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Bouchard K, Lalande K, Coutinho T, Mulvagh S, Pacheco C, Liu S, Saw J, So D, Reed JL, Chiarelli A, Stragapede E, Robert H, Lappa N, Sun L, Wells G, Tulloch H. Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient-Informed Investigation. J Am Heart Assoc 2023; 12:e032141. [PMID: 38084731 PMCID: PMC10863752 DOI: 10.1161/jaha.123.032141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient-informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities. METHODS AND RESULTS Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient-piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self-management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short- and longer-term follow-up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate. CONCLUSIONS This early-stage, pretrial research has important implications for the acute and long-term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient-oriented research.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Thais Coutinho
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Sharon Mulvagh
- Division of CardiologyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Christine Pacheco
- Department of CardiologyUniversity of Montréal Hospital CentreMontréalQuebecCanada
| | - Shuangbo Liu
- Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Jacqueline Saw
- Division of CardiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Derek So
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Jennifer L. Reed
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | | | - Elisa Stragapede
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Helen Robert
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Nadia Lappa
- Patient Partner, University of Ottawa Heart InstituteOttawaOntarioCanada
| | - Louise Sun
- Stanford MedicineStanford UniversityStanfordCAUSA
| | - George Wells
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
| | - Heather Tulloch
- University of Ottawa Heart InstituteOttawaOntarioCanada
- University of OttawaOttawaOntarioCanada
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Hoare S, Thomas GPA, Powell A, Armstrong N, Mant J, Burt J. Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation. Health Expect 2023; 26:2216-2227. [PMID: 37452480 PMCID: PMC10632648 DOI: 10.1111/hex.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION While screening uptake is variable, many individuals feel they 'ought' to participate in screening programmes to aid the detection of conditions amenable to early treatment. Those not taking part in screening are often presented as either hindered by practical or social barriers or personally at fault. Why some people choose not to participate receives less consideration. METHODS We explored screening nonparticipation by examining the accounts of participants who chose not to participate in screening offered by a national research trial of atrial fibrillation (AF) screening in England (SAFER: Screening for Atrial Fibrillation with ECG to Reduce stroke). AF is a heart arrhythmia that increases in prevalence with age and increases the risk of stroke. Systematic screening for AF is not a nationally adopted programme within the United Kingdom; it provides a unique opportunity to explore screening nonparticipation outside of the norms and values attached to existing population-based screening programmes. We interviewed people aged over 65 (n = 50) who declined an invitation from SAFER and analysed their accounts thematically. RESULTS Beyond practical reasons for nonparticipation, interviewees challenged the utility of identifying and managing AF earlier. Many questioned the benefits of screening at their age. The trial's presentation of the screening as research made it feel voluntary-something they could legitimately decline. CONCLUSION Nonparticipants were not resistant to engaging in health-promoting behaviours, uninformed about screening or unsupportive of its potential benefits. Instead, their consideration of the perceived necessity, legitimacy and utility of this screening shaped their decision not to take part. PATIENT OR PUBLIC CONTRIBUTION The SAFER programme is guided by four patient and carer representatives. The representatives are embedded within the team (e.g., one is a co-applicant, another sits on the programme steering committee) and by participating in regular meetings advise on all aspects of the design, management and delivery of the programme, including engaging with interpreting and disseminating the findings. For the qualitative workstream, we established a supplementary patient and public involvement group with whom we regularly consult about research design questions.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Gwilym P. A. Thomas
- The Guildhall and Barrow SurgeryBury St EdmundsUK
- Primary Care Unit, Department of Public Health and Primary CareStrangeways Research Laboratory, University of Cambridge School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Alison Powell
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Natalie Armstrong
- SAPPHIRE Research Group, Department of Population Health SciencesUniversity of LeicesterLeicesterUK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary CareStrangeways Research Laboratory, University of Cambridge School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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McCaffrey J, Terao M, McCaffrey C, Igoe A, Loughran O, McDonagh K, McDonogh S, Shackleton E, Whooley E, Jelovac A, McLoughlin DM, Hunter A. Protocol Development for a Qualitative Methodological Study Within a Trial (Qual-SWAT): The KARMA-Dep-2 Trial. HRB Open Res 2023; 6:29. [PMID: 37361338 PMCID: PMC10285324 DOI: 10.12688/hrbopenres.13721.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 06/28/2023] Open
Abstract
Background Despite methodological improvements in clinical trial design and conduct more generally, methodological limitations persist in trials concerning mental health care. A qualitative Study Within A Trial (Qual-SWAT), embedded in the KARMA-Dep-2 host trial, will be undertaken to explore and gain an understanding of two methodological questions in randomised trials specific to mental health care: (1) what are the key barriers and enablers of participation in randomised trials in mental health; and (2) how can randomised trials become part of routine mental health care. These issues will be examined from patient-participant and clinician- / researcher-participant perspectives, in alignment with PRioRiTy research themes. Methods A descriptive qualitative study design will be used. Data will be collected via one-to-one semi-structured interviews, conducted via Microsoft Teams. The interview data will be analysed using Braun and Clarke's Thematic Analysis approach. One-to-one interviews will be conducted with three participant groups ( N = 30): 1) host trial patient-participants ( n = 10); 2) potentially eligible host trial patient-participants who refused enrolment in the host trial ( n = 10); and 3) clinician- / researcher-participants who are associated with work on the host trial ( n = 10). Ethics and dissemination Ethical approval has been granted by St. Patrick's Mental Health Services Research Ethics Committee, Ireland (Ref: Protocol 09/20). When the study is completed, a report will be prepared and submitted to the Health Research Board (HRB). Findings will be shared with the host trial team and study participants, and submitted for publication. Host trial registration ClinicalTrials.gov ( NCT04939649); EudraCT ( 2019-003109-92). Official title: Ketamine as an Adjunctive Therapy for Major Depression - A Randomised Controlled Trial: [KARMA-Dep (2)].
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Affiliation(s)
- John McCaffrey
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Masashi Terao
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Cathal McCaffrey
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Anna Igoe
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Orlaith Loughran
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Kelly McDonagh
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Sarah McDonogh
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Ellie Shackleton
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Emma Whooley
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Ana Jelovac
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
| | - Declan M. McLoughlin
- Department of Psychiatry, Trinity College Dublin, St. Patrick’s University Hospital, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Qualitative Research in Trials Centre (QUESTS), University of Galway, Galway, Ireland
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Vindrola-Padros C, Froghi F, Gopalan V, Maruthan S, Filipe H, McNeil M, Garcia SM, Davidson B. The integration of rapid qualitative research in clinical trials: reflections from the ward-based goal-directed fluid therapy (GDFT) in acute pancreatitis feasibility trial. Trials 2023; 24:227. [PMID: 36964583 PMCID: PMC10039605 DOI: 10.1186/s13063-023-07191-6] [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: 06/01/2022] [Accepted: 02/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND There has been an increase in the integration of qualitative studies in randomised controlled trials. The purpose of this article is to reflect on our experience of carrying out a rapid qualitative study during a feasibility trial of goal-directed fluid therapy (GDFT) in patients with acute pancreatitis, including our sharing of emerging findings and the use of these findings by the trial team. METHODS The study was designed as a rapid feedback evaluation and combined interviews with staff and patients who took part in the trial. FINDINGS The rapid qualitative study pointed to common problems in trial recruitment among multiple sites, where lack of engagement of clinical teams across sites might impact negatively on patient recruitment. The article describes how the use of rapid feedback loops can be used as the trial is ongoing to inform changes in implementation. It also covers the potential challenges of working rapidly and collaborative with the trial team. CONCLUSIONS Rapid feedback evaluations can be used to generate findings across all stages of trial design and delivery. Additional research is required to explore the implementation of this research design in other settings and trial designs.
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Affiliation(s)
- Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, 3Rd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Farid Froghi
- Division of Surgery & Interventional Sciences, University College London, London, UK
| | | | | | | | | | | | - Brian Davidson
- Division of Surgery & Interventional Sciences, University College London, London, UK
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