1
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Bell JAH, Kelly MT, Gelmon K, Chi K, Ho A, Rodney P, Balneaves LG. Gatekeeping in cancer clinical trials in Canada: The ethics of recruiting the "ideal" patient. Cancer Med 2020; 9:4107-4113. [PMID: 32314549 PMCID: PMC7300392 DOI: 10.1002/cam4.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 01/11/2023] Open
Abstract
Background Perspectives of clinical trial (CT) personnel on accrual to oncology CTs are relatively absent from the literature. This study explores CT personnel's experience recruiting patients to oncology CTs. Methods A qualitative study design was utilized. In‐depth, individual interviews with 12 oncology CT personnel were conducted, including six CT nurses and six physician‐investigators. Interviews were digitally recorded and transcribed verbatim. Data were subjected to thematic and ethical analysis to identify key concepts and themes. Results CT personnel reported considering two ethical commitments in CT recruitment: maintaining trial integrity and ensuring patient autonomy through obtaining informed consent. The process of gatekeeping emerged as a way to navigate these ethical commitments during CT accrual. Gatekeeping was influenced by: (a) perceptions of patients’ personal suitability for a trial, and (b) healthcare resources and infrastructure. CT personnel's discernment of personal suitability was influenced by patients’ cognitive and mental health status, language and cultural background, geographic location, family support, and disease status. Three structural factors impacted gatekeeping: complexity of CTs, consent process, and time limitations in the healthcare system. CT personnel experienced most factors as constraints to accrual and gaining patients’ informed consent. Conclusion CT personnel discussed navigating ethical challenges in CT recruitment by offering enrollment to specific patient populations, exacerbating other ethical tensions. Systems‐level strategies are needed to address barriers to ethical CT recruitment. Future research should investigate the role of policies and/or tools (eg, decision aids) to support patients and CT personnel's discussions about CT participation, promote more ethical recruitment, and potentially increase accrual.
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Affiliation(s)
- Jennifer A H Bell
- University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Karen Gelmon
- University of British Columbia, Vancouver, BC, Canada
| | - Kim Chi
- University of British Columbia, Vancouver, BC, Canada
| | - Anita Ho
- University of British Columbia, Vancouver, BC, Canada.,University of California, Oakland, CA, USA.,Centre for Health Evaluation & Outcomes Sciences, University of British Columbia, Vancouver, BC, Canada
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2
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Peng W, Occa A, McFarlane SJ, Morgan SE. A Content Analysis of the Discussions about Clinical Trials on A Cancer-dedicated Online Forum. JOURNAL OF HEALTH COMMUNICATION 2019; 24:912-922. [PMID: 31709917 DOI: 10.1080/10810730.2019.1688895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Enrollment rates of cancer clinical trials remain low, affecting the delivery of effective medical treatments. Recent research has documented common factors affecting trial participation, but to improve these efforts more studies are needed to further understand specific concerns and issues of potential participants in multiple contexts. Forums and other online peer-to-peer health communities are crucial to the coping and survivorship of cancer patients. Online health communities will offer valuable information to understand how patients discuss perceptions, motivations, and challenges associated with clinical trial participation, and to understand how patients provide support to each other. The present study conducted a content analysis of 270 posts shared by 154 unique users between August 2017 and January 2018 on a popular online breast cancer forum. The analysis identifies common characteristics of patient users, salient post themes, perceived barriers, emotions, and misconceptions regarding clinical trial participation. The study findings are generally consistent with previous studies but provide in-depth insights into online support between cancer patients about clinical trial participation. Implications for practice and future research are also discussed.
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Affiliation(s)
- Wei Peng
- School of Communication, University of Miami, Coral Gables, Florida, USA
| | - Aurora Occa
- Department of Communication, University of Kentucky, Lexington, Kentucky, USA
| | | | - Susan E Morgan
- School of Communication, University of Miami, Coral Gables, Florida, USA
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3
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Hlubocky FJ, Sachs GA, Larson ER, Nimeiri HS, Cella D, Wroblewski KE, Ratain MJ, Peppercorn JM, Daugherty CK. Do Patients With Advanced Cancer Have the Ability to Make Informed Decisions for Participation in Phase I Clinical Trials? J Clin Oncol 2018; 36:2483-2491. [PMID: 29985748 DOI: 10.1200/jco.2017.73.3592] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose Patients with advanced cancer (ACPs) participating in phase I clinical trials inadequately understand many elements of informed consent (IC); however, the prevalence and impact of cognitive impairment has not been described. Patients and Methods ACPs enrolled onto phase I trials underwent neuropsychological assessment to evaluate cognitive functioning (CF) covering the following domains: memory (Hopkins Verbal Learning Test), executive functioning (Trail Making Test B), language (Boston Naming Test-Short Version and Controlled Oral Word Association Test), attention (Trail Making Test A and Wechsler Adult Intelligenence Scale-IV Digit Span), comprehension (Wechsler Adult Intelligence Scale-IV), and quality of life (Functional Assessment of Cancer Therapy-Cognitive Function). Structured interviews evaluated IC and decisional capacity. Psychological measures included distress (Hospital Anxiety Depression Scale) and depression (Beck Depression Inventory-II). Results One hundred eighteen ACPs on phase I trials were evaluated, with CF ranging from mild impairment to superior performance. Only 45% of ACPs recalled physician disclosure of the phase I trial purpose. The 50% of ACPs who correctly identified the phase I research purpose had greater CF compared with ACPs who did not, as revealed by the mean T scores for memory (37.2 ± 5.6 v 32.5 ± 5.1, respectively; P = .001), attention (29 ± 2.7 v 26.9 ± 2.4, respectively; P < .001), visual attention (35.2 ± 6.6 v 31.5 ± 6.2, respectively; P = .001), and executive function (38.9 ± 7.5 v 34 ± 7.1, respectively; P < .001). Older ACPs (≥ 60 years) were less likely to recall physician disclosure of phase I purpose than younger ACPs (30% v 70%, respectively; P = .02) and had measurable deficits in total memory (34.2 ± 5.0 v 37.3 ± 5.6, respectively; P = .002), attention (24.5 ± 2.6 v 28 ± 2.8, respectively; P < .001), and executive function (32.8 ± 7.3 v 36.4 ± 7.6, respectively; P = .01). Older ACPs, compared with younger ACPs, also had greater depression scores (10.6 ± 9.2 v 8.1 ± 5.2, respectively; P = .03) and lower quality-of-life scores (152 ± 29.6 v 167 ± 20, respectively; P = .03). After adjustment by age, no psychological or neuropsychological variable was further significantly associated with likelihood of purpose identification. Conclusion CF seems to play a role in ACP recall and comprehension of IC for early-phase clinical trials, especially among older ACPs.
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Affiliation(s)
- Fay J Hlubocky
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Greg A Sachs
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Eric R Larson
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Halla S Nimeiri
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - David Cella
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Kristen E Wroblewski
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Mark J Ratain
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Jeffery M Peppercorn
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
| | - Christopher K Daugherty
- Fay J. Hlubocky, Kristen E. Wroblewski, Mark J. Ratain, and Christopher K. Daugherty, The University of Chicago, Chicago; Halla S. Nimeiri and David Cella, Northwestern University, Evanston, IL; Greg A. Sachs, Indiana University and Regenstrief Institute, Indianapolis, IN; Eric R. Larson, Department of Veterans Affairs, Milwaukee, WI; and Jeffery M. Peppercorn, Massachusetts General Hospital, Dana-Farber Partners/Harvard Health System, Boston, MA
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4
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Reid EA, Gudina EK, Ayers N, Tigineh W, Azmera YM. Caring for Life-Limiting Illness in Ethiopia: A Mixed-Methods Assessment of Outpatient Palliative Care Needs. J Palliat Med 2018; 21:622-630. [PMID: 29425055 DOI: 10.1089/jpm.2017.0419] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Palliative care aims to reduce physical suffering and the emotional, spiritual, and psychosocial distress of life-limiting illness. Palliative care is a human right, yet there are vast disparities in its provision: of the 40 million people globally in need of palliative care, less than 10% receive it, largely in high-income countries. There is a particular paucity of data on palliative care needs across the spectrum of incurable disease in Ethiopia. OBJECTIVES The aims of this research were to assess the overall burden of life-limiting illness, the costs associated with life-limiting illness, and barriers to accessing palliative care in Ethiopia. DESIGN Mixed-methods case-series. SETTING/SUBJECTS One hundred adults (mean age: 43.7 ± 14 years, 64% female) were recruited at three outpatient clinics (oncology, HIV, noncommunicable disease) and hospice patient homes in Ethiopia. MEASUREMENTS Four internationally validated questionnaires were used to assess physical symptoms, psychosocial distress, and disability. In-depth interviews gauged poverty level, costs of care, and end-of-life preferences. Qualitative data were analyzed by thematic content, quantitative data by standard descriptive, frequency and regression analyses. RESULTS In oncology, 95.5% of the population endorsed moderate or severe pain, while 24% were not prescribed analgesia. Importantly, 80% of the noncommunicable disease population reported moderate or severe pain. The mean psychosocial distress score was 6.4/10. Severe disability was reported in 26% of the population, with mobility most affected. Statistically significant relationships were found between pain and costs, and pain and lack of well-being. Very high costs were reported by oncology patients. Oncology withstanding, the majority of subjects wished to die at home. Oncology patients cited pain control as the top reason they preferred a hospital death. CONCLUSION There are extensive unmet palliative care needs in Ethiopia. Untreated pain and high costs of illness are the major contributors to psychosocial distress and financial crisis in this Ethiopian population.
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Affiliation(s)
- Eleanor Anderson Reid
- 1 Section of Global Health and International Emergency Medicine, Department of Emergency Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - Esayas Kebede Gudina
- 2 Department of Internal Medicine, Jimma University College of Health Sciences , Jimma, Ethiopia
| | - Nicola Ayers
- 3 Federal Ministry of Health , Addis Ababa, Ethiopia .,4 Hospice Ethiopia , Addis Ababa, Ethiopia
| | - Wondimagegnu Tigineh
- 5 Department of Oncology, Tikur Anbessa Hospital, Addis Ababa University College of Health Sciences , Addis Ababa, Ethiopia
| | - Yoseph Mamo Azmera
- 3 Federal Ministry of Health , Addis Ababa, Ethiopia .,4 Hospice Ethiopia , Addis Ababa, Ethiopia
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5
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Walker MS, Farria D, Schmidt M, Monsees B, Wiele K, Bokern J, Swatske ME. Educational Intervention for Women Undergoing Image-Guided Breast Biopsy: Results of a Randomized Clinical Trial. Cancer Control 2017; 14:380-7. [PMID: 17914338 DOI: 10.1177/107327480701400408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The process of informed consent has been examined for patients undergoing various procedures but not breast biopsy. Our study was a randomized trial that examined the effect of an educational flip chart as part of the informed consent. Methods A total of 122 patients referred for stereotactic or ultrasound-guided core breast biopsy were randomly assigned to receive an informed consent discussion with or without an illustrated flip chart. The chart included information about breast anatomy, pathology, and diagnostic procedures. Outcome measures included objective knowledge, subjective knowledge, anxiety, and satisfaction. Results Analysis showed few significant main effects of the intervention. However, results showed interactions between experimental condition and race/ethnicity, indicating that the intervention was effective in enhancing objective and subjective knowledge for African American but not Caucasian patients. Anxiety after consultation was higher among patients assigned to the flip chart condition, possibly because they were better informed about the risks of the procedure. Patients who underwent biopsy sooner after learning they needed one were more satisfied with their care. Conclusions The usual care consent process is effective for many but not all patients. Informed consent that employs visual aids may help overcome characteristics of the consent process that are ineffective for some patients.
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Affiliation(s)
- Mark S Walker
- Departments of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
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6
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Weinfurt KP. Discursive Versus Information-Processing Perspectives on a Bioethical Problem. THEORY & PSYCHOLOGY 2016. [DOI: 10.1177/0959354304042016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article discusses an example of how the adoption of different theoretical views of the person can have practical implications for the field of bioethics. Patients who agree to receive new medical treatments with little chance of benefit routinely report strong confidence that they will experience benefit. These ‘unrealistic’ expectations are interpreted as false beliefs about treatment, and thus as evidence that the informed consent process has failed. This interpretation of patient reports is consistent with an information-processing framework in which the patient is viewed as transmitting information that enjoys an independent existence in the mental machinery of the person. The perspective of discursive psychology, on the other hand, views the patients’ reports as activities undertaken to achieve specific aims within particular discursive contexts. It is argued that if bioethicists adopt the discursive perspective, some cases of ‘false belief’ might not pose a bioethical problem.
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7
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Politi MC, Kuzemchak MD, Kaphingst KA, Perkins H, Liu J, Byrne MM. Decision Aids Can Support Cancer Clinical Trials Decisions: Results of a Randomized Trial. Oncologist 2016; 21:1461-1470. [PMID: 27511904 DOI: 10.1634/theoncologist.2016-0068] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/13/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer patients often do not make informed decisions regarding clinical trial participation. This study evaluated whether a web-based decision aid (DA) could support trial decisions compared with our cancer center's website. METHODS Adults diagnosed with cancer in the past 6 months who had not previously participated in a cancer clinical trial were eligible. Participants were randomized to view the DA or our cancer center's website (enhanced usual care [UC]). Controlling for whether participants had heard of cancer clinical trials and educational attainment, multivariable linear regression examined group on knowledge, self-efficacy for finding trial information, decisional conflict (values clarity and uncertainty), intent to participate, decision readiness, and trial perceptions. RESULTS Two hundred patients (86%) consented between May 2014 and April 2015. One hundred were randomized to each group. Surveys were completed by 87 in the DA group and 90 in the UC group. DA group participants reported clearer values regarding trial participation than UC group participants reported (least squares [LS] mean = 15.8 vs. 32, p < .0001) and less uncertainty (LS mean = 24.3 vs. 36.4, p = .025). The DA group had higher objective knowledge than the UC group's (LS mean = 69.8 vs. 55.8, p < .0001). There were no differences between groups in intent to participate. CONCLUSIONS Improvements on key decision outcomes including knowledge, self-efficacy, certainty about choice, and values clarity among participants who viewed the DA suggest web-based DAs can support informed decisions about trial participation among cancer patients facing this preference-sensitive choice. Although better informing patients before trial participation could improve retention, more work is needed to examine DA impact on enrollment and retention. IMPLICATIONS FOR PRACTICE This paper describes evidence regarding a decision tool to support patients' decisions about trial participation. By improving knowledge, helping patients clarify preferences for participation, and facilitating conversations about trials, decision aids could lead to decisions about participation that better match patients' preferences, promoting patient-centered care and the ethical conduct of clinical research.
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Affiliation(s)
- Mary C Politi
- Division of Public Health Sciences, Department of Surgery and Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Marie D Kuzemchak
- Division of Public Health Sciences, Department of Surgery and Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Kimberly A Kaphingst
- Department of Communication and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Hannah Perkins
- Division of Public Health Sciences, Department of Surgery and Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery and Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Margaret M Byrne
- Department of Public Health Sciences, Department of Surgery and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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8
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Chang A. Nurses’ Perceptions of Phase I Clinical Trials in Pediatric Oncology: A Review of the Literature. J Pediatr Oncol Nurs 2016; 21:343-9. [PMID: 15475471 DOI: 10.1177/1043454204270252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A review of literature was conducted to explore nurses’ perceptions of phase I clinical trials in pediatric oncology. Specifically, nurses’ perceptions of the goals and outcomes, the nurse’s role, and the informed consent process in pediatric oncology phase I clinical trials were investigated. Findings on possible factors influencing the nurses’ perceptions and the quality of work-life of nurses working at pediatric phase I clinical trial centers were also searched. However, despite an extensive review of published works, no studies on nurses’ perceptions of phase I trials in pediatric oncology were found. Therefore, this literature review consists of findings in similar or related studies such as nurses’ perceptions of experimental therapies in the adult setting, adult patients’ perceptions, parents’ perceptions, or oncologists’perceptions of phase I clinical trials.
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Affiliation(s)
- Ann Chang
- Haematology/Oncology/BMT/Immunology Program at the Hospital for Sick Children, Toronto, Ontario, Canada.
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9
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Kao CY, Aranda S, Krishnasamy M, Hamilton B. Interventions to improve patient understanding of cancer clinical trial participation: a systematic review. Eur J Cancer Care (Engl) 2016; 26. [PMID: 26786388 DOI: 10.1111/ecc.12424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
Patient misunderstanding of cancer clinical trial participation is identified as a critical issue and researchers have developed and tested a variety of interventions to improve patient understanding. This systematic review identified nine papers published between 2000 and 2013, to evaluate the effects of interventions to improve patient understanding of cancer clinical trial participation. Types of interventions included audio-visual information, revised written information and a communication training workshop. Interventions were conducted alone or in combination with other forms of information provision. The nine papers, all with methodological limitations, reported mixed effects on a small range of outcomes regarding improved patient understanding of cancer clinical trial participation. The methodological limitations included: (1) the intervention development process was poorly described; (2) only a small element of the communication process was addressed; (3) studies lacked evidence regarding what information is essential and critical to enable informed consent; (4) studies lacked reliable and valid outcome measures to show that patients are sufficiently informed to provide consent; and (5) the intervention development process lacked a theoretical framework. Future research needs to consider these factors when developing interventions to improve communication and patient understanding during the informed consent process.
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Affiliation(s)
- C Y Kao
- Department of Nursing, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, University of Melbourne, Melbourne, Vic., Australia
| | - S Aranda
- Department of Nursing, University of Melbourne, Melbourne, Vic., Australia.,Cancer Council Australia, Sydney, NSW, Australia
| | - M Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - B Hamilton
- Department of Nursing, University of Melbourne, Melbourne, Vic., Australia
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10
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Peay HL, Scharff H, Tibben A, Wilfond B, Bowie J, Johnson J, Nagaraju K, Escolar D, Piacentino J, Biesecker BB. "Watching time tick by…": Decision making for Duchenne muscular dystrophy trials. Contemp Clin Trials 2015; 46:1-6. [PMID: 26546066 DOI: 10.1016/j.cct.2015.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/28/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This interview study explored clinicians' perspectives and parents' decision making about children's participation in Duchenne muscular dystrophy (DMD) clinical trials. METHODS Data from semi-structured interviews conducted with clinicians and parents in U.S. or Canada were assessed using thematic analysis. RESULTS Eleven clinicians involved in ten trials and fifteen parents involved in six trials were interviewed. Parents described benefit-risk assessments using information from advocacy, peers, professionals, and sponsors. Strong influence was attributed to the progressive nature of DMD. Most expected direct benefit. Few considered the possibility of trial failure. Most made decisions to participate before the informed consent (IC) process, but none-the-less perceived informed choice with little to lose for potential gain. Clinicians described more influence on parental decisions than attributed by parents. Clinicians felt responsible to facilitate IC while maintaining hope. Both clinicians and parents reported criticisms about the IC process and regulatory barriers. CONCLUSIONS The majority of parents described undertaking benefit-risk assessments that led to informed choices that offered psychological and potential disease benefits. Parents' high expectations influenced their decisions while also reflecting optimism. Clinicians felt challenged in balancing parents' expectations and likely outcomes. Prognosis-related pressures coupled with decision making prior to IC suggest an obligation to ensure educational materials are understandable and accurate, and to consider an expanded notion of IC timeframes. Anticipatory guidance about potential trial failure might facilitate parents' deliberations while aiding clinicians in moderating overly-optimistic motivations. Regulators and industry should appreciate special challenges in progressive disorders, where doing nothing was equated with doing harm.
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Affiliation(s)
- Holly L Peay
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA; Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Hadar Scharff
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Janice Bowie
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Barbara B Biesecker
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA
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11
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Pawlowski J, Malik L, Mahalingam D. Advanced Cancer Patients' Understanding and Perceptions of Phase I Clinical Trials. Cancer Invest 2015; 33:490-5. [PMID: 26460889 DOI: 10.3109/07357907.2015.1069833] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This questionnaire-based study assessed the understanding and perceptions of cancer patients who were participating in a Phase I clinical trial at baseline and determined any changes after enrollment. Thirty-six patients participated. Less than one-third of respondents (28.5%) thought the purpose of Phase I trials was dose escalation for safety and efficacy. Patients anticipated varying degree of therapeutic benefit ranging from stable disease (47.1%) to complete shrinkage of the tumor (32.4%). No change in measured themes was observed. Patients participating in Phase I trials need further education to improve their understanding of the true intent of early Phase trials.
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Affiliation(s)
- Jamie Pawlowski
- a Department of Medicine, Division of Hematology/Oncology , University of Texas Health Science Center , San Antonio , TX , USA
| | - Laeeq Malik
- a Department of Medicine, Division of Hematology/Oncology , University of Texas Health Science Center , San Antonio , TX , USA.,b Institute for Drug Development , University of Texas Health Science Center , San Antonio , TX , USA.,c Cancer Therapy and Research Center , University of Texas Health Science Center , San Antonio , TX , USA
| | - Devalingam Mahalingam
- a Department of Medicine, Division of Hematology/Oncology , University of Texas Health Science Center , San Antonio , TX , USA.,b Institute for Drug Development , University of Texas Health Science Center , San Antonio , TX , USA.,c Cancer Therapy and Research Center , University of Texas Health Science Center , San Antonio , TX , USA
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12
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Tait AR, Voepel-Lewis T, Levine R. Using digital multimedia to improve parents' and children's understanding of clinical trials. Arch Dis Child 2015; 100:589-93. [PMID: 25829422 PMCID: PMC4439345 DOI: 10.1136/archdischild-2014-308021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/08/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Data show that many research subjects have difficulty understanding study information using traditional paper consent documents. This study, therefore, was designed to evaluate the effect of an interactive multimedia program on improving parents' and children's understanding of clinical trial concepts and participation. METHODS Parents (n=148) and children (n=135) were each randomised to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with inline exercises. Participants' understanding of the information was assessed using semistructured interviews prior to (pretest) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of information delivery and satisfaction with the process. RESULTS Regardless of the mode of information delivery, all participants demonstrated improved pretest to post-test understanding. While there were no statistical differences in parents' post-test understanding between the TF and IP groups, children in the IP group had significantly greater post-test understanding compared with children in the TF group (11.65 (4.1) vs 8.85 (4.1) (2.8, 1.4, 4.2) 0-18 scale where 18=complete understanding). Furthermore, the IP was found to be significantly 'easier to follow' and 'more effective' in presenting information compared with the TF. CONCLUSIONS Results demonstrated the importance of providing information regarding clinical trial concepts to parents and children. Importantly, the ability of interactive multimedia to improve understanding of clinical trial concepts and satisfaction with information delivery, particularly among children, supports this approach as a novel and effective vehicle for enhancing the informed consent process.
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Affiliation(s)
- Alan R. Tait
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor MI,Center for Bioethics and Social Sciences in Medicine, University of Michigan
| | - Terri Voepel-Lewis
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor MI
| | - Robert Levine
- Emergency Care Center, Jackson Memorial Hospital, Miami, FL,ArchieMD, Inc., Boca Raton, FL
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Malik L, Kuo J, Yip D, Mejia A. How well informed is the informed consent for cancer clinical trials? Clin Trials 2014; 11:686-8. [PMID: 25135910 DOI: 10.1177/1740774514548734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The purpose of this study was to analyze the content of informed consent forms for clinical trials in medical oncology to assess readability, determine their completeness, and identify any shortcomings. METHODS Informed consent forms for Phase I-III studies that were conducted at two tertiary care cancer centers over a 3-year period were reviewed. Information pertaining to length of the informed consent form, research regimen/methods, treatment agent, potential risks, and benefits was extracted. The reading level was assessed by Flesch-Kincaid and Gunning-Fog index readability tests. RESULTS All of the 112 informed consent forms clearly stated the voluntary nature of participation. Nearly one half of the forms (51.8%) were of Phase I studies. The median length of informed consent form was 20 pages (range: 8-28). A detailed estimation of the frequency or intensity of risks (range: 3-8 pages) was provided. The average reading level of the informed consent forms was high (Flesch-Kincaid Grade Level of 9.8), which corresponds roughly to 10th-grade reading level. Less than 15% of all consent forms were written at the recommended eighth-grade reading level. A substantial number of forms did not report a potential risk to pregnant/lactating women (16.9%), mechanism of action of the investigational agent (34.8%), study schema (77.6%), a possibility of receiving sub-therapeutic dose (37%), or death (12.5%). Nearly one half of the forms (49.1%) stated clearly that individual participants may not benefit. CONCLUSION Overall, these informed consent forms provided a detailed description of the trials in accordance to international guidelines. However, there remains room for improvement, particularly in areas of readability and document length.
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Affiliation(s)
- Laeeq Malik
- Institute for Drug Development, Cancer Therapy & Research Center, The University of Texas Health Science Center, San Antonio, TX, USA
| | - James Kuo
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia ANU Medical School, Australian National University, Acton, ACT, Australia
| | - Alex Mejia
- Institute for Drug Development, Cancer Therapy & Research Center, The University of Texas Health Science Center, San Antonio, TX, USA
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Malik L, Mejia A. Informed consent for phase I oncology trials: form, substance and signature. J Clin Med Res 2014; 6:205-8. [PMID: 24734147 PMCID: PMC3985563 DOI: 10.14740/jocmr1803w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Federal regulations state consent information should be understandable to participants; concerns have been voiced about the quality of informed consent forms (ICFs) in oncology trials. METHODS The content of ICFs for phase I studies that were conducted at a tertiary care cancer center over 3 years' period was reviewed. Information pertaining to the length of the ICF, description of study purpose, research regimen/methods, treatment agent, potential risks, benefits and alternatives to the research was extracted. RESULTS In total, 54 ICFs for phase I trials approved by the local Institutional Review Board were reviewed. Median length of ICF was 20 pages. Nearly one half of the forms (57.4%) were of first-in-human phase I studies. The main goal of research was explicitly stated as safety testing in 59.2% forms, while 37.1% studies described primary objective as dose finding. All of the forms identified serious risks, unexpected risks, possibility of death and risks to pregnant and or lactating women. A detailed estimation of the frequency or intensity of risks (range 3-8 pages) was provided qualitatively or quantitatively if known. Information regarding mechanism of action of investigational agent, study schema, dose escalation, loss of time/energy and possibility of receiving sub-therapeutic dose was missing in significant number of forms. CONCLUSION We found that these ICFs were compliant with approved guidelines and provided a thorough description of risks or potential benefits. However, there still remains room for improvement, so patients can make better informed decisions.
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Affiliation(s)
- Laeeq Malik
- Institute for Drug Development, Cancer Therapy and Research Center (CTRC), University of Texas Health Science Center, San Antonio, TX, USA
| | - Alex Mejia
- Institute for Drug Development, Cancer Therapy and Research Center (CTRC), University of Texas Health Science Center, San Antonio, TX, USA
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Sanchini V, Reni M, Calori G, Riva E, Reichlin M. Informed consent as an ethical requirement in clinical trials: an old, but still unresolved issue. An observational study to evaluate patient's informed consent comprehension. JOURNAL OF MEDICAL ETHICS 2014; 40:269-75. [PMID: 23728419 DOI: 10.1136/medethics-2012-101115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We explored the comprehension of the informed consent in 77 cancer patients previously enrolled in randomised phase II or phase III clinical trials, between March and July 2011, at the San Raffaele Scientific Institute in Milano. We asked participants to complete an ad hoc questionnaire and analysed their answers. Sixty-two per cent of the patients understood the purpose and nature of the trial they were participating in; 44% understood the study procedures and 40% correctly listed at least one of the major risks or complications related to their participation in the trial. We identified three factors associated with comprehension of the informed consent: age, education and type of tumour/investigator team. We suggest several possible improvements of how to obtain informed consent that will increase patient awareness, as well as the validity and effectiveness of the clinical trials.
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Gregg JR, Horn L, Davidson MA, Gilbert J. Patient enrollment onto clinical trials: the role of physician knowledge. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:74-79. [PMID: 24163050 DOI: 10.1007/s13187-013-0548-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sixty-six attending physicians at academic medical centers completed a 43-question self-assessment evaluating communication skills, comfort with clinical trial enrollment, and knowledge of patient-related barriers to enrollment on clinical trials. Responses and demographic information were analyzed for trends and for association with estimated trial enrollment. Physician-described enrollment of patients onto trials varied widely, with estimated enrollment varying from less than 5 patients to well over 125 enrolled during the previous year. Participants perceived themselves to have excellent communication skills and were comfortable with the trial enrollment process, though did not consistently identify patient-related barriers to enrollment. Physician knowledge of clinical trials currently enrolling within their field was associated with increased patient enrollment on study (p = 0.03). Academic physicians expressed confidence in their skills related to clinical trial enrollment despite less than ideal reported enrollment. Knowledge of clinical trials currently enrolling within a physician's specialty was associated with estimated patient enrollment, and may represent a correctable barrier to trial enrollment.
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Affiliation(s)
- Justin R Gregg
- Department of Urologic Surgery, Vanderbilt University Medical Center, A - 1302 Medical Center North, Nashville, TN, 37232-2765, USA,
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Scott J. Therapeutic misconceptions and misestimations in oncology: a clinical trial nurse's guide. Clin J Oncol Nurs 2013; 17:486-9. [PMID: 24080047 DOI: 10.1188/13.cjon.486-489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Therapeutic misconceptions and misestimations occur frequently in oncology clinical trials and can potentially compromise informed consent. Despite the increased awareness of these issues in medical literature, many practitioners and nurses continue to be unfamiliar with these concepts. This article will define therapeutic misconceptions and misestimations, explore contributing factors, and explain how they can be prevented by clinical trial nurses.
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Affiliation(s)
- Jennifer Scott
- Cancer Treatment Center, Saint Francis Medical Center, Grand Island, NE
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Koyfman SA, Agre P, Carlisle R, Classen L, Cheatham C, Finley JP, Kuhrik N, Kuhrik M, Mangskau TK, O'Neill J, Reddy CP, Kodish E, McCabe MS. Consent form heterogeneity in cancer trials: the cooperative group and institutional review board gap. J Natl Cancer Inst 2013; 105:947-53. [PMID: 23821757 DOI: 10.1093/jnci/djt143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cooperative group (CG) provided consent forms (CGP-CFs) undergo re-review and revision by local institutional review boards (IRB) before institutional approval. We compared the relative readability and length of IRB-approved consent forms (IRB-CFs) used at seven academic institutions with their corresponding CGP-CFs. We also assessed the variability of these metrics across our institutions. METHODS This study included 197 consent forms (CFs) from 56 CG trials that were open in at least two of the participating institutions. The Flesch Reading Ease Score (FRES), the Flesch-Kincaid Grade Level (FKGL), and document length were collected on all CFs. Unpaired t test was used to compare length and readability of CGP-CF with the IRB-CF. Analysis of variance and Bonferroni-Dunn tests were used to assess interinstitutional variability in readability for all IRB-CFs. All statistical tests were two-sided. RESULTS IRB-CFs were statistically significantly longer than CGP-CFs (mean number of pages = 17 vs 13; P < .001). Mean FKGLs were higher (10.3 vs 9.4; P < .0001) and the mean FRESs were lower (53.1 vs 57.1; P < .0001) for IRB-CFs compared with CGP-CFs. Readability varied statistically significantly between institutions for all sections of the IRB-CF (P < .0001). Finalized IRB-CFs for identical clinical trials at different institutions demonstrated substantial heterogeneity of readability and length. CONCLUSIONS As CFs progress from National Cancer Institute (NCI)-sponsored CGs to local IRBs, they seem to become longer and less readable. Interinstitutional heterogeneity in CF readability is substantial and widespread. More consistent adherence to CGP-CFs based on the newly revised NCI CF template with minimal modification by local IRBs should help simplify and standardize CFs used in cancer clinical trials.
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Affiliation(s)
- Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA.
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Abstract
BACKGROUND As therapy for non-small-cell lung cancer (NSCLC) patients becomes more personalized, additional tissue in the form of core-needle biopsies (CNBs) for biomarker analysis is increasingly required for determining appropriate treatment and for enrollment into clinical trials. We report our experience with small-caliber percutaneous transthoracic (PT) CNBs for the evaluation of multiple molecular biomarkers in BATTLE (biomarker-integrated approaches of targeted therapy for lung cancer elimination), a personalized, targeted therapy NSCLC clinical trial. METHODS The medical records of patients who underwent PTCNB for consideration of enrollment in BATTLE were reviewed for diagnostic yield of 11 predetermined molecular markers and procedural complications. Univariate and multivariate analyses of factors related to patient and lesion characteristics were performed to determine possible influences on diagnostic yield. RESULTS One hundred and seventy PTCNBs were performed using 20-gauge biopsy needles in 151 NSCLC patients screened for the trial. The biopsy specimens of 82.9% of the patients were found to have adequate tumor tissue for analysis of the required biomarkers. On multivariate analysis, metastatic lesions were 5.4 times more likely to yield diagnostic tissue as compared with primary tumors (p = 0.0079). Pneumothorax and chest tube insertion rates were 15.3% and 9.4%, respectively. CONCLUSIONS Image-guided 20-gauge PTCNB is safe and provides adequate tissue for analysis of multiple biomarkers in the majority of patients being considered for enrollment into a personalized, targeted therapy NSCLC clinical trial. Metastatic lesions are more likely to yield diagnostic tissue as compared with primary tumors.
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Godskesen T, Nygren P, Nordin K, Hansson M, Kihlbom U. Phase 1 clinical trials in end-stage cancer: patient understanding of trial premises and motives for participation. Support Care Cancer 2013; 21:3137-42. [DOI: 10.1007/s00520-013-1891-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
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Kanarek NF, Kanarek MS, Olatoye D, Carducci MA. Removing barriers to participation in clinical trials, a conceptual framework and retrospective chart review study. Trials 2012; 13:237. [PMID: 23227880 PMCID: PMC3551829 DOI: 10.1186/1745-6215-13-237] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 11/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enrollment in interventional therapeutic clinical trials is a small fraction of all patients who might participate given reasonable access. METHODS A hierarchical approach is utilized in measuring staged participation from trial availability to patient enrollment. Our framework suggests that concern for justice comes in the design and eligibility criteria for clinical trials; attention to beneficence is given in the eligibility and physician triage stages. The remaining four stages rely on respect for persons. An example is given where reasons for nonparticipation or barriers to participation in prostate cancer clinical trials are examined within the framework. In addition, medical oncology patients with an initial six month consultation are tracked from one stage to the next by race using the framework to assess participation comparability. RESULTS We illustrated seven transitions from being a patient to enrollment in a clinical trial in a small study of prostate cancer cases who consulted SKCCC Medical Oncology Department in early 2010. Pilot data suggest transition probabilities as follows: 65% availability, 84% eligibility, 92% patient triage, 89% trials discussed, 45% patient interested, 63% patient consented, and 92% patient enrolled. The average transition probability was 77.7%. The average transition probability, patient-trial-fit was 50%; opportunity was 51%, and acceptance was 66.7%. Trial availability, patient interest and patient consented were three transitions that were below the average; none were statistically significant. CONCLUSIONS The framework may serve to streamline comprehensive reporting of clinical trial participation to the benefit of patients and the ethical conduct of clinical trials.
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Affiliation(s)
- Norma F Kanarek
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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22
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Politi MC, Lewis CL, Frosch DL. Supporting shared decisions when clinical evidence is low. Med Care Res Rev 2012; 70:113S-128S. [PMID: 23124616 DOI: 10.1177/1077558712458456] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is growing interest in shared decision making (SDM) in the United States and globally, at both the clinical and policy levels. SDM is typically employed during "preference-sensitive" decisions, where there is equipoise between treatment options with equal or similar outcomes from a medical standpoint. In these situations, patients' preferences for the possible risks, benefits, and trade-offs between options are central to the decision. However, SDM also may be appropriate in clinical situations besides those in which data demonstrate equipoise. In situations of low evidence, where evidence is conflicting, unavailable or not applicable to an individual patient, supporting SDM can present unique challenges, above and beyond the challenges faced during more standard preference-sensitive decisions. This article discusses challenges in supporting shared decisions when clinical evidence is low, describes strategies that can facilitate SDM despite low evidence, and suggests avenues for future research to explore further these proposed strategies.
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Affiliation(s)
- Mary C Politi
- Department of Surgery, Division of Public Health Sciences, Washington University in St Louis, St Louis, MO 63110, USA.
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Flamm AL, Pentz RD. Communicating about phase I trials: objective disclosures are only a first step. Oncologist 2012; 17:466-8. [PMID: 22491003 DOI: 10.1634/theoncologist.2012-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ippoliti R. Clinical research, an empirical work on the European market of human experimentation. J Public Health (Oxf) 2011. [DOI: 10.1007/s10389-011-0472-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pedersen ER, Neighbors C, Tidwell J, Lostutter T. Do undergraduate student research participants read psychological research consent forms? Examining memory effects, condition effects, and individual differences. ETHICS & BEHAVIOR 2011; 21:332-350. [PMID: 23459667 DOI: 10.1080/10508422.2011.585601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While research has examined factors influencing understanding of informed consent in biomedical and forensic research, less is known about participants' attention to details in consent documents in psychological survey research. The present study used a randomized experimental design and found the majority of participants were unable to recall information from the consent form in both in-person and online formats. Participants were also relatively poor at recognizing important aspects of the consent form including risks to participants and confidentiality procedures. Memory effects and individual difference characteristics also appeared to influence recall and recognition of consent form information.
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Sheikhtaheri A, Farzandipour M. Factors Associated with Quality of Informed Consent in Patients Admitted for Surgery: An Iranian Study. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/21507716.2010.528507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Arai RJ, Mano MS, de Castro G, Del Pilar Estevez Diz M, Hoff PMG. Building research capacity and clinical trials in developing countries. Lancet Oncol 2010; 11:712-3. [DOI: 10.1016/s1470-2045(10)70168-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Satisfaction with the decision to participate in cancer clinical trials is high, but understanding is a problem. Support Care Cancer 2010; 19:371-9. [PMID: 20333413 DOI: 10.1007/s00520-010-0829-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 01/25/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND Partially presented in poster format at the 40th and 41st Annual Meetings of the American Society of Clinical Oncology, held in 2004 in New Orleans, Louisiana and in 2005 in Orlando, Florida. PURPOSE We aimed to: (a) assess patient knowledge about cancer clinical trials (CCT) and satisfaction with their decision to participate, (b) determine whether satisfaction correlates with objective understanding, or other factors, and (c) identify correlates of increased understanding. METHODS A convenience sample of 100 patients were recruited. Instruments assessed quality of informed consent (QuIC), quality of life (EORTC QLQ C-30), anxiety and depression (HADS), and preferences for information and involvement in decision making. Measures were completed within 2 weeks of clinical trial enrollment. RESULTS One hundred two patients (68 male) with a median age of 58.4 years (29-85) were registered in 27 of the 33 therapeutic cancer clinical trials approved for the Consent Study. Mean QuIC objective knowledge (QuIC-A) was 77.6 (/100) (95% CI, 75.7-79.4) and perceived (subjective) understanding (QuIC-B) 91.5 (95% CI, 89.6-93.3). There was low but significant correlation between QuIC-A and B (R = 0.26, p = 0.008). Satisfaction was very high. Correlation between QuIC-B and satisfaction was moderate (0.430, p < 0.001). QuIC-B, but not QuIC-A was associated with QOL scores. Preferences regarding participation in decision making and whether these preferences were achieved did not impact upon knowledge, understanding or satisfaction. CONCLUSIONS Patient knowledge regarding CCT is similar to published US data, and satisfaction is high. Satisfaction correlates with perceived but not objective understanding of CCT. Strategies to further improve the consent process need to be developed.
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[Motivation of patients to participate in clinical trials. An explorative survey]. ACTA ACUST UNITED AC 2010; 105:73-9. [PMID: 20174906 DOI: 10.1007/s00063-010-1016-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Difficulties in recruiting patients for clinical trials lead to increasing costs, and prolonged implementation of evidences into medical practice. Knowledge about motivation and barriers in potential participants would be helpful to develop successful recruitment strategies. Currently, no systematic research of determining factors affecting the decision to participate in clinical studies is available from German samples. METHODS After been given details about a potential participation in a clinical or diagnostic study in nine study centers, patients were recruited for an additional structured questionnaire survey concerning motivation and barriers to participation. RESULTS 62 patients were included into the survey. 95.1% did not have any experience with clinical studies before. 66.1% met the physician explaining the study and asking for informed consent for the first time. Despite this, 96.6% judged the physician to be competent. Family and friends were important for decision-making about the participation in a study. Gender was only of marginal influence. The majority of patients (91.4%) expected advantages of the study for their own. 88% of the patients denominated potential advantages for other patients as an additional motivator. The possibility of adverse events was inferior for patients in decision-making about participation in a clinical trial. CONCLUSION Physicians recruiting patients for clinical studies should be well prepared about details of the study and should have adequate time for an introductory conversation in a quiet environment. Including relatives into the introductory conversation may enhance the motivation and therefore the success of recruitment. Potential advantages of a participation for the own treatment and additionally for other patients should be highlighted. Possible side effects should be explained in a realistic manner.
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Affiliation(s)
- Stacey L Berg
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA.
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Abstract
Recent guidance from the Food and Drug Administration supports the conduct of a new type of exploratory clinical trial, commonly called phase 0 clinical trials. Proponents argue that phase 0 clinical trials have the potential to expedite the development of new oncology drugs while exposing fewer research subjects to the risks of experimental treatments. At the same time, phase 0 oncology trials raise important ethical concerns that have received little attention. In particular, there is a question of whether it is ethical to enroll individuals in research that offers them no potential for clinical benefit. Further concern focuses on the inclusion of terminally ill and consequently vulnerable cancer patients in these trials. To evaluate these concerns, this article considers relevant empirical data from phase 1 oncology trials and develops several recommendations regarding the conduct of phase 0 clinical trials in oncology.
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Affiliation(s)
- Emily Abdoler
- Department of Bioethics, NIH Clinical Center, Bethesda Maryland, USA
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Impediments to obtaining informed consent for clinical research in trauma patients. ACTA ACUST UNITED AC 2008; 64:1106-12. [PMID: 18404082 DOI: 10.1097/ta.0b013e318165c15c] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Informed consent is required for, but a substantial barrier to, clinic research in trauma care. Exceptions have been established but remain controversial, and little objective data are available to illuminate this debate. METHODS We prospectively assessed 2,011 consecutive patients admitted to the R Adams Cowley Shock Trauma Center of the University of Maryland Medical System for the potential to give consent for a hypothetical research trial within 1 hour of admission or whether consent could be obtained from a legally authorized representative (LAR) within 3 hours. These data were then linked with demographic, transport, physiologic, and injury data. RESULTS Complete data were available for 1,734 patients: 982 (57%) appeared able to consent and 752 (43%) appeared unable to consent. Of the latter, LAR consent was potentially available for 404, leaving 348 (46%, 20% of all admissions) unconsentable. Those apparently able to consent were significantly less injured than those unable, but a third were subsequently found to have objective barriers to giving consent, and a further third had findings strongly suggestive of impairment. For those unable to consent, subsequent LAR consent was strongly associated with being a minor or being a woman. Lack of LAR consent was strongly associated with being the victim of intentional injury, with being an African-American male and-for European-American men only-with being transported greater distances. CONCLUSIONS Severely injured trauma patients can seldom provide consent for research studies, and LARs are often unavailable. Further efforts to develop workable mechanisms for exception from informed consent are justified.
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Knifed E, Lipsman N, Mason W, Bernstein M. Patients' perception of the informed consent process for neurooncology clinical trials. Neuro Oncol 2008; 10:348-54. [PMID: 18388256 DOI: 10.1215/15228517-2008-007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The informed consent process is a cornerstone of modern medical research. This study was conducted to explore the process in the context of neurooncology clinical trials. Qualitative methodology and analysis were used on open-ended, face-to-face interviews conducted with 21 patients. Six comprehensive themes emerged: (1) general understanding of the objectives and purpose of clinical trials was good, (2) recall of risks was low, (3) patients did not believe that their care would be compromised by forgoing the clinical trial, (4) patients felt participation was voluntary and free of coercion, (5) patients would not have withdrawn from the trial in the event of complications, and (6) patients were satisfied with the informed consent process. Informed consent is a dynamic process; when appropriately executed, it can be a powerful safeguard protecting patient autonomy. If sufficient time is allowed to deliberate participation and ample opportunity is provided for information sharing and disclosure, researchers can be confident that participants are knowledgeable about the trial and aware of their rights.
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Affiliation(s)
- Eva Knifed
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
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Italiano A, Massard C, Bahleda R, Vataire AL, Deutsch E, Magné N, Pignon JP, Vassal G, Armand JP, Soria JC. Treatment outcome and survival in participants of phase I oncology trials carried out from 2003 to 2006 at Institut Gustave Roussy. Ann Oncol 2008; 19:787-92. [DOI: 10.1093/annonc/mdm548] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Clinical research has led to great advances in cancer therapy for children, and a greater proportion of children than adults with cancer participate in clinical trials. Despite this success, there remain important ethical challenges in conducting this research. There are challenges in obtaining informed consent and assent when children are research subjects; challenges arising from study design issues in phase III, II, or I clinical trials; and challenges related to the development of new classes of drugs, especially molecularly targeted therapies. It is important for researchers and clinicians to understand these challenges so that progress in cancer treatment is achieved in a sound ethical and regulatory fashion.
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Affiliation(s)
- Stacey L Berg
- Texas Children's Cancer Center, 6621 Fannin Street, MC3-3320, Houston, Texas 77030, USA.
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36
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Umutyan A, Chiechi C, Beckett LA, Paterniti DA, Turrell C, Gandara DR, Davis SW, Wun T, Chen MS, Lara PN. Overcoming barriers to cancer clinical trial accrual: impact of a mass media campaign. Cancer 2008; 112:212-9. [PMID: 18008353 DOI: 10.1002/cncr.23170] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Annually, only 3% of adult patients participate in cancer clinical trials (CCT). Accrual barriers include lack of CCT awareness and uncertain third-party coverage. In 2002, a California law (SB37) required all insurers to reimburse costs related to CCT. The objective of the current study was to increase awareness of CCT and SB37 through a mass multimedia campaign (MMC) in the University of California (UC) Davis (UCD) Cancer Center catchment area. The authors assessed willingness to participate in and accrual to CCT. METHODS Changes in CCT/SB37 awareness and willingness to participate were investigated before the MMC versus after the MMC and in UCD respondents versus UC San Diego (UCSD) catchment respondents-a control group that was not exposed to the MMC-by Pearson chi-square and logistic regression analyses. RESULTS Of 1081 post-MMC respondents, 957 were from UCD, and 124 from UCSD. UCD respondents had a greater awareness of CCT (59% vs 65%; P < .01) and SB37 (17% vs 32%; P < .01) compared with UCSD respondents. Willingness to participate did not change in either cohort. Awareness level predicted willingness (odds ratio, 2.3; P < .01). Blacks, Asians, and lowest income (<$25 K per year) groups were the least willing to participate (P < .01, P < .04, and P < .02, respectively). The CCT accrual rate at UCD was unchanged. CONCLUSIONS CCT and SB37 awareness increased significantly in the UCD cohort after the MMC. However, it was unclear whether this increase was attributable entirely to the MMC or to varying demographic variables. Enhancing patient willingness and accrual will require targeting other variables, such as physician or resource barriers, rather than just CCT and reimbursement awareness.
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Affiliation(s)
- Ari Umutyan
- University of California Davis Cancer Center, Sacramento, California 95817, USA
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Eggly S, Albrecht TL, Harper FWK, Foster T, Franks MM, Ruckdeschel JC. Oncologists' recommendations of clinical trial participation to patients. PATIENT EDUCATION AND COUNSELING 2008; 70:143-148. [PMID: 17983722 PMCID: PMC2248277 DOI: 10.1016/j.pec.2007.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 09/22/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the frequency, context and type of oncologists' recommendations to patients that they participate in a clinical trial and to analyze the relationship between recommendations and patients' decisions to participate. METHODS Data included 38 video recorded outpatient interactions during which 15 oncologists invited 38 patients to participate in clinical trials. We described the frequency, context, and type of oncologists' recommendations and analyzed the relationship between these factors and patient decisions to participate and socio-demographic characteristics. RESULTS Sixty-eight percent (n=26) of the 38 interactions included an explicit recommendation. Most recommendations were unprompted by patients and/or companions and were tailored to individual patients. A significant relationship was found between recommendations and patients' decisions to participate. Positive trends were found between receiving a recommendation and being female and having higher education. CONCLUSION Oncologists routinely make recommendations to patients during the presentation of clinical trials. These recommendations may influence patients' decisions and may occur more frequently with some demographic groups. PRACTICE IMPLICATIONS Oncologists should be aware of the potential influence of their recommendations when discussing clinical trials with patients.
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Affiliation(s)
- Susan Eggly
- Program in Communication and Behavioral Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48201, USA.
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38
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Chanaud CM. Determination of required content of the informed consent process for human participants in biomedical research conducted in the U.S. A practical tool to assist clinical investigators. Contemp Clin Trials 2007; 29:501-6. [PMID: 18249042 DOI: 10.1016/j.cct.2007.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 11/23/2007] [Accepted: 11/27/2007] [Indexed: 11/18/2022]
Abstract
Clinical Investigators conducting biomedical research involving human participants in the U.S. are responsible for the content of the consent document(s) and for the conduct of the informed consent conference(s) with the human participants. The content of the consent forms and consent process may be governed by two different sets of U.S. regulations and may be impacted upon by separate, generally accepted, international guidelines. It can be difficult and confusing for an Investigator to determine which set(s) of regulations or guidelines apply to which studies. This article compares the two sets of U.S. regulations and two sets of well-respected international guidelines with respect to their requirements for the content of the consent document and consent conference. A practical decision tree is proposed as a tool to assist Investigators in determining which set(s) of requirements is applicable to a particular study.
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39
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Agrawal M, Hampson LA, Emanuel EJ. Ethics of Clinical Oncology Research. Oncology 2007. [DOI: 10.1007/0-387-31056-8_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
This study examines the informed consent process from the perspective of intensive care patients. Using the largest single-method database of patient-derived information in the United States, we systematically outlined and tested several key factors that influence patient evaluations of the intensive care unit (ICU) informed consent process. Measures of information, understanding, and decision-making involvement were found to predict overall patient satisfaction and patient loyalty intentions. Specific actions supportive of ICU informed consent, such as giving patients information on advance directives, patient's rights, and organ donation, resulted in significantly higher patient evaluation scores with large effect sizes. This research suggests that the effectiveness of the informed consent process in the ICU from the patient's perspective can be measured and evaluated and that ICU patients place a high value on the elements of the informed consent process.
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Gray SW, Hlubocky FJ, Ratain MJ, Daugherty CK. Attitudes Toward Research Participation and Investigator Conflicts of Interest Among Advanced Cancer Patients Participating in Early Phase Clinical Trials. J Clin Oncol 2007; 25:3488-94. [PMID: 17687154 DOI: 10.1200/jco.2007.11.7283] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Although both financial and intrinsic conflicts of interest can exist throughout the drug development process, little is known about how advanced cancer patients enrolled onto early phase clinical trials perceive investigator conflicts of interests. Patients and Methods We interviewed 102 advanced cancer patients enrolled onto phase I clinical trials using a standardized survey that addressed multiple issues related to conflicts of interest and research participation. Results Fifty-five percent of patients would not be concerned if physicians involved in running a clinical trial had financial conflicts of interest, whereas 65% of patients would be concerned if physicians involved in running a trial had intrinsic conflicts of interest. Most patients reported that potential conflicts of interest should be disclosed to patients on research trials (52% for financial conflicts of interest and 61% for more intrinsic conflicts of interest). Most patients would be willing to participate in trials after learning conflict of interest information (63%). Younger patients expressed more concern regarding financial conflict of interest than older patients (odds ratio, 6.22; 95% CI, 1.41 to 27.24). Conclusion Patients with advanced cancer are equally, if not more, concerned about traditional intrinsic conflicts of interest as compared with financial conflicts of interest. Patients generally believed that conflict of interest information should be disclosed to research participants. The fact that younger patients expressed more concern about financial conflicts of interest may have the potential to influence clinical trial participation rates. The actual impact of conflict of interest disclosure to research subjects needs to be evaluated more carefully.
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Affiliation(s)
- Stacy W Gray
- Section of Hematology, Cancer Research Center, Committee on Clinical Pharmacology and Pharmacogenomics, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL 60637, USA.
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Fleischmann R. Primer: establishing a clinical trial unit--obtaining studies and patients. NATURE CLINICAL PRACTICE. RHEUMATOLOGY 2007; 3:459-63. [PMID: 17664953 DOI: 10.1038/ncprheum0554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 02/26/2007] [Indexed: 05/16/2023]
Abstract
Rheumatologists with clinical expertise should perform clinical investigations of new molecules in an effort to discover therapies that could be of greater benefit or safety than those currently available for patients with chronic rheumatic diseases. Over the past few years, many studies have been conducted outside the United States and Europe because of the dearth of investigative sites in these countries. A clinician, whether in private practice or academia, who has the resources and desire to conduct clinical investigations, should be able to become involved in the process. The task of starting a new investigative unit is daunting, as it involves acquiring studies, hiring staff and obtaining space prior to any cash flow. If done properly, however, clinical investigation can be rewarding--both intellectually and financially.
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Affiliation(s)
- Roy Fleischmann
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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43
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Abstract
Therapeutic clinical trials are an absolute necessity to enhance the therapy of serious illnesses, and Phase I trials are the only way to introduce new therapeutic modalities into use in human beings. However, since the first obligation a physician has is to the individual patient's well-being and avoidance of doing harm, offering such patients an unproven therapy with low probability of benefit to him/herself and significant potential toxicities poses major ethical problems. These ethical problems can only be solved by full disclosure of all facts to the patient, a detailed explanation that the primary goal of the trial is to improve medical care (altruistic motivation), and by making sure that in addition to the trial mandated treatment the patient receives optimal palliative care, including hospice care when needed.
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Affiliation(s)
- Hans W Grünwald
- Division of Hematology-Oncology, Cancer Center, Mount Sinai Services at Queens Hospital Center, Jamaica, New York, USA.
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44
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Hlubocky FJ, Ratain MJ, Wen M, Daugherty CK. Complementary and Alternative Medicine Among Advanced Cancer Patients Enrolled on Phase I Trials: A Study of Prognosis, Quality of Life, and Preferences for Decision Making. J Clin Oncol 2007; 25:548-54. [PMID: 17290064 DOI: 10.1200/jco.2005.03.9800] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We sought to describe complementary and alternative medicine (CAM) usage among phase I trial participants and to describe these patients' treatment decision-making preferences, awareness of prognosis, survival, and quality of life. Patients and Methods Advanced cancer patients enrolling onto phase I trials were surveyed regarding biologically based CAM use. Decision-making preferences and awareness of prognosis were assessed using validated and/or standardized instruments. The Functional Assessment of Cancer Therapy–General instrument was used to assess quality of life. Univariate and multivariate analyses were performed to detect differences between CAM users and nonusers. Results Of 212 interviewed patients, 34% (n = 72) described taking biologically based CAM. Median age of those taking biologically based CAM was 55 years, compared with 62 years for nonusers (P < .005). There were no statistically significant differences found between CAM usage and preferences for degree of patient involvement in medical decision making. Those patients who acknowledged that their deaths were likely to occur within 1 year were more likely to admit to prior CAM use (70% v 34%; P = .02). CAM users had poorer overall quality of life compared with nonusers (87.0 ± 12.4 v 91.2 ± 14.7; P = .007). No differences in survival were identified. Conclusion Prior CAM use among phase I cancer trial patients studied was common and associated with age, stated acknowledgment of prognosis, and quality of life. Patients enrolling onto early-phase trials should be questioned about CAM use. Additional study is needed to determine the frequency of use of those biologically based CAM agents that threaten the accuracy of early-phase cancer trial data.
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Affiliation(s)
- Fay J Hlubocky
- Department of Medicine, Section of Hematology/Oncology, MacLean Center for Clinical Medical Ethics, the Cancer Research Center, The University of Chicago, Chicago, IL 60637, USA
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45
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Mitchell SA. Informed Consent for Cancer Treatment and Research. Oncol Nurs Forum 2007. [DOI: 10.1188/03.onf.751-755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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46
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Verástegui EL. Consenting of the vulnerable: the informed consent procedure in advanced cancer patients in Mexico. BMC Med Ethics 2006; 7:E13. [PMID: 17166274 PMCID: PMC1764745 DOI: 10.1186/1472-6939-7-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 12/13/2006] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important. METHODS To gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1) a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2) researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3) the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale. RESULTS Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8th grade. CONCLUSION The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the complexity of the information provided to the patients may question the validity of the informed consent procedure in this group of patients.
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Affiliation(s)
- Emma L Verástegui
- Ethics Committee, Instituto Nacional de Cancerologia, Avenida San Fernando 22, Mexico City, Mexico.
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Helft PR, Daugherty CK. Are We Taking Without Giving in Return? The Ethics of Research-Related Biopsies and the Benefits of Clinical Trial Participation. J Clin Oncol 2006; 24:4793-5. [PMID: 17050863 DOI: 10.1200/jco.2006.05.7125] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Agrawal M, Grady C, Fairclough DL, Meropol NJ, Maynard K, Emanuel EJ. Patients' Decision-Making Process Regarding Participation in Phase I Oncology Research. J Clin Oncol 2006; 24:4479-84. [PMID: 16983117 DOI: 10.1200/jco.2006.06.0269] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study assesses the decision-making process of patients enrolling in phase I oncology studies. Patients and Methods Participants were eligible if they had consented to participate in a phase I cancer study at one of five cancer centers, understood English, and were older than 18 years. Trained interviewers conducted structured in-person interviews. Results Of the 163 participants, 88% were white, 96% had health insurance, and 51% were college graduates or post graduates. Overall, 81% were aware of hospice, but only 6% had seriously considered hospice for themselves; 84% were aware of palliative care and 10% seriously considered it for themselves; and 7% considered getting no treatment at all. Overall, 75% reported moderate or a lot of pressure to participate in the phase I study because their cancer was growing, whereas 7% reported such pressure from the study investigators and 9% felt such pressure from their families. For 63% of patients, the most important information for decision making was that the phase I drug killed cancer cells; only 12% reported that the adverse effects of the drug(s) was the most useful information. More than 90% of patients said they would still participate in the study even if the experimental drug caused serious adverse effects, including a 10% chance of dying. Conclusion Patients are aware of many alternatives to phase I studies, but do not seriously consider them. Very few experience pressure from family or researchers to participate in research. Their main goal is to fight their cancer, and almost no adverse effect, including death, would dissuade them from enrolling.
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Affiliation(s)
- Manish Agrawal
- Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1156, USA.
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Silverman DI, Cirullo L, DeMartinis NA, Damato K, DeMeo M, Fernandez GA, Glynn L, Hegde U, Laskay E, Leger R, Abu-Hasaballah K, Caron JM. Systematic identification and classification of adverse events in human research. Contemp Clin Trials 2006; 27:295-303. [PMID: 16624631 DOI: 10.1016/j.cct.2006.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 12/30/2005] [Accepted: 02/03/2006] [Indexed: 11/20/2022]
Abstract
Widely accepted standards and safeguards for research participants now include systematic surveillance and recording of adverse events. In the absence of a uniform regulation or structure for such reporting, each institution must now establish suitable yet efficient procedures to accomplish this task. We report herein our single center experience with a customized data collection, storage and review system specifically designed to identify and react appropriately to adverse events. Adverse events are classified by each investigator using three criteria in specific order: seriousness, expectedness and relatedness to the investigational intervention. Once classified, events are entered into an online database that includes collation, retrieval and search capabilities. Events meeting specified criteria are reviewed and adjudicated on a weekly basis by The University of Connecticut Research Adverse Events Committee, which makes advisory recommendations to the hospital's two Institutional Research Boards ranging from modification of informed consent to study suspension. Three hundred and seventy-one serious adverse events from > 900 studies were reviewed in the previous academic year. Our system, which combines timely on-line reporting with regular surveillance, provides a potential model that meets the need for comprehensive yet practical adverse events assessment and reporting.
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Affiliation(s)
- David I Silverman
- University of Connecticut Health Center, Department of Cardiology, 263 Farmington Ave, Farmington, CT 06117, USA.
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Shamoo AE, Resnik DB. Strategies to minimize risks and exploitation in phase one trials on healthy subjects. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:W1-13. [PMID: 16754430 PMCID: PMC3943957 DOI: 10.1080/15265160600686281] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Most of the literature on phase one trials has focused on ethical and safety issues in research on patients with advanced cancer, but this article focuses on healthy, adult subjects. The article makes six specific recommendations for protecting the rights and welfare of healthy subjects in phase one trials: 1) because phase one trials are short in duration (usually 1 to 3 months), researchers should gather more data on the short-term and long-term risks of participation in phase one studies by healthy subjects; 2) researchers should develop strict inclusion/exclusion criteria that exclude unhealthy or vulnerable subjects, such as decisionally impaired people, in phase one studies; 3) subjects should not participate in more than one phase one study at the same time and should wait at least 30 days between participating in different studies; 4) researchers should develop a database to keep track of phase one participants; 5) subjects should be guaranteed a minimum wage equivalent to the equivalent type of unskilled labor, but there should be no upper limits on wages; and 6) subjects should be allowed to engage in collective bargaining with research sponsors.
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