R.P.A.v.E.), Department of Rehabilitation, Physical Therapy Science & Sports (A.B.), and Center of Excellence for Rehabilitation Medicine (A.B.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (A.B.), Utrecht; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Lucie A G van Leeuwen
- From the Department of Neurology (D.N.W., T.K., L.A.G.v.L., L.H.v.d.B., R.P.A.v.E.), Department of Rehabilitation, Physical Therapy Science & Sports (A.B.), and Center of Excellence for Rehabilitation Medicine (A.B.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (A.B.), Utrecht; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology (D.N.W., T.K., L.A.G.v.L., L.H.v.d.B., R.P.A.v.E.), Department of Rehabilitation, Physical Therapy Science & Sports (A.B.), and Center of Excellence for Rehabilitation Medicine (A.B.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (A.B.), Utrecht; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Ruben P A van Eijk
- From the Department of Neurology (D.N.W., T.K., L.A.G.v.L., L.H.v.d.B., R.P.A.v.E.), Department of Rehabilitation, Physical Therapy Science & Sports (A.B.), and Center of Excellence for Rehabilitation Medicine (A.B.), UMC Utrecht Brain Center, University Medical Center Utrecht; De Hoogstraat Rehabilitation (A.B.), Utrecht; and Biostatistics & Research Support (R.P.A.v.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
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Ling J, Ordway MR, Zhang N. Baseline higher hair cortisol moderated some effects in a healthy lifestyle intervention. Psychoneuroendocrinology 2024; 165:107058. [PMID: 38636353 PMCID: PMC11139563 DOI: 10.1016/j.psyneuen.2024.107058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
Children and families from socioeconomically marginalized background experience high levels of stress, especially persistent chronic stress, due to unstable housing, employment, and food insecurity. Although consistent evidence supports a stress-obesity connection, little research has examined the potential moderation role of stress in childhood obesity interventions. Therefore, this study aimed to explore how chronic stress (hair cortisol) moderated the effects of a healthy lifestyle intervention on improving behavioral and anthropometric outcomes among 95 socioeconomically marginalized parent-child dyads. Data were collected in a cluster randomized controlled trial with 10 Head Start childcare centers being randomized into intervention and control. The child sample (3-5 years old) included 57.9 % female, 12.6 % Hispanic, and 40.0 % Black. For the parents, 91.6 % were female, 8.4 % were Hispanic, 36.8 % were Black, and 56.8 % were single. Parent baseline hair cortisol significantly moderated the intervention effects on child fruit intake (B = -1.56, p = .030) and parent nutrition self-efficacy (B = 1.49, p = .027). Specifically, higher parent hair cortisol lowered the increases in child fruit intake but improved the increases in parent nutrition self-efficacy in the intervention group compared to control group. Child higher baseline hair cortisol was significantly associated with the decreases in child fruit intake (B = -0.60, p = .025). Child baseline hair cortisol significantly moderated the intervention effects on parent physical activity (PA) self-efficacy (B = -1.04, p = .033) and PA parental support (B = -0.50, p = .016), with higher child hair cortisol decreasing the improvement on these two outcomes in the intervention group compared to control group. Results from this study shed lights on the moderation role of chronic stress on impacting healthy lifestyle intervention effects. Although needing further investigation, the adverse effects of chronic stress on intervention outcomes should be considered when developing healthy lifestyle interventions for preschoolers and their families.
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Affiliation(s)
- Jiying Ling
- Michigan State University College of Nursing, 1355 Bogue St., C241, East Lansing, MI 48824, USA.
| | - Monica R Ordway
- Yale School of Nursing, 400 West Campus Dr., West Haven, CT 06516, USA
| | - Nanhua Zhang
- University of Cincinnati College of Medicine, Department of Pediatrics; Cincinnati Children's Hospital Medical Center, Division of Biostatistics & Epidemiology, Cincinnati, OH 45229, USA
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Thallner R, Gumbinger C, Hohmann A, Wick A, Wick W, Busetto L. Patient, Relative and Staff Experiences of Clinical Trial Participation in Neurooncology: "Maybe You Can Also Show the Positive, No Matter How It Ends". Cancer Manag Res 2024; 16:663-676. [PMID: 38919873 PMCID: PMC11197948 DOI: 10.2147/cmar.s447407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Purpose There is a lack of evidence regarding how patients with malignant brain tumor and their relatives experience participation in neurooncological clinical trials. Similarly, insights from the perspective of trial staff caring for this group of patients are missing. This study aims to investigate patient, relative and trial staff experiences regarding participation in clinical neurooncological trials. Methods Within a qualitative exploratory study, 29 semi-structured interviews with brain tumor patients, relatives and trial staff were conducted and analyzed using reflexive thematic analysis (RTA) by Braun and Clarke. A patient researcher and patient council were involved in data analysis and interpretation. Results Four themes were developed reflecting significant aspects of the trial experience: 1. "It all revolves around hope"; 2. "Trial participation: experiencing unique medical care"; 3. "Everyone's roles are changing"; 4. "Communication as a possible area of conflict". Experiencing trial participation and general medical treatment were found to be interconnected to such a degree that they were often not meaningfully distinguished by patients and relatives. Conclusion In addition to assessing traditional endpoints for patient outcomes, we recommend increased emphasis on investigating the impact of the "soft" components constituting trial participation. Due to the interconnectedness of medical treatment and trial participation, we recommend further investigation in comparison to experiences in regular care. A deeper understanding of trial participation is needed to inform improvements for patient experiences and staff satisfaction alongside medical and scientific progress.
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Affiliation(s)
- Ronja Thallner
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Gumbinger
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anja Hohmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Antje Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Loraine Busetto
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Medical Virology, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
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Kelley AT, Incze MA, Baumgartner M, Campbell ANC, Nunes EV, Scharfstein DO. Predictors of urine toxicology and other biologic specimen missingness in randomized trials of substance use disorders. Drug Alcohol Depend 2024; 261:111368. [PMID: 38896944 DOI: 10.1016/j.drugalcdep.2024.111368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/08/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND High levels of missing outcome data for biologically confirmed substance use (BCSU) threaten the validity of substance use disorder (SUD) clinical trials. Underlying attributes of clinical trials could explain BCSU missingness and identify targets for improved trial design. METHODS We reviewed 21 clinical trials funded by the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) and published from 2005 to 2018 that examined pharmacologic and psychosocial interventions for SUD. We used configurational analysis-a Boolean algebra approach that identifies an attribute or combination of attributes predictive of an outcome-to identify trial design features and participant characteristics associated with high levels of BCSU missingness. Associations were identified by configuration complexity, consistency, coverage, and robustness. We limited results using a consistency threshold of 0.75 and summarized model fit using the product of consistency and coverage. RESULTS For trial design features, the final solution consisted of two pathways: psychosocial treatment as a trial intervention OR larger trial arm size (complexity=2, consistency=0.79, coverage=0.93, robustness score=0.71). For participant characteristics, the final solution consisted of two pathways: interventions targeting individuals with poly- or nonspecific substance use OR younger age (complexity=2, consistency=0.75, coverage=0.86, robustness score=1.00). CONCLUSIONS Psychosocial treatments, larger trial arm size, interventions targeting individuals with poly- or nonspecific substance use, and younger age among trial participants were predictive of missing BCSU data in SUD clinical trials. Interventions to mitigate missing data that focus on these attributes may reduce threats to validity and improve utility of SUD clinical trials.
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Affiliation(s)
- A Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Vulnerable Veteran Patient-Aligned Care Team, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Michael A Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Greater Intermountain Node, National Institute on Drug Abuse Clinical Trial Network, Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Aimee N C Campbell
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Edward V Nunes
- New York State Psychiatric Institute, Division on Substance Use Disorders, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel O Scharfstein
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
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Stinissen L, Bouma S, Böhm J, van Tienen J, Fischer H, Hughes Z, Lennox A, Ward E, Wood M, Foley AR, Oortwijn W, Jungbluth H, Voermans NC. The experience of clinical study and trial participation in rare diseases: A scoping review of centronuclear myopathy and other neuromuscular disorders. Neuromuscul Disord 2024; 38:1-7. [PMID: 38290938 DOI: 10.1016/j.nmd.2023.12.014] [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: 05/24/2023] [Revised: 11/09/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024]
Abstract
The design of a clinical trial for a rare disease can be challenging. An optimal study design is required to effectively study the clinical outcomes for possible therapies for these types of disorders. Understanding the study participants' experiences as well as barriers and facilitators of participation are important to optimize future research and to inform clinical trial management. Centronuclear myopathies (CNMs) including X-linked myotubular myopathy (XLMTM) are a group of rare congenital myopathies for which there is no cure currently. Since 2014, a number of natural history studies and clinical trials have been conducted in CNMs. Two trials have been prematurely terminated because of severe adverse events. Since no research has been conducted regarding trial experience in CNM, we performed a scoping literature research on clinical trial experience of patients with neuromuscular disorders in general. The most common barriers to trial participation of patients comprise concerns about potential harmful effects, opportunity loss and the expected burden on daily life. The most common facilitators were an expected benefit on the disease course, altruism and collateral benefit. While several results are in line with trial experiences of other types of patients, for example oncological patients, distinctions can be made for patients with CNM and other neuromuscular disorders. However, the limited availability of relevant literature suggests that future (qualitative) research should focus on trial experiences in CNM patients.
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Affiliation(s)
- Lizan Stinissen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Sietse Bouma
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Johann Böhm
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U 1258, CNRS UMR 7104, Université de Strasbourg, Illkirch, France
| | | | | | | | | | | | | | - A Reghan Foley
- Neuromuscular & Neurogenetic Diseases of Childhood, Neurogenetics Branch (NGB), NIH, USA
| | - Wija Oortwijn
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College, London, United Kingdom
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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Shankar M, Hazfiarini A, Zahroh RI, Vogel JP, McDougall ARA, Condron P, Goudar SS, Pujar YV, Somannavar MS, Charantimath U, Ammerdorffer A, Rushwan S, Gülmezoglu AM, Bohren MA. Factors influencing the participation of pregnant and lactating women in clinical trials: A mixed-methods systematic review. PLoS Med 2024; 21:e1004405. [PMID: 38814991 PMCID: PMC11139290 DOI: 10.1371/journal.pmed.1004405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Poor representation of pregnant and lactating women and people in clinical trials has marginalised their health concerns and denied the maternal-fetal/infant dyad benefits of innovation in therapeutic research and development. This mixed-methods systematic review synthesised factors affecting the participation of pregnant and lactating women in clinical trials, across all levels of the research ecosystem. METHODS AND FINDINGS We searched 8 databases from inception to 14 February 2024 to identify qualitative, quantitative, and mixed-methods studies that described factors affecting participation of pregnant and lactating women in vaccine and therapeutic clinical trials in any setting. We used thematic synthesis to analyse the qualitative literature and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. We compared quantitative data against the thematic synthesis findings to assess areas of convergence or divergence. We mapped review findings to the Theoretical Domains Framework (TDF) and Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to inform future development of behaviour change strategies. We included 60 papers from 27 countries. We grouped 24 review findings under 5 overarching themes: (a) interplay between perceived risks and benefits of participation in women's decision-making; (b) engagement between women and the medical and research ecosystems; (c) gender norms and decision-making autonomy; (d) factors affecting clinical trial recruitment; and (e) upstream factors in the research ecosystem. Women's willingness to participate in trials was affected by: perceived risk of the health condition weighed against an intervention's risks and benefits, therapeutic optimism, intervention acceptability, expectations of receiving higher quality care in a trial, altruistic motivations, intimate relationship dynamics, and power and trust in medicine and research. Health workers supported women's participation in trials when they perceived clinical equipoise, had hope for novel therapeutic applications, and were convinced an intervention was safe. For research staff, developing reciprocal relationships with health workers, having access to resources for trial implementation, ensuring the trial was visible to potential participants and health workers, implementing a woman-centred approach when communicating with potential participants, and emotional orientations towards the trial were factors perceived to affect recruitment. For study investigators and ethics committees, the complexities and subjectivities in risk assessments and trial design, and limited funding of such trials contributed to their reluctance in leading and approving such trials. All included studies focused on factors affecting participation of cisgender pregnant women in clinical trials; future research should consider other pregnancy-capable populations, including transgender and nonbinary people. CONCLUSIONS This systematic review highlights diverse factors across multiple levels and stakeholders affecting the participation of pregnant and lactating women in clinical trials. By linking identified factors to frameworks of behaviour change, we have developed theoretically informed strategies that can help optimise pregnant and lactating women's engagement, participation, and trust in such trials.
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Affiliation(s)
- Mridula Shankar
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Alya Hazfiarini
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rana Islamiah Zahroh
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Annie R. A. McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Patrick Condron
- University Library, University of Melbourne, Carlton, Victoria, Australia
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Manjunath S. Somannavar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Umesh Charantimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | - Sara Rushwan
- Concept Foundation, Geneva, Switzerland/Bangkok, Thailand
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Symons T, Woollett A, Zalcberg J, Eckstein L. Implementing Decentralized Clinical Trials in Australia through Teletrials: Where to From Here? Ther Innov Regul Sci 2024:10.1007/s43441-024-00658-x. [PMID: 38683418 DOI: 10.1007/s43441-024-00658-x] [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: 01/18/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
Implementation of decentralized approaches can improve access to clinical trials. The Australian government has focused on a teletrial model, which resources and upskills health care organisations to enable collaboration in trials to extend to rural and remote areas. This commentary describes the Australian teletrial model, its context within the established DCT model, its value, and likely challenges moving forward.
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Affiliation(s)
- Tanya Symons
- T Symons Associates Pty Ltd, Sydney, NSW, Australia.
| | | | - John Zalcberg
- Cancer Research Program, School of Public Health, Monash University, Clayton, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, Australia
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Garrity K, Krzyzanowski Guerra K, Hart H, Al-Muhanna K, Kunkler EC, Braun A, Poppe KI, Johnson K, Lazor E, Liu Y, Garner JA. Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review. Adv Nutr 2024; 15:100156. [PMID: 38616069 PMCID: PMC11031423 DOI: 10.1016/j.advnut.2023.100156] [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: 07/08/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 04/16/2024] Open
Abstract
Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000-2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescription programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532.
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Affiliation(s)
- Katharine Garrity
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | | | - Hannah Hart
- College of Public Health, The Ohio State University
| | - Khawlah Al-Muhanna
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emily C Kunkler
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Ashlea Braun
- Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University
| | | | - Kara Johnson
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emma Lazor
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Yang Liu
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Jennifer A Garner
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University; John Glenn College of Public Affairs, The Ohio State University.
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Jordan ES, Grover PL, Lin J, Starkey CA, Finley EA, Ni H, Hershberger RE. The DCM Project Portal: A direct-to-participant platform of The DCM Research Project. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 38:100356. [PMID: 38348286 PMCID: PMC10861184 DOI: 10.1016/j.ahjo.2023.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Study objective To develop a digital platform to conduct family-based, dilated cardiomyopathy (DCM) genetic research. Design The DCM Project Portal, a direct-to-participant electronic recruitment, consent, and communication tool, was designed using prior experience with traditional enrollment methods and characteristics and feedback of current participants. Participants DCM patients (probands) and their family members enrolled from June 7, 2016 to March 15, 2020 at 25 US advanced heart failure programs. Results The portal was designed as a self-guided, three module (registration, eligibility, and consent) process with supporting informational and messaging resources integrated throughout. The experience is tailored to user type and the format adaptable with programmatic growth. Characteristics of participants of the recently completed DCM Precision Medicine Study were assessed as an exemplary user population. A majority of the diverse (34 % non-Hispanic Black (NHE-B), 9.1 % Hispanic; 53.6 % female) proband (n = 1223) and family member (n = 1781) participants aged ≥18 years reported not at all or rarely having problems learning about their health from written information (81 %) and a high confidence in completing medical forms (77.2 % very much or often confident), supporting a self-guided model. A majority of participants across age and race-ethnicity groups reported internet access, with highest rates of no reported access in those ≥77 years (31.9 %), NHE-B (25.2 %), and Hispanic (22.9 %), a similar pattern to those reported by the US Census Bureau as of 2021. Conclusions The portal is an example of a digital approach to family-based genetic research that offers opportunity to improve access and efficiency of research operations.
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Affiliation(s)
- Elizabeth S. Jordan
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Phoenix L. Grover
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Jay Lin
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Carl A. Starkey
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Elizabeth A. Finley
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Hanyu Ni
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Ray E. Hershberger
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States of America
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States of America
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10
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van Rijssel TI, van Thiel GJMW, Gardarsdottir H, van Delden JJM. Which Benefits Can Justify Risks in Research? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-11. [PMID: 38181217 DOI: 10.1080/15265161.2023.2296404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs.
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11
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Alhajahjeh A, Hmeidan M, Elatrsh M, Al-Abbadi F, Kakish D, Sukerji R, Salah M, Al Awamlh BAH, Lee DI, Shahait M. Understanding the Termination of Urologic Cancer Clinical Trials: Insights and Challenges. JCO Glob Oncol 2024; 10:e2300349. [PMID: 38207249 DOI: 10.1200/go.23.00349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Clinical trials are valuable evidence for managing urologic malignancies. Early termination of clinical trials is associated with a waste of resources and may substantially affect patient care. We sought to study the termination rate of urologic cancer clinical trials and identify factors associated with trial termination. METHODS A cross-sectional search of ClinicalTrials.gov identified completed and terminated kidney, prostate, and bladder cancer clinical trials started. Trials were assessed for reasons for termination. Multivariable analyses were conducted to determine the significant factors associated with the termination. RESULTS Between 2000 and 2020, 9,145 oncology clinical trials were conducted, of which 11.30% (n = 1,033) were urologic cancer clinical trials. Of the urologic cancer clinical trials, 25.38% (n = 265) were terminated, with low patient accrual being the most common reason for termination, 52.9% (n = 127). Multivariable analysis showed that only the university funding source odds ratio (OR) of 2.20 (95% CI, 1.45 to 3.32), single-center studies OR of 2.11 (95% CI, 1.59 to 2.81), and sample size of <50 were significant predictors of clinical trial termination OR of 5.26 (95% CI, 3.85 to 7.69); all P values are <.001. CONCLUSION The termination rate of urologic cancer clinical trials was 25%, with low accrual being the most frequently reported reason. Trials funded by a university, single-center trials, and small trials (sample size <50) were associated with early termination. A better understanding of these factors might help researchers, funding agencies, and other stakeholders prioritize resource allocations for multicenter trials that aim to recruit a sufficient number of patients.
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Affiliation(s)
- Abdulrahman Alhajahjeh
- Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Department of Internal Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
- School of Medicine, University of Jordan, Amman, Jordan
| | | | | | | | - Diala Kakish
- School of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | | | - David I Lee
- Department of Urology, University of California, Irvine, CA
| | - Mohammed Shahait
- Department of Urology, Clemenceau Medical Center, Dubai, UAE
- School of Medicine, University of Sharjah, Sharjah, UAE
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12
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Durán CO, Bonam M, Björk E, Hughes R, Ghiorghiu S, Massacesi C, Campbell A, Hutchison E, Pangalos MN, Galbraith S. Implementation of digital health technology in clinical trials: the 6R framework. Nat Med 2023; 29:2693-2697. [PMID: 37587220 DOI: 10.1038/s41591-023-02489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | - Matthew Bonam
- Digital Health Research and Development, AstraZeneca PLC, Cambridge, UK
| | - Elisabeth Björk
- Cardiovascular, Renal and Metabolism Biopharmaceuticals R&D, AstraZeneca PLC, Gothenburg, UK
| | - Rod Hughes
- Research and Early Development, Respiratory and Immunology, AstraZeneca PLC, Cambridge, UK
| | | | | | - Alicyn Campbell
- Digital Health Oncology Research and Development, AstraZeneca PLC, San Francisco, CA, USA
| | | | - Menelas N Pangalos
- Biophamaceuticals Research and Development, AstraZeneca PLC, Cambridge, UK
| | - Susan Galbraith
- Oncology Research and Development, AstraZeneca PLC, Gaithersburg, MD, USA
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13
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Kamisato A, Hong H, Okubo S. Public Awareness of Medical Research Terminology in Japan, and the Accuracy of Physicians' Predictions regarding that Awareness. Asian Bioeth Rev 2023; 15:397-416. [PMID: 37808447 PMCID: PMC10555973 DOI: 10.1007/s41649-023-00247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/31/2023] Open
Abstract
One of the ethical principles of medical research involving human subjects is obtaining proper informed consent (IC). However, if the participants' actual awareness of medical research terminology is lower than the researchers' prediction of that awareness, it may cause difficulty obtaining proper IC. Therefore, this study aims to clarify the presence of "perception gaps" and then discuss IC-related issues and measures based on the insights obtained. We conducted two online surveys: a "public survey" to understand the Japanese public's awareness of 11 medical research terms and a "physicians' survey" to investigate physicians' predictions regarding public awareness. In the "public survey," for each term, respondents were instructed to select their situation from "understand," "have heard," or "have never heard." In the "physicians' survey," respondents were asked to estimate the proportions of the general public who would "have understood," "have heard," or "have never heard" by using an 11-step scale. We analyzed separately in two age groups to understand the age-related difference. We received 1002 valid responses for the "public survey" and 275 for the "physicians' survey." Of the public respondents, more than 80% had never heard of terms such as interventional study, prospective clinical study, cohort study, Phase I clinical trial, or double-blind study. Concurrently, physicians overestimated general public awareness of the terms placebo, cohort study, double-blind study, and randomized clinical trial (in the group of people under 60). The results revealed the perception gap between the general public and physicians which raise serious concerns about obtaining proper IC from clinical research participants. Supplementary Information The online version contains supplementary material available at 10.1007/s41649-023-00247-4.
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Affiliation(s)
- Ayako Kamisato
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hyunsoo Hong
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Suguru Okubo
- Ritsumeikan University, Kyoto, Japan
- BMS Yokohama Inc., Yokohama, Kanagawa Japan
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14
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Ying X, Ehrhardt S. Pilot Trial Characteristics, Postpilot Design Modifications, and Feasibility of Full-Scale Trials. JAMA Netw Open 2023; 6:e2333642. [PMID: 37707813 PMCID: PMC10502523 DOI: 10.1001/jamanetworkopen.2023.33642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/05/2023] [Indexed: 09/15/2023] Open
Abstract
Importance Pilot trials often lead to study design changes in subsequent full-scale trials. Yet, it remains unclear whether these modifications improve the feasibility of the larger trial. Objective To compare feasibility estimates between pilot and full-scale trials and identify pilot trial characteristics and modifications associated with equivalent or improved feasibility in the full-scale trial. Design, Setting, and Participants This cohort study used pilot trials published between January 2005 and December 2018 and their corresponding full-scale trials. PubMed was searched for trials on February 19, 2022. Exposures Pilot trial characteristics and postpilot trial design modifications. Main Outcomes and Measures The outcome of interest was difference in 3 feasibility parameters: successful screening probability, enrollment rate, and retention probability. These metrics were defined as equivalent or improved if the full-scale trial's estimate was within or exceeding 10% of the pilot trial's estimate. Results A total of 249 pairs of pilot and full-scale trials were analyzed, with 43%, 77%, and 82% of full-scale trials having equivalent or improved successful screening probabilities, enrollment rates, and retention probabilities, respectively. When pilot trials used feasibility progression criteria (relative risk [RR], 1.94; 95% CI, 1.02-5.97) and maintained masking for participants (RR, 1.82; 95% CI, 1.04-4.33) or health care practitioners (RR, 1.81; 95% CI, 1.03-3.97) consistent with the full-scale trial, the likelihood of achieving equivalent or improved screening success in full-scale trials increased. Increasing study sites after the pilot was associated with higher likelihood of equivalent or improved enrollment rates (RR, 1.03; 95% CI, 1.01-1.08). Adding extra content to the intervention (RR, 0.82; 95% CI, 0.66-0.98), changing to active control (RR, 0.74; 95% CI, 0.48-0.99), administrating the control treatment more frequently (RR, 0.60; 95% CI, 0.29-0.93), different follow-up lengths (RR, 0.85; 95% CI, 0.73-0.97), and more follow-up visits (RR, 0.86; 95% CI, 0.75-0.98) were associated with lower likelihood of equivalent or improved retention probability in the full-scale trial. Conclusions and relevance In this cohort study of pilot and full-scale trial pairs, pilot trial characteristics and postpilot modifications had varying associations with full-scale trial's feasibility. If full-scale trials planned for masking, it was desirable to use it in the pilot. Modifications increasing participant burden might decrease full-scale trial feasibility. Trialists and funders should consider both pilot trial data and proposed design changes when assessing full-scale trials.
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Affiliation(s)
- Xiangji Ying
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephan Ehrhardt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Meskell P, Biesty LM, Dowling M, Roche K, Meehan E, Glenton C, Devane D, Shepperd S, Booth A, Cox R, Chan XHS, Houghton C. Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 9:MR000065. [PMID: 37655964 PMCID: PMC10472890 DOI: 10.1002/14651858.mr000065.pub2] [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] [Indexed: 09/02/2023]
Abstract
BACKGROUND The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.
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Affiliation(s)
- Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | | | - Elaine Meehan
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, ScHARR, Sheffield, UK
| | - Rebecca Cox
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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Menon U, Gentry-Maharaj A, Burnell M, Apostolidou S, Ryan A, Kalsi JK, Singh N, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Dawnay A, Parmar M, Jacobs IJ. Insights from UKCTOCS for design, conduct and analyses of large randomised controlled trials. Health Technol Assess 2023:1-38. [PMID: 37843101 PMCID: PMC10591208 DOI: 10.3310/cldc7214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Abstract Randomised controlled trials are challenging to deliver. There is a constant need to review and refine recruitment and implementation strategies if they are to be completed on time and within budget. We present the strategies adopted in the United Kingdom Collaborative Trial of Ovarian Cancer Screening, one of the largest individually randomised controlled trials in the world. The trial recruited over 202,000 women (2001-5) and delivered over 670,000 annual screens (2001-11) and over 3 million women-years of follow-up (2001-20). Key to the successful completion were the involvement of senior investigators in the day-to-day running of the trial, proactive trial management and willingness to innovate and use technology. Our underlying ethos was that trial participants should always be at the centre of all our processes. We ensured that they were able to contact either the site or the coordinating centre teams for clarifications about their results, for follow-up and for rescheduling of appointments. To facilitate this, we shared personal identifiers (with consent) with both teams and had dedicated reception staff at both site and coordinating centre. Key aspects were a comprehensive online trial management system which included an electronic data capture system (resulting in an almost paperless trial), biobanking, monitoring and project management modules. The automation of algorithms (to ascertain eligibility and classify results and ensuing actions) and processes (scheduling of appointments, printing of letters, etc.) ensured the protocol was closely followed and timelines were met. Significant engagement with participants ensured retention and low rates of complaints. Our solutions to the design, conduct and analyses issues we faced are highly relevant, given the renewed focus on trials for early detection of cancer. Future work There is a pressing need to increase the evidence base to support decision making about all aspects of trial methodology. Trial registration ISRCTN-22488978; ClinicalTrials.gov-NCT00058032. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/46/01. The long-term follow-up UKCTOCS (2015 20) was supported by National Institute for Health and Care Research (NIHR HTA grant 16/46/01), Cancer Research UK, and The Eve Appeal. UKCTOCS (2001-14) was funded by the MRC (G9901012 and G0801228), Cancer Research UK (C1479/A2884), and the UK Department of Health, with additional support from The Eve Appeal. Researchers at UCL were supported by the NIHR UCL Hospitals Biomedical Research Centre and by the MRC Clinical Trials Unit at UCL core funding (MC_UU_00004/09, MC_UU_00004/08, MC_UU_00004/07). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health and Social Care.
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Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Sophia Apostolidou
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jatinderpal K Kalsi
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian J Jacobs
- Department of Women's Cancer, Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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17
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Garner JA, Hanson KL, Jilcott Pitts SB, Kolodinsky J, Sitaker MH, Ammerman AS, Kenkel D, Seguin-Fowler RA. Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families. Int J Behav Nutr Phys Act 2023; 20:84. [PMID: 37430305 DOI: 10.1186/s12966-023-01481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The food system has a dynamic influence on disparities in food security and diet-related chronic disease. Community supported agriculture (CSA) programs, in which households receive weekly shares of produce from a local farmer during the growing season, have been examined as a possible food systems-based approach for improving diet and health outcomes. The purpose of this study was to estimate the cost of implementing and participating in a multi-component subsidized community supported agriculture intervention and calculate cost-effectiveness based on diet and food security impacts. METHODS Using data from the Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (n = 305; 2016-2018), we estimated programmatic and participant costs and calculated incremental cost-effectiveness ratios (ICERs) for caregivers' daily fruit and vegetable (FV) intake, skin carotenoids, and household food security from program and societal perspectives. RESULTS F3HK cost $2,439 per household annually ($1,884 in implementation-related expenses and $555 in participant-incurred costs). ICERs ranged from $1,507 to $2,439 per cup increase in caregiver's FV intake (depending on perspective, setting, and inclusion of juice); from $502 to $739 per one thousand unit increase in skin carotenoid score; and from $2,271 to $3,137 per household shifted out of food insecurity. CONCLUSIONS Given the known public health, healthcare, and economic consequences of insufficient FV intake and living in a food insecure household, the costs incurred to support these positive shifts in individual- and household-level outcomes via a F3HK-like intervention may be deemed by stakeholders as a reasonable investment. This work helps to advance a critical body of literature on the cost-effectiveness of subsidized CSAs and other economic and food system interventions for the sake of evidence-based allocation of public health resources. TRIAL REGISTRATION ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. https://www. CLINICALTRIALS gov/ct2/show/NCT02770196 .
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Affiliation(s)
- Jennifer A Garner
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - Karla L Hanson
- Master of Public Health Program, Cornell University, Ithaca, NY, USA
| | - Stephanie B Jilcott Pitts
- Brody School of Medicine, Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Marilyn H Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, Olympia, WA, USA
| | - Alice S Ammerman
- Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald Kenkel
- Cornell Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
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18
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Dibley L, Hart A, Duncan J, Knowles CH, Kerry S, Lanz D, Berdunov V, Madurasinghe VW, Wade T, Terry H, Verjee A, Fader M, Norton C. Supported Intervention Versus Intervention Alone for Management of Fecal Incontinence in Patients With Inflammatory Bowel Disease: A Multicenter Mixed-Methods Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2023; 50:235-244. [PMID: 37146115 DOI: 10.1097/won.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The aims of this study were to test a noninvasive self-management intervention supported by specialist nurses versus intervention alone in patients with inflammatory bowel disease (IBD) experiencing fecal incontinence and to conduct a qualitative evaluation of the trial. DESIGN Multicenter, parallel-group, open-label, mixed-methods randomized controlled trial (RCT). SUBJECTS AND SETTING The sample comprised patients from a preceding case-finding study who reported fecal incontinence and met study requirements; the RCT was delivered via IBD outpatient clinics in 6 hospitals (5 in major UK cities, 1 rural) between September 2015 and August 2017. Sixteen participants and 11 staff members were interviewed for qualitative evaluation. METHODS Adults with IBD completed the study activities over a 3-month period following randomization. Each participant received either four 30-minute structured sessions with an IBD clinical nurse specialist and a self-management booklet or the booklet alone. Low retention numbers precluded statistical analysis; individual face-to-face or telephone interviews, recorded digitally and transcribed professionally, were conducted to evaluate the RCT. Transcripts were analyzed thematically using an inductive method. RESULTS Sixty-seven participants (36%) of the targeted 186 participants were recruited. The groups comprised 32 participants (17% of targeted participants) allocated to the nurse + booklet intervention and 35 (18.8% of targeted participants) allocated to the booklet alone. Less than one-third (n = 21, 31.3%) completed the study. Given the low recruitment and high attrition, statistical analysis of quantitative data was considered futile. Participant interviews were conducted concerning study participation and 4 themes emerged that described experiences of patients and staff. These data provided insights into reasons for low recruitment and high attrition, as well as challenges of delivering resource-heavy studies in busy health service environments. CONCLUSIONS Alternative approaches to trials of nurse-led interventions in hospital settings are needed as many interfering factors may prevent successful completion.
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Affiliation(s)
- Lesley Dibley
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Ailsa Hart
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Julie Duncan
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Charles H Knowles
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Sally Kerry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Doris Lanz
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vladislav Berdunov
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Vichithranie W Madurasinghe
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Tiffany Wade
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Helen Terry
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Azmina Verjee
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Mandy Fader
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
| | - Christine Norton
- Lesley Dibley, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom; University of Greenwich, London, United Kingdom
- Ailsa Hart, PhD, St Mark's Hospital (IBD Unit), Northwick Park Hospital, Harrow, Middlesex, United Kingdom
- Julie Duncan, MSc, Department of Gastroenterology, St Thomas' NHS Foundation Trust, London, London, United Kingdom; Takeda UK, London, United Kingdom
- Charles H. Knowles, PhD, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
- Sally Kerry, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Doris Lanz, MA, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vladislav Berdunov, PhD, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom
- Vichithranie W. Madurasinghe, MSc, Pragmatic Clinical Trials Unit (PCTU), Institute for Population Health Sciences, Queen Mary University of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom
- Tiffany Wade, MSc, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
- Helen Terry, BA(Hons), Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Azmina Verjee, PGDip, Patient and Public Involvement Team Lead. Crohn's and Colitis UK, Hatfield Business Park, Hatfield, United Kingdom
- Mandy Fader, PhD, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Christine Norton, PhD, Florence Nightingale Faculty of Nursing, Midwifery and Palliative, King's College London, London, United Kingdom
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19
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Baker FA, Blauth L, Bloska J, Bukowska AA, Flynn L, Hsu MH, Janus E, Johansson K, Odell-Miller H, Miller H, Petrowitz C, Pool J, Stensæth K, Tamplin J, Teggelove K, Wosch T, Sousa TV. Recruitment approaches and profiles of consenting family caregivers and people living with dementia: A recruitment study within a trial. Contemp Clin Trials Commun 2023; 32:101079. [PMID: 36949849 PMCID: PMC10025412 DOI: 10.1016/j.conctc.2023.101079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/04/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Background While studies have identified strategies that are useful for recruiting people living with dementia, none have focused on psychosocial interventions involving arts therapies, or have examined the profiles of older people living in the community who consent or decline participation, particularly during a global pandemic. We aimed to identify the most effective recruitment strategies according to participant characteristics and transnational differences and develop a profile of consenting and non-consenting participants. Methods Recruitment teams in Australia, Norway, Germany, Poland, and the United Kingdom, recorded participants' source of study awareness and characteristics of consenting and non-consenting participants. Distributions of participants 'consenting to participate' were compared and logistic regressions were used to estimate the odds ratios. Results Consenting female caregivers were disproportionally represented. Study awareness differed between countries but overall, most expressions of interest to participate were derived from referrals from professionals or organisations, or from databases of people wanting to participate in research. Troughs in recruitment rates occurred during Northern Hemisphere summer vacation periods, and during Christmas periods. Conclusions This study found that recruiting for a trial with community-dwelling family caregivers and people living with dementia is challenging, especially during a global pandemic. While spousal caregivers comprised the highest proportion of dyads recruited, overall spousal caregivers were more reluctant to consent to participate than adult child caregivers. More targeted recruitment strategies designed for minority groups are also needed to ensure broader representation in dementia treatment studies.
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Affiliation(s)
- Felicity A. Baker
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
- Corresponding author. The University of Melbourne, The Conservatorium of Music, Gate 12, Royal Parade, Parkville, Melbourne, Victoria, 3010, Australia.
| | - Laura Blauth
- Hochschule für Angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Germany
| | - Jodie Bloska
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Anna A. Bukowska
- Institute for Applied Science, University of Physical Education, Kraków, Poland
| | - Libby Flynn
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ming-Hung Hsu
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Edyta Janus
- Institute for Applied Science, University of Physical Education, Kraków, Poland
| | - Kjersti Johansson
- Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
| | - Helen Odell-Miller
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Hayley Miller
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carina Petrowitz
- Hochschule für Angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Germany
| | - Jonathan Pool
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
| | - Karette Stensæth
- Centre for Research in Music and Health, Norwegian Academy of Music, Oslo, Norway
| | - Jeanette Tamplin
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Teggelove
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Wosch
- Hochschule für Angewandte Wissenschaften Würzburg-Schweinfurt, Würzburg, Germany
| | - Tanara Vieira Sousa
- Faculty of Fine Arts and Music, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Knowlson C, Tharmanathan P, Arundel C, James S, Flett L, Gascoyne S, Welch C, Warwick D, Dias J. Can learnings from the COVID-19 pandemic improve trial conduct post-pandemic? A case study of strategies used by the DISC trial. RESEARCH METHODS IN MEDICINE & HEALTH SCIENCES 2023; 4:50-60. [PMID: 38603296 PMCID: PMC9500425 DOI: 10.1177/26320843221128296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background RCTs often face issues such as slow recruitment, poor intervention adherence and high attrition, however the 2020/2021 COVID-19 pandemic intensified these challenges. Strategies employed by the DISC trial to overcome pandemic-related barriers to recruitment, treatment delivery and retention may be useful to help overcome routine problems. Methods A structured survey and teleconference with sites was undertaken. Key performance indicators in relation to recruitment, treatment delivery and retention were compared descriptively before and after the pandemic started. This was situated also in relation to qualitative opinions of research staff. Results Prior to the pandemic, retention was 93.6%. Increased support from the central trial management team and remote data collection methods kept retention rates high at 81.2% in the first 6 months of the pandemic, rising to 89.8% in the subsequent 6 months. Advertising the study to patients resulted in 12.8 patients/month enquiring about participation, however only six were referred to recruiting sites. Sites reported increased support from junior doctors resolved research nurse capacity issues. One site avoided long delays by using theatre space in a private hospital. Conclusions Recruitment post-pandemic could be improved by identification of barriers, increased support from junior doctors through the NIHR associate PI scheme and advertising. Remote back-up options for data collection can keep retention high while reducing patient and site burden. To future proof studies against similar disruptions and provide more flexibility for participants, we recommend that RCTs have a back-up option of remote recruitment, a back-up location for surgeries and flexible approaches to collecting data.
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Affiliation(s)
| | | | | | - Sophie James
- Department of Health Sciences, York Trials Unit, York, UK
| | - Lydia Flett
- Department of Health Sciences, York Trials Unit, York, UK
| | | | - Charlie Welch
- Department of Health Sciences, York Trials Unit, York, UK
| | | | - Joseph Dias
- University Hospitals of Leicester NHS Trust, York, UK
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21
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Nwolise C, Corrie P, Fitzpatrick R, Gupta A, Jenkinson C, Middleton M, Matin R. Burden of cancer trial participation: A qualitative sub-study of the INTERIM feasibility RCT. Chronic Illn 2023; 19:81-94. [PMID: 34787471 PMCID: PMC9841458 DOI: 10.1177/17423953211060253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/23/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A qualitative sub-study was carried out within a larger phase II feasibility trial, to identify and describe the burden experienced by advanced melanoma patients participating in a clinical trial and the factors affecting their capacity to cope with the burden. METHODS Semi-structured interviews were conducted with fourteen patients with advanced melanoma recruited from National Health Service hospitals in the United Kingdom. Qualitative analysis was undertaken using a framework analysis approach. Normalisation process theory was applied to the concept of research participation burden in order to interpret and categorise findings. RESULTS Burdens of participation were identified as arising from making sense of the trial and treatment; arranging transport, appointment and prescriptions; enacting management strategies and enduring side effects; reflecting on trial documents and treatment efficacy, and emotional and mental effects of randomisation and treatment side effects. Factors reported as influencing capacity include personal attributes and skills, physical and cognitive abilities and support network. DISCUSSION This is the first study to highlight the substantial burden faced by patients with advanced melanoma in a clinical trial and factors that may lessen or worsen the burden. Consideration of identified burdens during trial design and execution will reduce the burden experienced by research participants.
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Affiliation(s)
- Chidiebere Nwolise
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Applied Research
Collaboration Oxford, Oxford, UK
| | - Pippa Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS
Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Applied Research
Collaboration Oxford, Oxford, UK
| | | | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
| | - Mark Middleton
- University of Oxford Department of
Oncology, Cancer Research UK Oxford
Centre, Oxford, UK
| | - Rubeta Matin
- Dermatology Department, Churchill Hospital, Oxford, UK
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22
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Evidence from ClinicalTrials.gov on the growth of Digital Health Technologies in neurology trials. NPJ Digit Med 2023; 6:23. [PMID: 36765123 PMCID: PMC9918454 DOI: 10.1038/s41746-023-00767-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
Digital Health Technologies (DHTs) such as connected sensors offer particular promise for improving data collection and patient empowerment in neurology research and care. This study analyzed the recent evolution of the use of DHTs in trials registered on ClinicalTrials.gov for four chronic neurological disorders: epilepsy, multiple sclerosis, Alzheimer's, and Parkinson's disease. We document growth in the collection of both more established digital measures (e.g., motor function) and more novel digital measures (e.g., speech) over recent years, highlighting contexts of use and key trends.
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23
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Han A, Yuen HK, Jenkins J. The feasibility and preliminary effects of a pilot randomized controlled trial: Videoconferencing acceptance and commitment therapy in distressed family caregivers of people with dementia. J Health Psychol 2023; 28:554-567. [PMID: 36591636 PMCID: PMC10119897 DOI: 10.1177/13591053221141131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This pilot randomized controlled trial (RCT) examined preliminary effects of an 8-week videoconferencing acceptance and commitment therapy (ACT) program supplemented with psychoeducation materials on distressed family caregivers of persons living with dementia (PLWD) compared to the control group provided with psychoeducation materials only. Nineteen family caregivers of PLWD in the USA were randomly assigned to the ACT group or the control group. Data was collected at pretest, posttest, and 1-month follow-up (F/U). Compared to the control group, the ACT group showed a significantly larger reduction in grief at posttest, with a medium effect size. Small effects of ACT were found in anxiety, psychological quality of life, and engagement in meaningful activities at posttest and grief, engagement in meaningful activities, and psychological flexibility at F/U compared to the control group. These promising findings warrant a full-scale RCT with adequate power to measure the efficacy of videoconferencing ACT for caregivers of PLWD.
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Affiliation(s)
- Areum Han
- University of Alabama at Birmingham, USA
| | - Hon K Yuen
- University of Alabama at Birmingham, USA
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24
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Nathe JM, Oskoui TT, Weiss EM. Parental Views of Facilitators and Barriers to Research Participation: Systematic Review. Pediatrics 2023; 151:e2022058067. [PMID: 36477217 PMCID: PMC9808610 DOI: 10.1542/peds.2022-058067] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Low enrollment within pediatric research increases the cost of research, decreases generalizability, and threatens to exacerbate existing health disparities. To assess barriers and facilitators to pediatric research participation and evaluate differences by enrollment status. METHODS Data Sources include PubMed, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, and Web of Science. Study selection include peer reviewed articles that contained information related to facilitators and barriers to the parental decision whether to enroll their child in research and included the views of parents who declined. We extracted barriers and facilitators to research, enrollment status, and study characteristics, including study design, quality, and patient population. RESULTS Seventy articles were included for analysis. Facilitators of participation included: benefits, trust, support of research, informational and consent related, and relational issues. Common facilitators within those categories included health benefit to child (N = 39), altruism (N = 30), and the importance of research (N = 26). Barriers to participation included: study-related concerns, burdens of participation, lack of trust, general research concerns, informational and consent related, and relational issues. Common barriers within those categories included risks to child (N = 46), burdens of participation (N = 35), and the stress of the decision (N = 29). We had a limited ability to directly compare by enrollment status and no ability to analyze interactions between facilitators and barriers. We only included studies written in English. CONCLUSIONS This review identified key facilitators and barriers to research participation in pediatrics. The findings from this review may guide researchers aiming to create interventions to improve the parental experience of recruitment for pediatric studies and to optimize enrollment rates.
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Affiliation(s)
- Julia M. Nathe
- University of Washington School of Medicine, Seattle, Washington
| | - Tira T. Oskoui
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Elliott Mark Weiss
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
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25
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Paulissen JM, Zegers CM, Nijsten IR, Reiters PH, Houben RM, Eekers DB, Roelofs E. Performance and usability evaluation of a mobile health data capture application in clinical cancer trials follow-up. Tech Innov Patient Support Radiat Oncol 2022; 24:107-112. [PMID: 36387779 PMCID: PMC9641052 DOI: 10.1016/j.tipsro.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 10/26/2022] [Indexed: 11/05/2022] Open
Abstract
A mobile health data capture application can improve quality of data collection in clinical cancer trials. The use of a mobile health data capture application optimizes the efficiency and effectivity of a trial participant’s visit to a clinic. A mobile health data capture application relieves participants from instant recall on possible health changes during visits. The use of a mobile health data capture application helps a healthcare provider in preparing a participant’s visit.
Mobile health data capture applications (mHDA’s) may improve communication between healthcare providers and patients. However, there is limited literature about the use of mHDA’s facilitating clinical trials. In this study, the effectiveness of an application, supporting follow-up visits of cancer trial participants was investigated. Twenty participants were provided with an e-questionnaire via the mHDA. Participants rated the usability of the application as high performing (mean Systems Usability Scale 87 points). The research team rated the mHDA as highly applicable and efficient in preparing visits. Anamnesis, physical examination and agreement on further policy were performed within an average of 31 min.
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26
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Hanlon P, Butterly E, Shah ASV, Hannigan LJ, Wild SH, Guthrie B, Mair FS, Dias S, Welton NJ, McAllister DA. Assessing trial representativeness using serious adverse events: an observational analysis using aggregate and individual-level data from clinical trials and routine healthcare data. BMC Med 2022; 20:410. [PMID: 36303169 PMCID: PMC9615407 DOI: 10.1186/s12916-022-02594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial serious adverse events (SAE) to rates of hospitalisation/death in routine care. METHODS This was an observational analysis of individual (125 trials, n=122,069) and aggregate-level drug trial data (483 trials, n=636,267) for 21 index conditions compared to population-based routine healthcare data (routine care). Trials were identified from ClinicalTrials.gov . Routine care comparison from linked primary care and hospital data from Wales, UK (n=2.3M). Our outcome of interest was SAEs (routinely reported in trials). In routine care, SAEs were based on hospitalisations and deaths (which are SAEs by definition). We compared trial SAEs in trials to expected SAEs based on age/sex standardised routine care populations with the same index condition. Using IPD, we assessed the relationship between multimorbidity count and SAEs in both trials and routine care and assessed the impact on the observed/expected SAE ratio additionally accounting for multimorbidity. RESULTS For 12/21 index conditions, the pooled observed/expected SAE ratio was <1, indicating fewer SAEs in trial participants than in routine care. A further 6/21 had point estimates <1 but the 95% CI included the null. The median pooled estimate of observed/expected SAE ratio was 0.60 (95% CI 0.55-0.64; COPD) and the interquartile range was 0.44 (0.34-0.55; Parkinson's disease) to 0.87 (0.58-1.29; inflammatory bowel disease). Higher multimorbidity count was associated with SAEs across all index conditions in both routine care and trials. For most trials, the observed/expected SAE ratio moved closer to 1 after additionally accounting for multimorbidity count, but it nonetheless remained below 1 for most. CONCLUSIONS Trial participants experience fewer SAEs than expected based on age/sex/condition hospitalisation and death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess the applicability of trial findings to older populations in whom multimorbidity and frailty are common.
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Affiliation(s)
- Peter Hanlon
- School for Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Elaine Butterly
- School for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anoop S V Shah
- London School of Hygiene and Tropical Medicine, London, UK
| | - Laurie J Hannigan
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Frances S Mair
- School for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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27
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Romo-Avilés N, Zapata JF, Keuneke A, Petroff D, Etz CD, Epstein D. "There is nothing better than participating in this study": Living the PAPAartis cardiovascular randomised controlled trial. Contemp Clin Trials Commun 2022; 29:100987. [PMID: 36111175 PMCID: PMC9468490 DOI: 10.1016/j.conctc.2022.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Qualitative research can bring new dimensions of understanding decision-making process in clinical trials. Participating in a randomized clinical trial requires patients to accept complex information and make decisions in a context of uncertainty. It becomes especially complicated in the case of serious diseases in which the treatment itself implies unknown risks. This study examines these issues in the context of the PAPAartis randomized clinical trial, which aims to prevent spinal cord injuries that can occur as an adverse event following complex surgical repair of thoracoabdominal aneurysm. In this study, we accessed a group of 16 patients participating in the trial and, through in-depth interviews, sought to understand the decision-making process when taking part in the trial and their experience of it. Our results showed that patients participated for different reasons: due to trust in doctors, the hope of having a better treatment or for altruistic and collaborative reasons with science. Many patients felt they did not fully understand the extraneous information provided about the study and the complex nature of the procedure. Avoidance of paraplegia played a fundamental role in the decision to participate in this trial. Family support and the socioeconomic conditions of the patients influenced the recovery process after surgery.
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Affiliation(s)
| | | | - Alena Keuneke
- Department of Social Anthropology, University of Granada, Spain
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Epstein
- Department of Applied Economics, University of Granada, Spain
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28
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Reoma LB, Karp BI. The Human Cost: Patient Contribution to Clinical Trials in Neurology. Neurotherapeutics 2022; 19:1503-1506. [PMID: 36083396 PMCID: PMC9606162 DOI: 10.1007/s13311-022-01292-x] [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] [Accepted: 08/19/2022] [Indexed: 10/14/2022] Open
Abstract
Drug development abounds with corporate pharmaceutical capital investment and expenditure costs for new therapeutics. However, there is little data on the human investment, in particular, the number of participants required or the potential burden on and cost to individual trial participants so instrumental to this endeavor. Indeed, the human participant burden in clinical trials is poorly, if at all, described in the literature and we could identify no reports that have detailed the participant burden unique to neurology trials. The cost of clinical trials to participants, including the unique circumstances affecting enrollment of diverse participant populations, has only begun to be reflected in the wider clinical trial literature. Additionally, details of the indirect costs, including time commitment, out-of-pocket expenses, emotional expenditure, and potential loss of enrollment into a more successful trial by participants in trials that fail - the majority in the field - is also particularly striking in the lack of representation in the literature. Even in successful clinical trials, participants in the placebo group face both an emotional burden and medical risk of morbidity and mortality without potential offsetting therapeutic benefit.
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Affiliation(s)
- Lauren B. Reoma
- Clinical Trials Unit, Office of the Clinical Director, Disorders and Stroke, National Institute of Neurological, National Institutes of Health, Bethesda, MD 20892 USA
| | - Barbara Illowsky Karp
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, MD 20892 Bethesda, USA
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29
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Czwikla J, Herzberg A, Kapp S, Kloep S, Rothgang H, Nitschke I, Haffner C, Hoffmann F. Generalizability and reach of a randomized controlled trial to improve oral health among home care recipients: comparing participants and nonparticipants at baseline and during follow-up. Trials 2022; 23:560. [PMID: 35804423 PMCID: PMC9264743 DOI: 10.1186/s13063-022-06470-y] [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: 01/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The generalizability of randomized controlled trials (RCTs) with a low response can be limited by systematic differences between participants and nonparticipants. This participation bias, however, is rarely investigated because data on nonparticipants is usually not available. The purpose of this article is to compare all participants and nonparticipants of a RCT to improve oral health among home care recipients at baseline and during follow-up using claims data. Methods Seven German statutory health and long-term care insurance funds invited 9656 home care recipients to participate in the RCT MundPflege. Claims data for all participants (n = 527, 5.5% response) and nonparticipants (n = 9129) were analyzed. Associations between trial participation and sex, age, care dependency, number of Elixhauser diseases, and dementia, as well as nursing, medical, and dental care utilization at baseline, were investigated using multivariable logistic regression. Associations between trial participation and the probability of (a) moving into a nursing home, (b) being hospitalized, and (c) death during 1 year of follow-up were examined via Cox proportional hazards regressions, controlling for baseline variables. Results At baseline, trial participation was positively associated with male sex (odds ratio 1.29 [95% confidence interval 1.08–1.54]), high (vs. low 1.46 [1.15–1.86]) care dependency, receiving occasional in-kind benefits to relieve caring relatives (1.45 [1.15–1.84]), having a referral by a general practitioner to a medical specialist (1.62 [1.21–2.18]), and dental care utilization (2.02 [1.67–2.45]). It was negatively associated with being 75–84 (vs. < 60 0.67 [0.50–0.90]) and 85 + (0.50 [0.37–0.69]) years old. For morbidity, hospitalizations, and formal, respite, short-term, and day or night care, no associations were found. During follow-up, participants were less likely to move into a nursing home than nonparticipants (hazard ratio 0.50 [0.32–0.79]). For hospitalizations and mortality, no associations were found. Conclusions For half of the comparisons, differences between participants and nonparticipants were observed. The RCT’s generalizability is limited, but to a smaller extent than one would expect because of the low response. Routine data provide a valuable source for investigating potential differences between trial participants and nonparticipants, which might be used by future RCTs to evaluate the generalizability of their findings. Trial registration German Clinical Trials Register DRKS00013517. Retrospectively registered on June 11, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06470-y.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany. .,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany. .,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Alexandra Herzberg
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Sonja Kapp
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.,Competence Center for Clinical Trials, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Ina Nitschke
- Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, University Medical Center, Liebigstraße 10-14, 04103, Leipzig, Germany.,Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstraße 11, CH-8032, Zurich, Switzerland
| | - Cornelius Haffner
- Special Care- and Geriatric Dentistry, Städtisches Klinikum Harlaching München, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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30
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Chevance A, Ravaud P, Cornelius V, Mayo-Wilson E, Furukawa TA. Designing clinically useful psychopharmacological trials: challenges and ways forward. Lancet Psychiatry 2022; 9:584-594. [PMID: 35525252 DOI: 10.1016/s2215-0366(22)00041-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/15/2022] [Accepted: 02/01/2022] [Indexed: 12/23/2022]
Abstract
The clinical guidelines that underpin the use of drugs for mental disorders are informed by evidence from randomised controlled trials (RCTs). RCTs are performed to obtain marketing authorisation from regulators. The methods used in these RCTs could be appropriate for early phases of drug development because they identify drugs with important harms and drugs that are efficacious for specific health problems and populations. RCTs done before marketing authorisation do not tend to address clinical questions that concern the effectiveness of a drug in heterogeneous and comorbid populations, the optimisation of drug sequencing and discontinuation, or the comparative benefits and harms of different drugs that could be used for the same health problem. This Review proposes an overview of some shortcomings of RCTs, at an individual level and at the whole portfolio level, and identifies some methods in planning, conducting, and carrying out analyses in RCTs that could enhance their ability to support therapeutic decisions. These suggestions include: identifying patient-important questions to be investigated by psychopharmacological RCTs; embedding pragmatic RCTs within clinical practice to improve generalisability to target populations; collecting evidence about drugs in overlooked populations; developing methods to facilitate the recruitment of patients with mental disorders and to reduce the number of patients who drop out, using specific methods; using core outcome sets to standardise the assessment of benefits and harms; and recording systematically serious objective outcomes, such as suicide or hospitalisation, to be evaluated in meta-analyses. This work is a call to address questions relevant to patients using diverse design of RCTs, thus contributing to the development of a patient-centred, evidence-based psychiatry.
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Affiliation(s)
- Astrid Chevance
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France.
| | - Philippe Ravaud
- Université Paris Cité, CRESS, INSERM, INRAE, Paris, France; Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
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31
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Exploring Effects of Sensory Garments on Participation of Children on the Autism Spectrum: A Pretest-Posttest Repeated Measure Design. Occup Ther Int 2022; 2022:3540271. [PMID: 35800976 PMCID: PMC9192327 DOI: 10.1155/2022/3540271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Autistic children experience sensory challenges that interfere with participation and increase parent stress. Sensory-based interventions are used to address children's behaviors affected by sensory processing difficulties, but research is limited regarding use of sensory garments to support participation of autistic children. This study explored sensory garment effects on participation, parental competence, and perceived stress of autistic children and their parents. Method Twenty-one children were recruited and 17 males with ASD and atypical sensory processing patterns completed the 14-week study. The Canadian Occupational Performance (COPM) and Goal Attainment Scaling (GAS) were used to set and monitor participation goals. After a baseline period, children wore sensory garment(s) for 8 weeks. The COPM, GAS, Parent Stress Index-Short Form (PSI-SF), and Parent Sense of Competence Scale (PSOC) were administered four times (prebaseline, before and after the intervention, and three weeks postintervention). Results There were moderate to large significant differences in both COPM and GAS scores after the intervention and from the beginning to the end of the study indicating sensory garments may improve participation of autistic children. There were no significant differences in PSI or PSOC at any timepoint. Two children rejected the garments. Conclusions Parent- or child-selected sensory garments may improve participation in individually meaningful activities for children who can tolerate wearing them. Children's improvement in participation did not improve parent stress or competence, possibly due to the passive nature of the intervention. More research is needed explore the influence of heterogeneous sensory patterns on response to intervention.
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32
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Kushnir I, Clemons M, Fergusson D, Bossé D, Reaume MN. Attitudes towards open-label versus placebo-control designs in oncology randomized trials: A survey of medical oncologists. J Eval Clin Pract 2022; 28:495-499. [PMID: 35191169 PMCID: PMC9302988 DOI: 10.1111/jep.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Randomized trials are considered the gold standard when assessing the efficacy of new therapeutic agents. In clinical situations where no standard of care therapy is approved, randomized trials usually compare experimental agents to either a placebo or an open-label nonintervention arm (i.e., best supportive care). We surveyed Canadian medical oncologists to understand their attitudes towards each design. METHODS Members of the Canadian Association of Medical Oncologists were invited to participate in an anonymous online survey. Standardized case scenarios were used to determine participants' attitudes regarding the role of open-label versus placebo-controlled trials. RESULTS A total of 322 medical oncologists and trainees were invited to participate and 86 responded (response rate 27%). Fifty-one (59%) believed that open-label trials are an acceptable alternative to placebo-controlled design when investigating a therapeutic agent in the adjuvant setting. Thirty-eight (49%) deemed it acceptable to compare the investigational agent to an open-label arm instead of a placebo to assess progression-free survival in the metastatic setting. Twenty-eight (38%) of respondents felt that open-label design was acceptable when assessing the quality of life endpoint. Most physicians were unsure whether the US Food and Drug Administration require a placebo-controlled arm in oncology trials. CONCLUSION Canadian medical oncologists participating in this survey are divided in their opinions regarding the acceptability of an open-label design in randomized-controlled trials, where no standard therapy is approved. Clearer guidance from regulatory bodies on the adequacy of different trial designs is needed.
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Affiliation(s)
- Igal Kushnir
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, The University of Ottawa and the Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.,Meir Medical Center, Institute of Oncology, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark Clemons
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, The University of Ottawa and the Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean Fergusson
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dominick Bossé
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, The University of Ottawa and the Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Martin Neil Reaume
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital, The University of Ottawa and the Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
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33
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Martínez C, Feliu A, Torres N, Nieva G, Pinet C, Raich A, Mondon S, Barrio P, Andreu M, Hernández-Ribas R, Vicens J, Costa S, Suelves JM, Vilaplana J, Enríquez M, Alaustre L, Vilalta E, Subirà S, Bruguera E, Castellano Y, Saura J, Guydish J, Fernández E, Ballbè M. Acceptability and participation predictors for a pragmatic randomized controlled trial to test a smoking cessation intervention after discharge from mental health wards. Drug Alcohol Depend 2022; 234:109390. [PMID: 35278807 DOI: 10.1016/j.drugalcdep.2022.109390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Hospitalization is an ideal time to promote smoking cessation, but interventions are limited for supporting cessation maintenance after discharge. This study aimed to evaluate the acceptability of participating in a trial that tested the efficacy of an intensive telephone-based intervention for smokers after discharge. METHODS Adult smokers admitted to mental health wards of six hospitals were invited to participate in the trial. We studied the study acceptance/decline rates by analyzing the characteristics of participants (e.g., sex, age, psychiatric disorder, smoking pattern) and hospitals (e.g., size, tobacco control implementation). We calculated adjusted odds ratios (aOR) to assess predictors of non-participation. RESULTS Of 530 smokers that met the study inclusion criteria, 55.5% (n = 294) agreed to participate. Participant and non-participants were not different in sex, age, or psychiatric diagnosis. Compared to non-participants, participants had made more attempts to quit in the past year (66.1% vs 33.9%; p < 0.001) and reported higher abstinence rates during the hospital stay (66.7% vs. 33.3%; p = 0.05). Participation rates by hospital varied from 30.9% to 82.0% (p < 0.001). Predictors of non-participation were not having attempted to quit in the last year (aOR=2.42; 95%CI: 1.66-3.53) and low level of tobacco control in the hospital (aOR range: 1.79-6.39, p < 0.05). CONCLUSIONS A telephone-based intervention to promote smoking cessation after discharge was accepted by half of the smokers with mental health disorders. Smokers that had attempted to quit previously and those that stayed in hospitals with a strong tobacco control policy were more likely to participate in the trial.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., 7th floor, San Francisco, CA 94158, United States; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Maternal Health and Mental Health, School of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Núria Torres
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Nieva
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Cristina Pinet
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - Antònia Raich
- Mental Health Department, Althaia Xarxa Assistencial Universitària, C. Dr. Llatjós s/n, 08243 Manresa, Barcelona, Spain
| | - Sílvia Mondon
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Pablo Barrio
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Magalí Andreu
- Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Rosa Hernández-Ribas
- Alcohol Program, Psychiatry Department, Hospital Universitari de Bellvitge, Institut Català d'Oncologia, IDIBELL, CIBERSAM, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Vicens
- Psychiatry Department, Hestia Duran i Reynals, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sílvia Costa
- Addictive Behaviors Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, C. San Antoni Mª Claret 167, 08025 Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, C. San Antoni Mª Claret 167, 08025 Barcelona, Spain
| | - Josep Maria Suelves
- Public Health Agency of Catalonia, Health Department, Government of Catalonia, C. Roc Boronat 81-95, 08005 Barcelona, Spain; Universitat Oberta de Catalunya, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Jordi Vilaplana
- Serra Húnter Fellow / Computer Science Department, University of Lleida, Jaume II, 69, 25001 Lleida, Spain
| | - Marta Enríquez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Alaustre
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Vilalta
- 061 CatSalut Respon, Sistema d'Emergències Mèdiques, C. Pablo Iglesias 115, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Subirà
- Psychiatry Department, Hestia Duran i Reynals, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eugeni Bruguera
- Smoking Cessation Unit, Addictive Behaviors Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Saura
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., 7th floor, San Francisco, CA 94158, United States
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, C. Feixa Llarga s/n, 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Gran Via de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain.
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Elfeky A, Treweek S, Hannes K, Bruhn H, Fraser C, Gillies K. Using qualitative methods in pilot and feasibility trials to inform recruitment and retention processes in full-scale randomised trials: a qualitative evidence synthesis. BMJ Open 2022; 12:e055521. [PMID: 35437247 PMCID: PMC9016401 DOI: 10.1136/bmjopen-2021-055521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/28/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To systematically review published pretrial qualitative research studies and explore how their findings were used to inform recruitment and retention processes in full-scale trials. DESIGN Qualitative evidence synthesis using thematic analysis. DATA SOURCES AND ELIGIBILITY CRITERIA We conducted a comprehensive search of databases; Dissertation Abstracts International, CINAHL, Embase, MEDLINE, Sociological Abstracts and PsycINFO. We included all reports of pretrial qualitative data on recruitment and retention in clinical trials up to March 2018. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data using a predefined data extraction form that captured study aims, design, methodological approach and main findings, including barriers and facilitators to recruitment and or retention. The synthesis was undertaken using Thomas and Harden's thematic synthesis method and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Confidence was assessed using Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. RESULTS Thirty-five papers (connected to 31 feasibility studies) from three different countries, published between 2010 and 2017 were included. All studies were embedded in pilot or feasibility studies to inform design aspects in preparation for a subsequent full-scale trial. Twelve themes were identified as recruitment barriers and three as recruitment facilitators. Two themes were identified as barriers for retention and none as retention facilitators. The findings from qualitative research in feasibility or pilot trials are often not explicitly linked to proposed changes to the recruitment and retention strategies to be used in the future or planned full-scale trial. CONCLUSIONS Many trial teams do pretrial qualitative work with the aim of improving recruitment and retention in future full-scale trials. Just over half of all reports of such work do not clearly show how their findings will change the recruitment and retention strategy of the future trial. The scope of pretrial work needs to expand beyond looking for problems and also look for what might help and spend more time on retention.
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Affiliation(s)
- Adel Elfeky
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Karin Hannes
- Research Group SoMeTHin'K, Faculty of Social Sciences, KU Leuven, Leuven, Belgium
| | - Hanne Bruhn
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Clegg A, Bandeen-Roche K, Farrin A, Forster A, Gill TM, Gladman J, Kerse N, Lindley R, McManus RJ, Melis R, Mujica-Mota R, Raina P, Rockwood K, Teh R, van der Windt D, Witham M. New horizons in evidence-based care for older people: individual participant data meta-analysis. Age Ageing 2022; 51:afac090. [PMID: 35460409 PMCID: PMC9034697 DOI: 10.1093/ageing/afac090] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Evidence-based decisions on clinical and cost-effectiveness of interventions are ideally informed by meta-analyses of intervention trial data. However, when undertaken, such meta-analyses in ageing research have typically been conducted using standard methods whereby summary (aggregate) data are extracted from published trial reports. Although meta-analysis of aggregate data can provide useful insights into the average effect of interventions within a selected trial population, it has limitations regarding robust conclusions on which subgroups of people stand to gain the greatest benefit from an intervention or are at risk of experiencing harm. Future evidence synthesis using individual participant data from ageing research trials for meta-analysis could transform understanding of the effectiveness of interventions for older people, supporting evidence-based and sustainable commissioning. A major advantage of individual participant data meta-analysis (IPDMA) is that it enables examination of characteristics that predict treatment effects, such as frailty, disability, cognitive impairment, ethnicity, gender and other wider determinants of health. Key challenges of IPDMA relate to the complexity and resources needed for obtaining, managing and preparing datasets, requiring a meticulous approach involving experienced researchers, frequently with expertise in designing and analysing clinical trials. In anticipation of future IPDMA work in ageing research, we are establishing an international Ageing Research Trialists collective, to bring together trialists with a common focus on transforming care for older people as a shared ambition across nations.
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Affiliation(s)
- Andrew Clegg
- Academic Unit for Ageing & Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda Farrin
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Anne Forster
- Academic Unit for Ageing & Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas M Gill
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland School of Population Health, Auckland, New Zealand
| | - Richard Lindley
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Ruben Mujica-Mota
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Parminder Raina
- Department of Health Evidence and Impact & McMaster Institute for Research on Aging, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - Ruth Teh
- Department of General Practice and Primary Health Care, University of Auckland School of Population Health, Auckland, New Zealand
| | | | - Miles Witham
- AGE Research Group, Newcastle University, Newcastle, UK
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Hoenemeyer TW, Cole WW, Oster RA, Pekmezi DW, Pye A, Demark-Wahnefried W. Test/Retest Reliability and Validity of Remote vs. In-Person Anthropometric and Physical Performance Assessments in Cancer Survivors and Supportive Partners. Cancers (Basel) 2022; 14:1075. [PMID: 35205823 PMCID: PMC8869803 DOI: 10.3390/cancers14041075] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Anthropometric and physical performance testing is commonly done in lifestyle research and is traditionally performed in-person. To expand the scalability of lifestyle interventions among cancer survivors, in-person assessments were adapted to remote means and evaluated for feasibility, safety, validity, and reliability. (2) Methods: Cancer survivors and supportive partners were approached to participate in three anthropometric and physical performance testing sessions (two remote/one in-person). Correlations, concordance, and differences between testing modes were evaluated. (3) Results: 110-of-112 individuals approached for testing participated (98% uptake); the sample was 78% female, 64% non-Hispanic White, of mean age 58 years and body mass index = 32.4 kg/m2. ICCs for remote assessments ranged from moderate (8' walk = 0.47), to strong (8' get-up-and-go = 0.74), to very strong (30 s chair stand = 0.80; sit-and-reach = 0.86; 2 min step test = 0.87; back scratch = 0.90; weight = 0.93; waist circumference = 0.98) (p-values < 0.001). Perfect concordance (100%) was found for side-by-side and semi-tandem balance, and 87.5-90.3% for tandem balance. No significant differences between remote and in-person assessments were found for weight, 8' walk, and 8' get-up-and-go. No adverse events occurred and 75% indicated no preference or preferred virtual testing to in-person. (4) Conclusions: Remote anthropometric and physical performance assessments are reliable, valid, acceptable, and safe among cancer survivors and supportive partners.
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Affiliation(s)
- Teri W. Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
| | - William W. Cole
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
| | - Robert A. Oster
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA; (R.A.O.); (D.W.P.)
- Department of Preventive Medicine, UAB School of Medicine, Birmingham, AL 35233, USA
| | - Dorothy W. Pekmezi
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA; (R.A.O.); (D.W.P.)
- Department of Health Behavior, UAB School of Public Health, Birmingham, AL 35233, USA
| | - Andrea Pye
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA; (W.W.C.); (A.P.); (W.D.-W.)
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA; (R.A.O.); (D.W.P.)
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She H, Man Y. Anticipatory Burden in Adult-Child Caregivers: A Concept Analysis. Healthcare (Basel) 2022; 10:healthcare10020356. [PMID: 35206970 PMCID: PMC8872093 DOI: 10.3390/healthcare10020356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
This study aims to analyze the concept of anticipatory burden in adult-child caregivers. A systematic literature review was performed using four databases, Pubmed, CINAHL, PsycINFO and Medline, with the keywords of “anticipatory burden” and “anticipated burden”. Simplified Wilson’s classic concept analysis modified by Walker and Avant was employed to identify the attributes, antecedents and consequences of anticipatory burden in the adult-child caregivers. Eighteen articles were analyzed. Attributes of anticipatory burden in adult-child caregivers were found to be: (1) subjective burden, (2) anticipation, (3) overestimation, (4) inability, and (5) family relationship. Antecedents were identified as: (1) potential care recipients, (2) caregiving willingness, and (3) a lack of resources. Consequences included: (1) prediction of caregiving willingness, (2) impacts on caregivers’ health, (3) intervention promotion, and (4) behavioral changes. As the adult-child caregiver is one of the main types of family caregivers for the fast-growing aging population, it is important to understand the attributes, antecedents, and consequences of their anticipatory burden. Based on the results of this study, resources such as intervention, policy, and counseling services are recommended to help adult-child caregivers lower their anticipatory burden and get better prepared for providing family care.
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Affiliation(s)
- Hangying She
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA
- Correspondence:
| | - Yuncheng Man
- Case School of Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
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Nguyen VT, Ravaud P, Tran VT, Young B, Boutron I. Patients' Perspectives on Transforming Clinical Trial Participation: Large Online Vignette-based Survey. J Med Internet Res 2022; 24:e29691. [PMID: 35103603 PMCID: PMC8848233 DOI: 10.2196/29691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/04/2021] [Accepted: 11/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background Patients’ participation is crucial to the success of randomized controlled trials (RCTs). However, recruiting and retaining patients in trials remain a challenge. Objective This study aims to describe patients’ preferences for the organization of RCTs (visits on- site or remotely) and evaluate the potential impact of fulfilling preferences on their willingness to participate in a clinical trial. Methods This was a vignette-based survey. Vignettes were case scenarios of real clinical trials assessing pharmacological treatments. These RCTs evaluated 6 prevalent chronic diseases (ie, osteoporosis, osteoarthritis, asthma, cardiovascular diseases, diabetes, and endometriosis). Each vignette described (1) the RCT and characteristics of the treatment tested (ie, doses, administration routes) and (2) the trial procedures and different options (on-site or remotely) for how the trial was organized for informed consent, follow-up visits, and communication of results when the trial was completed. We recruited 628 participants from ComPaRe (www.compare.aphp.fr), a French e-cohort of patients with chronic diseases. The outcomes were the participants’ preferences for the way the trial was organized (on-site or remotely) and their willingness to participate in the trial. Results Of the 628 participants who answered the vignettes, 491 (78.2%) were female (median age 55 years), with different chronic diseases ranging from endometriosis in 59 of 491 (12%) patients to asthma in 133 of 628 (21.2%) patients. In addition, 38 (6.1%) participants wanted to provide informed consent and all trial visits on-site, 176 (28%) wished to participate in the trial entirely remotely, and 414 (65.9%) wanted to combine remote-based and hospital-based visits. Considering the trial as a whole, when the trial was organized in a way that the patients preferred, the median (Q1-Q3) likelihood of participation in the trial was 90% (80-100) versus 60% (30-80) if the trial followed the patients’ nonpreferred model. Furthermore, 256 (40.8%) patients responded to open-ended questions expressing their experience with trial participation and visits to the hospital and providing suggestions for improvement. The patients emphasized the need to personalize the way a trial is organized according to each patient’s needs and conditions. Conclusions There was a significant diversity in the participants’ preferences. Most participants preferred hybrid organization involving both on-site and remote visits. Participants were more likely to participate in a trial organized according to their preferences.
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Affiliation(s)
- Van Thu Nguyen
- Université de Paris, Centre of Research Epidemiology and Statistics, Inserm, Paris, France.,Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Philippe Ravaud
- Université de Paris, Centre of Research Epidemiology and Statistics, Inserm, Paris, France.,Cochrane France, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Viet Thi Tran
- Université de Paris, Centre of Research Epidemiology and Statistics, Inserm, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Bridget Young
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Isabelle Boutron
- Université de Paris, Centre of Research Epidemiology and Statistics, Inserm, Paris, France.,Cochrane France, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
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Knowlson C, Dean A, Doherty L, Fairhurst C, Brealey S, Torgerson DJ. Recruitment patterns in multicentre randomised trials fit more closely to Price's Law than the Pareto Principle: A review of trials funded and published by the United Kingdom Health Technology Assessment Programme. Contemp Clin Trials 2021; 113:106665. [PMID: 34968767 DOI: 10.1016/j.cct.2021.106665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This review investigates whether the distribution of recruitment to multicentre randomised controlled trials (RCTs) fits the "Pareto Principle", i.e. 80% of participants are recruited by 20% of sites, or Price's Law, i.e. 50% of participants are recruited by the square root of the total number of sites. METHODS A review of HTA reports published between 2017 and 2019. RESULTS 40 RCTs conducted face-to-face recruitment, five recruited via mail-outs and one used both methods. For face-to-face recruitment (n = 41 studies), 80% of participants were recruited by the top recruiting 42.6% of sites; for mail-out methods (n = 6 studies) this was 52.0%. From the square root of sites, 51.3% and 31.8% of participants were recruited for the two recruitment approaches, respectively. Specifically, 3 (7.3%, 95% CI 2.5% to 19.4%) and 20 (48.8%, 95% CI 34.3% to 63.5%) RCTs followed Pareto Principle and Price's Law, respectively. One mail-out recruitment study followed one of these principles, Price's Law. Chief Investigator (CI) sites (n = 24) in face-to-face recruitment studies recruited 18.1% of participants. CONCLUSION Face-to-face recruitment to HTA-funded RCTs fits more closely to Price's Law than the Pareto Principle, with the CI's site recruiting nearly a fifth of participants. Since we focussed on HTA-funded RCTs with ≥9 recruiting sites and for which the recruitment method and number recruited by site were known, our findings are limited in their generalizability. However, this trend could be used as a guide to aid in estimating how many sites RCTs need. More accurate estimation may prevent the need for recruitment extensions.
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Affiliation(s)
- Catherine Knowlson
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK.
| | - Alexandra Dean
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - Laura Doherty
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - Stephen Brealey
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York YO10 5DD, UK
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Aguayo GA, Goetzinger C, Scibilia R, Fischer A, Seuring T, Tran VT, Ravaud P, Bereczky T, Huiart L, Fagherazzi G. Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study. J Med Internet Res 2021; 23:e25743. [PMID: 34941554 PMCID: PMC8738987 DOI: 10.2196/25743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023] Open
Abstract
Background Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies.
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Affiliation(s)
- Gloria A Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Catherine Goetzinger
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Renza Scibilia
- Diabetes Australia, Melbourne, Australia.,Diabetogenic, Melbourne, Australia
| | - Aurélie Fischer
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Viet-Thi Tran
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Centre of Research in Epidemiology and Statistic Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM), French National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.,Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tamás Bereczky
- European Patients' Academy on Therapeutic Innovation, Brussels, Belgium
| | - Laetitia Huiart
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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McKinney M, Bell R, Samborski C, Attwood K, Dean G, Eakle K, Yu W, Edge S. Clinical Trial Participation: A Pilot Study of Patient-Identified Barriers. Clin J Oncol Nurs 2021; 25:647-654. [PMID: 34800100 PMCID: PMC10150445 DOI: 10.1188/21.cjon.647-654] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical trial enrollment in the United States is lacking, particularly among older adult and ethnic and racial minority populations. OBJECTIVES The aim of the current study was to identify patient-related barriers to clinical trial participation using a mixed-methods patient survey and to offer insights to develop evidence-based implementation strategies to address these barriers. METHODS A retrospective survey was conducted of patients who were not interested in participating in a clinical trial to quantify the reasons these patients chose not to participate. Directed qualitative content analysis was used to identify themes that emerged from the write-in responses. FINDINGS The greatest patient-reported barriers were misperceptions about placebos, a desire to not feel like a human guinea pig, uncertainty surrounding clinical trial treatment effectiveness compared to standard care, and concerns about additional appointments or tests. Oncology nurses can address patient enrollment barriers by providing targeted education and participating in the informed consent process.
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Challenges to Internationalisation of University Programmes: A Systematic Thematic Synthesis of Qualitative Research on Learner-Centred English Medium Instruction (EMI) Pedagogy. SUSTAINABILITY 2021. [DOI: 10.3390/su132212642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As many universities in non-Anglophone countries have committed to internationalising their academic programmes, more content courses in Arts and Sciences are being taught in English. When content courses are taught in English in a country where English is not the first language, this is called English Medium Instruction (EMI). Using specific country cases, previous studies have confirmed that an EMI course can pose many challenges to the learning of course content by students. To date, there have been few attempts to examine these challenges through a large-scale qualitative prism, which would be useful for gaining new insights in order to inform policy as well as classroom interventions. In this systematic thematic synthesis we have aimed to identify the obstacles to implementing learner-centred pedagogy in EMI tertiary programmes, focusing on student perspectives. The Critical Appraisal Skills Programme (CASP) and Consolidated Criteria for Reporting Qualitative Studies (COREQ) were used to appraise and synthesise 40 empirical articles. The articles included 1769 participants in 20 non-Anglophone countries and jurisdictions. The participants were both local and international non-native English-speaking students enrolled in EMI courses. The synthesis yielded 46 descriptive themes stratified into six analytical domains. The suggested domains are meta/linguistic, instructional, meta/cognitive, socio-cultural, affective, and institutional obstacles. They suggest that students in different regions faced quite similar challenges in their EMI courses. The challenges consist of inadequate use of English by students and lecturers, and a lack of student-centred pedagogy, particularly in teacher–student and student–student interactions. The findings of most learner-centred EMI studies revealed that the main challenges came from English comprehension (the first three suggested domains); fewer studies included factors related to the learning environment (the last three domains). This review can inform university administrators, teaching staff and researchers engaged in internationalising higher education and aid in designing appropriate EMI programmes that offer better learner-centred educational experiences.
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Rix J, Docherty S, Breen AC, Sewell P, Branney J. A public and patient consultation process as an aid to design a person-centred randomized clinical trial. Health Expect 2021; 24:1639-1648. [PMID: 34223683 PMCID: PMC8483211 DOI: 10.1111/hex.13304] [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] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/08/2021] [Accepted: 06/06/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Involving patients and members of the public, together with researchers, in decisions about how studies are designed and conducted can create a study that is more person-centred. The aim of this consultation process was to explore ways of designing a study which takes the person into consideration for the randomized clinical study entitled 'Biomechanical Effects of Manual Therapy-A Feasibility Study' using the novel approach of usability testing. DESIGN Patient and public volunteers were sought with experience of low back pain. Volunteers were invited to participate in usability testing (a physical walkthrough) of the proposed study method. This was followed by a discussion of areas where usability testing could not be used, such as recruitment strategies, continuity of participant care and dissemination of results. Resulting feedback was considered by the research team and alterations to the original study method were incorporated, provided the research questions could be answered and were practical within the resources available. RESULTS Additional recruitment strategies were proposed. Alterations to the study included reduction in study time burden; completion of study paperwork in a quieter location; continuity of participant care after the study; and methods of dissemination of overall study results to participants. CONCLUSION The consultation process used the unique method of usability testing, together with a post-usability discussion, and resulted in alterations to the future study which may facilitate making it more person-centred. PATIENT AND PUBLIC CONTRIBUTION Patients and public developed the future study design but did not participate in manuscript preparation.
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Affiliation(s)
- Jacqueline Rix
- Department of Design and EngineeringFaculty of Science and TechnologyBournemouth UniversityPooleUK
- Centre for Biomechanics ResearchAECC University CollegeBournemouthUK
| | - Sharon Docherty
- Department of Medical Science & Public HealthFaculty of Health & Social SciencesBournemouth UniversityPooleUK
| | | | - Philip Sewell
- Department of Design and EngineeringFaculty of Science and TechnologyBournemouth UniversityPooleUK
| | - Jonathan Branney
- Department of Nursing ScienceFaculty of Health & Social SciencesBournemouth UniversityPooleUK
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Lucas P, Boyd S, Milloy MJ, Walsh Z. The impact of non-medical cannabis legalization and other exposures on retention in longitudinal cannabis research: a survival analysis of a prospective study of Canadian medical cannabis patients. J Cannabis Res 2021; 3:34. [PMID: 34321108 PMCID: PMC8320176 DOI: 10.1186/s42238-021-00089-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite repeated calls by medical associations to gather evidence on the harms and benefits of cannabis, there are ongoing methodological challenges to conducting observational and clinical studies on cannabis, including a high rate of patients that are lost to follow-up (LTFU). This study explores factors potentially associated with retention in a large prospective study of Canadian medical cannabis patients, with the goal of reducing the probability that patients will be lost to follow-up in future cannabis research. METHODS The Tilray Observational Patient Study (TOPS) was a multi-site, prospective study assessing the impact of medical cannabis over 6 months in a broad population of authorized Canadian cannabis patients. The study took place from 2016 to 19, and we conducted a series of exploratory analyses including a Kaplan-Meier survival analysis and logistic regressions to assess the potential association between study retention and variables including patient characteristics, cannabis and prescription drug use, quality of life, and the legalization of non-medical cannabis. RESULTS Overall, 1011 participants were included in this analysis, contributing 287 patient-years of data. Retention was 728 (72%) at 3 months, and 419 (41.4%) at 6 months. Our analyses found significantly lower adjusted odds of retention following legalization (AOR 0.28, 95% CI 0.18-0.41), and in patients that used prescription opioids at baseline (AOR 0.62, 95% CI 0.46-0.85), while increased odds of retention were found in patients with a higher baseline psychological score (AOR 1.43, 95% CI 1.08-1.90) or that used anti-seizure medications at baseline (AOR 1.91, 95% CI 1.30-2.81). DISCUSSION TOPS provided a unique opportunity to examine patient characteristics and other variables that may be associated with retention in prospective medical cannabis studies. Our findings highlight some of the challenges of conducting medical cannabis research at a time when patients have a multitude of cannabis access options, including legal adult dispensaries and a robust illicit market. High LTFU rates can impact the validity of studies, and potentially lead to misestimations of the harms and benefits of medical cannabis use. Despite being a multi-site prospective study, this was a convenience sample, thereby limiting the generalizability of these findings. Additionally, data regarding the use of cannabis was self-reported by patients, so is subject to potential recall bias. CONCLUSION We found evidence that external policy changes that affect access to cannabis such as the legalization of non-medical adult use and patient characteristics associated with patient physical/psychological capacity can impact retention in prospective medical cannabis studies. Evidence-based strategies to reduce study burden on participants, such as minimizing in-person visits by providing digitized internet-based surveys and phone or telemedicine follow-up options as well as ensuring adequate participant compensation could improve retention. Additionally, policy-related changes aimed at improving access to medical cannabis, including increased cost-coverage and community-based distribution, could encourage patients to remain in the federal medical cannabis program and thereby reduce LTFU in associated studies.
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Affiliation(s)
- Philippe Lucas
- Social Dimensions of Health, University of Victoria, 3800 Finnerty Rd, Victoria, B.C V8P 5C2 Canada
- 1100 Maughan Rd, Nanaimo, BC V9X1J2 Canada
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC V8N 5M8 Canada
| | - Susan Boyd
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Rd, Victoria, B.C V8P 5C2 Canada
| | - M.-J. Milloy
- Faculty of Medicine, University of British Columbia, St. Paul’s Hospital, Burrard Street, Vancouver, B.C 806-1081 Canada
- British Columbia Centre On Substance Use, 400-1045 Howe St, Vancouver, B.C V6Z 2A9 Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, 3333 University Way, OkanaganKelowna, B.C V1V 1V7 Canada
- Centre for the Advancement of Psychological Science and Law, University of British Columbia, 3333 University Way, OkanaganKelowna, BC V1V 1V7 Canada
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Chi PC, Owino EA, Jao I, Olewe F, Ogutu B, Bejon P, Kapulu M, Kamuya D, Marsh V. Understanding the benefits and burdens associated with a malaria human infection study in Kenya: experiences of study volunteers and other stakeholders. Trials 2021; 22:494. [PMID: 34311781 DOI: 10.21203/rs.3.rs-143195/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/13/2021] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Human infection studies (HIS) that involve deliberately infecting healthy volunteers with a pathogen raise important ethical issues, including the need to ensure that benefits and burdens are understood and appropriately accounted for. Building on earlier work, we embedded social science research within an ongoing malaria human infection study in coastal Kenya to understand the study benefits and burdens experienced by study stakeholders in this low-resource setting and assess the wider implications for future research planning and policy. METHODS Data were collected using qualitative research methods, including in-depth interviews (44), focus group discussions (10) and non-participation observation. Study participants were purposively selected (key informant or maximal diversity sampling), including volunteers in the human infection study, study staff, community representatives and local administrative authorities. Data were collected during and up to 18 months following study residency, from sites in Coastal and Western Kenya. Voice recordings of interviews and discussions were transcribed, translated, and analysed using framework analysis, combining data- and theory-driven perspectives. FINDINGS Physical, psychological, economic and social forms of benefits and burdens were experienced across study stages. Important benefits for volunteers included the study compensation, access to health checks, good residential living conditions, new learning opportunities, developing friendships and satisfaction at contributing towards a new malaria vaccine. Burdens primarily affected study volunteers, including experiences of discomfort and ill health; fear and anxiety around aspects of the trial process, particularly deliberate infection and the implications of prolonged residency; anxieties about early residency exit; and interpersonal conflict. These issues had important implications for volunteers' families, study staff and the research institution's reputation more widely. CONCLUSION Developing ethically and scientifically strong HIS relies on grounded accounts of volunteers, study staff and the wider community, understood in the socioeconomic, political and cultural context where studies are implemented. Recognition of the diverse, and sometimes perverse, nature of potential benefits and burdens in a given context, and who this might implicate, is critical to this process. Prior and ongoing stakeholder engagement is core to developing these insights.
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Affiliation(s)
- Primus Che Chi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Esther Awuor Owino
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Irene Jao
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Fredrick Olewe
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
| | - Bernhards Ogutu
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
| | - Philip Bejon
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
| | - Melissa Kapulu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
| | - Dorcas Kamuya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
| | - Vicki Marsh
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
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Chi PC, Owino EA, Jao I, Olewe F, Ogutu B, Bejon P, Kapulu M, Kamuya D, Marsh V. Understanding the benefits and burdens associated with a malaria human infection study in Kenya: experiences of study volunteers and other stakeholders. Trials 2021; 22:494. [PMID: 34311781 PMCID: PMC8313115 DOI: 10.1186/s13063-021-05455-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background Human infection studies (HIS) that involve deliberately infecting healthy volunteers with a pathogen raise important ethical issues, including the need to ensure that benefits and burdens are understood and appropriately accounted for. Building on earlier work, we embedded social science research within an ongoing malaria human infection study in coastal Kenya to understand the study benefits and burdens experienced by study stakeholders in this low-resource setting and assess the wider implications for future research planning and policy. Methods Data were collected using qualitative research methods, including in-depth interviews (44), focus group discussions (10) and non-participation observation. Study participants were purposively selected (key informant or maximal diversity sampling), including volunteers in the human infection study, study staff, community representatives and local administrative authorities. Data were collected during and up to 18 months following study residency, from sites in Coastal and Western Kenya. Voice recordings of interviews and discussions were transcribed, translated, and analysed using framework analysis, combining data- and theory-driven perspectives. Findings Physical, psychological, economic and social forms of benefits and burdens were experienced across study stages. Important benefits for volunteers included the study compensation, access to health checks, good residential living conditions, new learning opportunities, developing friendships and satisfaction at contributing towards a new malaria vaccine. Burdens primarily affected study volunteers, including experiences of discomfort and ill health; fear and anxiety around aspects of the trial process, particularly deliberate infection and the implications of prolonged residency; anxieties about early residency exit; and interpersonal conflict. These issues had important implications for volunteers’ families, study staff and the research institution’s reputation more widely. Conclusion Developing ethically and scientifically strong HIS relies on grounded accounts of volunteers, study staff and the wider community, understood in the socioeconomic, political and cultural context where studies are implemented. Recognition of the diverse, and sometimes perverse, nature of potential benefits and burdens in a given context, and who this might implicate, is critical to this process. Prior and ongoing stakeholder engagement is core to developing these insights. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05455-7.
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Affiliation(s)
- Primus Che Chi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Esther Awuor Owino
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Irene Jao
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Fredrick Olewe
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya.,Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
| | - Bernhards Ogutu
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya.,Center for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya
| | - Philip Bejon
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
| | - Melissa Kapulu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
| | - Dorcas Kamuya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
| | - Vicki Marsh
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, UK
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van der Hout A, van Uden-Kraan C, Holtmaat K, Jansen F, Lissenberg-Witte B, Nieuwenhuijzen G, Hardillo J, Baatenburg de Jong R, Tiren-Verbeet N, Sommeijer D, de Heer K, Schaar C, Sedee R, Bosscha K, van den Brekel M, Petersen J, Westerman M, Honings J, Takes R, Houtenbos I, van den Broek W, de Bree R, Jansen P, Eerenstein S, Leemans C, Zijlstra J, Cuijpers P, van de Poll-Franse L, Verdonck-de Leeuw I. Reasons for not reaching or using web-based self-management applications, and the use and evaluation of Oncokompas among cancer survivors, in the context of a randomised controlled trial. Internet Interv 2021; 25:100429. [PMID: 34401388 PMCID: PMC8350584 DOI: 10.1016/j.invent.2021.100429] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/22/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The web-based self-management application Oncokompas was developed to support cancer survivors to monitor health-related quality of life and symptoms (Measure) and to provide tailored information (Learn) and supportive care options (Act). In a previously reported randomised controlled trial (RCT), 68% of 655 recruited survivors were eligible, and of those 45% participated in the RCT. Among participants of the RCT that were randomised to the intervention group, 52% used Oncokompas as intended. The aim of this study was to explore reasons for not participating in the RCT, and reasons for not using Oncokompas among non-users, and the use and evaluation of Oncokompas among users. METHODS Reasons for not participating were assessed with a study-specific questionnaire among 243 survivors who declined participation. Usage was investigated among 320 participants randomised to the intervention group of the RCT via system data and a study-specific questionnaire that was assessed during the 1 week follow-up (T1) assessment. RESULTS Main reasons for not participating were not interested in participation in scientific research (40%) and not interested in scientific research and Oncokompas (28%). Main reasons for not being interested in Oncokompas were wanting to leave the period of being ill behind (29%), no symptom burden (23%), or lacking internet skills (18%). Out of the 320 participants in the intervention group 167 (52%) used Oncokompas as intended. Among 72 non-users, main reasons for not using Oncokompas were no symptom burden (32%) or lack of time (26%). Among 248 survivors that activated their account, satisfaction and user-friendliness were rated with a 7 (scale 0-10). Within 3 (IQR 1-4) sessions, users selected 32 (IQR 6-37) topics. Main reasons for not using healthcare options in Act were that the information in Learn was already sufficient (44%) or no supportive care needs (32%). DISCUSSION Main reasons for not reaching or using Oncokompas were no symptom burden, no supportive care needs, or lack of time. Users selected many cancer-generic and tumour-specific topics to address, indicating added value of the wide range of available topics.
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Affiliation(s)
- A. van der Hout
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - C.F. van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - K. Holtmaat
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
| | - F. Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - B.I. Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | | | - J.A. Hardillo
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R.J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Centre, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N.L. Tiren-Verbeet
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - D.W. Sommeijer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands
| | - K. de Heer
- Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - C.G. Schaar
- Department of Internal Medicine, Gelre ziekenhuis, Apeldoorn, the Netherlands
| | - R.J.E. Sedee
- Department of Otolaryngology, Head and Neck Surgery, Haaglanden MC, The Hague, the Netherlands
| | - K. Bosscha
- Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | - M.W.M. van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J.F. Petersen
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M. Westerman
- Department of Hematology, Northwest Clinics, Alkmaar, the Netherlands
| | - J. Honings
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - R.P. Takes
- Department of Otorhinolaryngology – Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I. Houtenbos
- Department of Hematology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | - R. de Bree
- Department of Head and Neck Surgical Oncology, Utrecht University Medical Center, Utrecht, the Netherlands
| | - P. Jansen
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - S.E.J. Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - C.R. Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
| | - J.M. Zijlstra
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - P. Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - L.V. van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, the Netherlands
- CoRPS - Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - I.M. Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology – Head and Neck Surgery, Amsterdam, the Netherlands
- Corresponding author at: Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
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48
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Saposnik G, Bueno-Gil G, Sempere ÁP, Rodríguez-Antigüedad A, Del Río B, Baz M, Terzaghi M, Ballesteros J, Maurino J. Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol. Front Neurol 2021; 12:675520. [PMID: 34234734 PMCID: PMC8256155 DOI: 10.3389/fneur.2021.675520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS). Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: "regret and decision," "regret and physicians," and "regret and nurses." An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports-recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty. Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals. Spanish National Register (SL42129-20/598-E).
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Affiliation(s)
- Gustavo Saposnik
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland.,Clinical Outcomes & Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Beatriz Del Río
- Department of Neurology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mar Baz
- Department of Psychiatry, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - María Terzaghi
- Clinical Outcomes & Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, ON, Canada
| | - Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of the Basque Country (UPV/EHU), Leioa, Spain
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49
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Ferrar J, Griffith GJ, Skirrow C, Cashdollar N, Taptiklis N, Dobson J, Cree F, Cormack FK, Barnett JH, Munafò MR. Developing Digital Tools for Remote Clinical Research: How to Evaluate the Validity and Practicality of Active Assessments in Field Settings. J Med Internet Res 2021; 23:e26004. [PMID: 34142972 PMCID: PMC8277353 DOI: 10.2196/26004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/23/2021] [Accepted: 05/04/2021] [Indexed: 01/27/2023] Open
Abstract
The ability of remote research tools to collect granular, high-frequency data on symptoms and digital biomarkers is an important strength because it circumvents many limitations of traditional clinical trials and improves the ability to capture clinically relevant data. This approach allows researchers to capture more robust baselines and derive novel phenotypes for improved precision in diagnosis and accuracy in outcomes. The process for developing these tools however is complex because data need to be collected at a frequency that is meaningful but not burdensome for the participant or patient. Furthermore, traditional techniques, which rely on fixed conditions to validate assessments, may be inappropriate for validating tools that are designed to capture data under flexible conditions. This paper discusses the process for determining whether a digital assessment is suitable for remote research and offers suggestions on how to validate these novel tools.
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Affiliation(s)
- Jennifer Ferrar
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Gareth J Griffith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Caroline Skirrow
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Cambridge Cognition Ltd, Cambridge, United Kingdom
| | - Nathan Cashdollar
- Cambridge Cognition Ltd, Cambridge, United Kingdom.,Cambridge Cognition Ltd, Cambridge, MA, United States
| | | | - James Dobson
- Cambridge Cognition Ltd, Cambridge, United Kingdom
| | - Fiona Cree
- Cambridge Cognition Ltd, Cambridge, United Kingdom
| | | | - Jennifer H Barnett
- Cambridge Cognition Ltd, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Marcus R Munafò
- School of Psychological Science, Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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50
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Vorderstrasse A, Reagan L, D'Eramo Melkus G, Nowlin SY, Birdsall SB, Burd A, Cho YH, Jang M, Johnson C. Recruitment and enrollment of participants in an online diabetes self-management intervention in a virtual environment. Contemp Clin Trials 2021; 105:106399. [PMID: 33857681 PMCID: PMC8172527 DOI: 10.1016/j.cct.2021.106399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
Effective recruitment of research participants is essential for successful randomized controlled trials and remains one of the most challenging and labor-intensive aspects of conducting research. The purpose of this manuscript is to describe recruitment methods for this two-group, internet-based intervention trial and enrollment status in relation to recruitment methods, accounting for accrual rates and recruitment costs and to discuss our recruitment results and limitations informed by the Clinical Trials Transformation Initiative (CTTI) team's evidence and expert-based recommendations for recruitment. The primary study was a two-group randomized controlled trial designed to evaluate the efficacy of a virtual environment, Diabetes LIVE©, compared to a traditional website format to provide diabetes self-management education and support to adults with type 2 diabetes. Our recruitment experience was labor-intensive, multimodal, and required multiple iterations throughout the study to meet recruitment goals. To allow for more efficient and realistic budgets aligned with funding, researchers should engage stakeholders in recruitment planning and monitor and report personnel time and cost by recruitment methods. To allow for more efficient and effective recruitment into meaningful clinical trials and of interest to participants, researchers should use a participative approach during all study phases, including question development.
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Affiliation(s)
- Allison Vorderstrasse
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA; College of Nursing, University of Massachusetts Amherst, 651 North Pleasant Street, Amherst, MA 01003-9299, USA
| | - Louise Reagan
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA; University of Connecticut School of Nursing, 231 Glenbrook Rd., Unit 4026, Storrs, CT 06269-3237, USA.
| | - Gail D'Eramo Melkus
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Sarah Y Nowlin
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Stacia B Birdsall
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Andrew Burd
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA
| | - Yoon Hee Cho
- New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, USA
| | - Myoungock Jang
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA; College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Constance Johnson
- Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710I, USA; Jane and Robert Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave. SON-539D, Houston, TX 77030, USA
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