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Robles JM, Ruiz J, Correa R, Dinescu-Munoz N, Patel C, Noyd D, Alvarez M, Frost E, Ledbetter L, LeBlanc TW. The impact of language discordance on pediatric cancer care outcomes: A systematic review. Pediatr Blood Cancer 2024:e31338. [PMID: 39323048 DOI: 10.1002/pbc.31338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/23/2024] [Accepted: 09/09/2024] [Indexed: 09/27/2024]
Abstract
Language discordance between clinicians and families in pediatrics has been associated with adverse events and lower quality of care. We aimed to summarize the existing literature evaluating the impact of language discordance among healthcare professionals and families within pediatric oncology by conducting a systematic review. Of 8364 studies, 43 studies met eligibility for inclusion in this review. These studies highlight the impact of language discordance on pediatric cancer care outcomes, including communication challenges, obstacles to research participation, and potentially higher risk disease features at presentation. Healthcare professionals endorsed inconsistent professional interpreter use and lack of formal training on communicating via interpreters. Interventions to address barriers to language-appropriate care are sparse. Further research is warranted to design and implement interventions promoting language justice and provision of high-quality, equitable pediatric cancer care for all families.
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Affiliation(s)
- Joanna M Robles
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Jenny Ruiz
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ramon Correa
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
| | - Nicole Dinescu-Munoz
- Department of Pediatrics, University of South Florida School of Medicine, Tampa, Florida, USA
| | - Chandni Patel
- Department of Pediatrics, University of South Florida School of Medicine, Tampa, Florida, USA
| | - David Noyd
- Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington, USA
| | - Monica Alvarez
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erin Frost
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Leila Ledbetter
- Medical Center Library, Duke University, Durham, North Carolina, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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2
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Beauchemin MP, Ortega M, Santacroce SJ, Robles JM, Ruiz J, Hall AG, Kahn JM, Fu C, Orjuela-Grimm M, Hillyer GC, Solomon S, Pelletier W, Montiel-Esparza R, Blazin LJ, Kline C, Seif AE, Aristizabal P, Winestone LE, Velez MC. Clinical trial recruitment of people who speak languages other than English: a Children's Oncology Group report. JNCI Cancer Spectr 2024; 8:pkae047. [PMID: 38889291 PMCID: PMC11272047 DOI: 10.1093/jncics/pkae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/09/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Persons who speak languages other than English are underrepresented in clinical trials, likely in part because of inadequate multilevel resources. We conducted a survey of institutions affiliated with the Children's Oncology Group (COG) to characterize current research recruitment practices and resources regarding translation and interpretation services. METHODS In October 2022, a 20-item survey was distributed electronically to institutions affiliated with COG to assess consent practices and resources for recruiting participants who speak languages other than English to COG trials. Descriptive statistics were used to summarize responses; responses were compared by institution size and type as well as respondent role. RESULTS The survey was sent to 230 institutions, and the response rate was 60% (n = 139). In total, 60% (n = 83) of those respondents had access to short-form consent forms. Full consent form translation was required at 50% of institutions, and 12% of institutional review boards restricted use of centrally translated consent forms. Forty-six percent (n = 64) of institutions reported insufficient funding to support translation costs; 19% (n = 26) had access to no-cost translation services. Forty-four percent (n = 61) were required to use in-person interpreters for consent discussions; the most frequently cited barrier (56%) to obtaining consent was lack of available in-person interpreters. Forty-seven percent (n = 65) reported that recruiting persons who speak languages other than English to clinical trials was somewhat or very difficult. CONCLUSIONS Institutions affiliated with COG face resource-specific challenges that impede recruitment of participants who speak languages other than English for clinical trials. These findings indicate an urgent need to identify strategies aimed at reducing recruitment barriers to ensure equitable access to clinical trials.
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Affiliation(s)
- Melissa P Beauchemin
- Division of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria Ortega
- Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Sheila J Santacroce
- School of Nursing and Linberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanna M Robles
- Pediatric Oncology, Wake Forest University Health Sciences, Winston Salem, NC, USA
| | - Jenny Ruiz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anurekha G Hall
- University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA
| | - Justine M Kahn
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Pediatric Oncology, Columbia University Irving Medical Center, New York City, NY, USA
| | - Cecilia Fu
- Keck School of Medicine, Children’s Hospital of Los Angeles, Los Angeles, CA, USA
| | - Manuela Orjuela-Grimm
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Pediatric Oncology, Columbia University Irving Medical Center, New York City, NY, USA
| | - Grace C Hillyer
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Samrawit Solomon
- Division of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA
| | | | | | - Lindsay J Blazin
- Division of Oncology, Riley Children’s Hospital, Indianapolis, IN, USA
| | - Cassie Kline
- Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Alix E Seif
- Children’s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA, USA
| | - Paula Aristizabal
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego/Rady Children’s Hospital San Diego and Moores Cancer Center, La Jolla, CA, USA
| | - Lena E Winestone
- Division of Allergy, Immunology & BMT, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA, USA
| | - Maria C Velez
- Children’s Hospital New Orleans/Louisiana State University Health Sciences Center, New Orleans, LA, USA
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3
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Barrio C, Fuentes D, Tibiriçá L, Hernandez M, Helu-Brown P, Golshan S, Palmer BW. Consent for Research Involving Spanish- and English-Speaking Latinx Adults With Schizophrenia. Schizophr Bull 2024; 50:673-683. [PMID: 37962384 PMCID: PMC11059799 DOI: 10.1093/schbul/sbad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Latinxs are vastly underrepresented in mental health research; one of many contributing factors may be complexities in the research consent process, including language preferences. We examined determinants of comprehension of research consent procedures and tested the effects of a preconsent research schema condition among 180 adults with schizophrenia (60 Latinx-English and 60 Latinx-Spanish preference, and 60 non-Latinx White). STUDY DESIGN Participants were randomly assigned (equal allocation) to an educational session regarding clinical research concepts and processes (schema condition) or to an attention control. Following a subsequent simulated consent procedure for a hypothetical drug trail, comprehension of consent disclosures was measured with 2 standard measures. STUDY RESULTS One-way ANOVAs showed significant medium effect size differences between ethnicity/language groups on both measures of comprehension (η2s = 0.066-0.070). The Latinx-Spanish group showed lower comprehension than non-Latinx White participants; differences between the 2 Latinx groups did not reach statistical significance. Group differences were not statistically significant after adjusting for differences in education, or on scores from structured measures of acculturation, health literacy, or research literacy. Two-way ANOVAs showed no significant main effects for consent procedure on either comprehension measure (Ps > .369; partial η2s < 0.006) and no significant group-by-consent interactions (Ps > .554; partial η2s < 0.008). CONCLUSIONS Although the preconsent procedure was not effective, the results suggest health and research literacy may be targets for reducing disparities in consent comprehension. The onus is on researchers to improve communication of consent information as an important step to addressing health care disparities.
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Affiliation(s)
- Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Dahlia Fuentes
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Lize Tibiriçá
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas, Austin, Austin, TX, USA
| | - Paula Helu-Brown
- Department of Psychology, Mount Saint Mary’s University, Los Angeles, CA, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, USA
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4
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Stall M, Germann JN, Orta M, Winick N, Kaye EC. Equitable communication for pediatric cancer patients and families who speak languages other than English. Pediatr Blood Cancer 2024; 71:e30828. [PMID: 38146021 PMCID: PMC10831864 DOI: 10.1002/pbc.30828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Affiliation(s)
- Melanie Stall
- University of Texas Southwestern Medical Center, Division of Pediatric Hematology-Oncology, Dallas, TX, USA
| | - Julie N. Germann
- University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA
- Children’s Medical Center Dallas, Department of Psychiatry, Dallas, TX, USA
| | - Martin Orta
- Children’s Medical Center Dallas, Department of Language Access Services, Dallas, TX, USA
| | - Naomi Winick
- University of Texas Southwestern Medical Center, Division of Pediatric Hematology-Oncology, Dallas, TX, USA
| | - Erica C. Kaye
- St. Jude Children’s Research Hospital, Department of Oncology, Memphis, TN, USA
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5
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Wu C, Wang N, Wang Q, Wang C, Wei Z, Wu Z, Yu S, Jiang X. Participants' understanding of informed consent in clinical trials: A systematic review and updated meta-analysis. PLoS One 2024; 19:e0295784. [PMID: 38166097 PMCID: PMC10760836 DOI: 10.1371/journal.pone.0295784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/29/2023] [Indexed: 01/04/2024] Open
Abstract
Obtaining written informed consent from participants before enrolment in a study is essential. A previous study showed that only 50% of the participants in clinical trials understood the components of informed consent, and the methods of participants' understanding of informed consent were controversial. This updated meta-analysis aimed to estimate the proportion of participants in clinical trials who understand the different informed consent components. PubMed, EMBASE, the Cochrane Library, and Scopus were searched till April 2023. Therapeutic misconception, ability to name one risk, knowing that treatments were being compared, and understanding the nature of the study, the purpose of the study, the risks and side-effects, the direct benefits, placebo, randomization, voluntariness, freedom to withdraw, the availability of alternative treatment if withdrawn from the trial, confidentiality, compensation, or comprehension were evaluated. This meta-analysis included 117 studies (155 datasets; 22,118 participants). The understanding of the risks and side-effects was investigated in the largest number of studies (n = 100), whereas comparehension was investigated in the smallest number (n = 11). The highest proportions were 97.5%(95% confidence interval (CI): 97.1-97.9) for confidentiality, 95.9% (95% confidence interval (CI): 95.4-96.4) for compensation, 91.4% (95% CI: 90.7-92.1) for the nature of study, 68.1% (95% CI: 51.6-84.6) for knowing that treatments were being compared, and 67.3% (95% CI: 56.6-78) for voluntary nature of participants. The smallest proportions were the concept of placebo (4.8%, 95%CI: 4.4-5.2) and randomization(39.4%, 95%CI: 38.3-40.4). Our findings suggested that most participants understood the fundamental components of informed consent (study confidentiality, nature, compensation, voluntariness, and freedom to withdraw). The understanding of other components, such as placebo and randomization was less satisfactory.
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Affiliation(s)
- Chengai Wu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Na Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Qianqian Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhenjie Wei
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhimin Wu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Shunan Yu
- Department of Molecular Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xieyuan Jiang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
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Aristizabal P, Nataraj S, Ma AK, Kumar NV, Perdomo BP, Martinez ME, Nodora J, Liu L, Lee E, Thornburg CD. Social Determinants of Health and Informed Consent Comprehension for Pediatric Cancer Clinical Trials. JAMA Netw Open 2023; 6:e2346858. [PMID: 38079173 PMCID: PMC10714248 DOI: 10.1001/jamanetworkopen.2023.46858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Ensuring valid informed consent (IC) prior to enrollment in clinical trials is a fundamental ethical right. Objective To assess whether social determinants of health (SDOH) and related sociocontextual factors are associated with parental IC comprehension in therapeutic childhood cancer clinical trials. Design, Setting, and Participants This cross-sectional study prospectively enrolled 223 parents of children with newly diagnosed cancer at Rady Children's Hospital San Diego, a large quaternary academic center in California, from October 1, 2014, to March 31, 2021. Linear mixed effects models were used to assess whether IC comprehension overall and by domain (purpose, procedures, and randomization; risks and benefits; alternatives; and voluntariness) were associated with SDOH and sociocontextual factors. Data were analyzed from January 1, 2022, to July 31, 2023. Exposures Informed consent for a therapeutic childhood cancer clinical trial. Main Outcomes and Measures The primary outcome of interest was IC comprehension and its associations with SDOH (marital status, language, educational attainment, employment, insurance type, socioeconomic status, and health literacy) and sociocontextual factors (ethnicity, satisfaction with informed consent, and cancer type). Results Of 223 parents, 172 (77.1%) were aged 18 to 44 years, 111 (49.8%) were Hispanic, 152 (68.2%) were women, and 163 (73.1%) were married. In terms of race, 2 (0.9%) were American Indian or Alaska Native, 22 (9.9%) were Asian or Pacific Islander, 8 (3.6%) were Black, 149 (66.8%) were White, and 42 (18.8%) were more than 1 race. In multivariable linear mixed-effects analyses, limited vs adequate health literacy was associated with lower comprehension of informed consent overall (mean [SD], 68.28 [11.81] vs 79.24 [11.77]; β estimate, -9.02 [95% CI, -12.0 to -6.07]; P < .001) and with lower comprehension of the purpose, procedures, and randomization (mean [SD], 65.00 [12.64] vs 76.14 [11.53]; β estimate, -7.87 [95% CI, -10.9 to -4.85]; P < .001); risks and benefits (mean [SD], 62.84 [20.24] vs 73.14 [20.86]; β estimate, -10.1 [95% CI, -15.6 to -4.59]; P < .001); alternatives (mean [SD], 54.27 [43.18] vs 82.98 [34.24]; β estimate, -14.3 [95% CI, -26.1 to -2.62]; P .02); and voluntariness (mean [SD], 76.52 [24.33] vs 95.39 [13.89]; β estimate, -9.14 [95% CI, -14.9 to -3.44]; P = .002) domains. Use of Spanish vs English language for medical communication was associated with lower comprehension overall (mean [SD], 66.45 [12.32] vs 77.25 [12.18]; β estimate, -5.30 [95% CI, -9.27 to -1.34]; P = .01) and with lower comprehension of the purpose, procedures, and randomization (mean [SD], 63.33 [11.98] vs 74.07 [12.52]; β estimate, -4.33 [95% CI, -8.43 to -0.23]; P = .04) and voluntariness (mean [SD], 70.83 [24.02] vs 92.54 [17.27]; β estimate, -9.69 [95% CI, -16.8 to -2.56]; P = .009) domains. Conclusions and Relevance In this cross-sectional study including parents of children with newly diagnosed cancer who provided IC for their child's participation in a therapeutic clinical trial, limited health literacy and use of Spanish language for medical communication were associated with lower comprehension of IC. These findings suggest that, in this setting, parents with limited health literacy or those who use Spanish language for medical communication may not fully comprehend IC and therefore may not make truly informed decisions. These findings support the investigation of interventions, across pediatric disciplines, tailored to the participant's language and health literacy level to improve IC comprehension, particularly in racial and ethnic minority populations.
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Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
- Peckham Center for Cancer & Blood Disorders, Rady Children’s Hospital San Diego, San Diego, California
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Dissemination and Implementation Science Center, University of California, San Diego, Altman Clinical and Translational Research Institute, La Jolla
| | - Shilpa Nataraj
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Pediatrics, Division of Hematology Oncology, Stanford University, Stanford, California
| | - Arissa K. Ma
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Family Medicine, Kaiser Permanente, Long Beach, California
| | - Nikhil V. Kumar
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Pediatrics, University of California Irvine, Irvine, California
| | - Bianca P. Perdomo
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
| | - Maria Elena Martinez
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
| | - Jesse Nodora
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
| | - Lin Liu
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla
| | - Courtney D. Thornburg
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
- Peckham Center for Cancer & Blood Disorders, Rady Children’s Hospital San Diego, San Diego, California
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7
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Umaretiya PJ, Johnston EE. Opportunities to Advance Equity Through Informed Consent Discussions. JAMA Netw Open 2023; 6:e2346814. [PMID: 38079175 DOI: 10.1001/jamanetworkopen.2023.46814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Puja J Umaretiya
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham
- Pediatric Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
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8
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Murong M, Giannopoulos E, Pirrie L, Giuliani ME, Fazelzad R, Bender J, Jones J, Papadakos J. The Experience of Informal Newcomer Cancer Caregivers with Limited Language Proficiency: A Scoping Review. J Immigr Minor Health 2023; 25:436-448. [PMID: 36538206 DOI: 10.1007/s10903-022-01442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
This scoping review explored what is known about the experiences of informal cancer caregivers (CGs) who are newcomers with limited language proficiency. A literature search was performed in seven databases and the search yielded 11,289 articles. After duplicate removal and title and abstract screening, 216 articles underwent full text review and 57 articles and were synthesized. Most studies (n = 41, 72%) were qualitative and were published in North America (n = 35, 61%). Most CG participants were female (69%) and only 19 studies explicitly identified the CG country of origin. Of those that did, 26% originated from Asia, with most migrating from East Asia. Significant challenges were experienced by newcomer CGs and chief among these were related to communication challenges with HCPs that were exacerbated by a lack of availability of medical interpreters and the complexity of oncology health information. Efforts are needed to better integrate newcomer CGs into cancer care.
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Affiliation(s)
- Mijia Murong
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Eleni Giannopoulos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Lorraine Pirrie
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Meredith Elana Giuliani
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada.,The Institute for Education Research, University Health Network, Toronto, Canada.,Department of Radiation of Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jacqueline Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Janet Papadakos
- Cancer Health Literacy Research Centre, Cancer Education Program, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,The Institute for Education Research, University Health Network, Toronto, Canada.
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9
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Sisk BA, Harvey K, Friedrich AB, Antes AL, Yaeger LH, Mack JW, DuBois J. Multilevel barriers and facilitators of communication in pediatric oncology: A systematic review. Pediatr Blood Cancer 2022; 69:e29405. [PMID: 34662485 PMCID: PMC8875310 DOI: 10.1002/pbc.29405] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023]
Abstract
Multiple factors can facilitate or impede the fulfillment of communication functions in pediatric cancer. In this systematic review, we evaluated 109 studies from the preceding 20 years that presented qualitative or quantitative evidence of barriers or facilitators to communication in pediatric cancer. Using a multilevel framework developed in our prior study, we then analyzed and categorized the levels of barriers and facilitators identified in included studies. The vast majority of studies focused on individual-level barriers, rather than team, organization/system, collaborating hospital, community, or policy-level barriers. Future studies should explore the full range of factors that affect communication.
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Affiliation(s)
- Bryan A. Sisk
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kieandra Harvey
- Brown School of Social Work, Washington University School of Medicine, St. Louis, Missouri
| | - Annie B. Friedrich
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri
| | - Alison L. Antes
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer W. Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts; and Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
| | - James DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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10
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Aristizabal P, Winestone LE, Umaretiya P, Bona K. Disparities in Pediatric Oncology: The 21st Century Opportunity to Improve Outcomes for Children and Adolescents With Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e315-e326. [PMID: 34061564 PMCID: PMC9126642 DOI: 10.1200/edbk_320499] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Adult cancer disparities have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Pediatric cancer survival has improved significantly in the United States for the past 5 decades to over 80%; however, disparate outcomes among children and adolescents with cancer still affect many populations in the United States and globally, including racial and ethnic minorities, populations with low socioeconomic status, and residents of underserved areas. To achieve equitable outcomes for all children and adolescents with cancer, it is imperative that concerted multilevel approaches be carried out to understand and address health disparities and to ensure access to high-quality cancer care. Addressing social determinants of health, such as removing barriers to health care access and ensuring access to social supports, can reduce pediatric cancer disparities. Nevertheless, public health policy, health system interventions, and innovative delivery of evidence-based services are critically needed. Partnerships among patients, caregivers, and health care providers, and among health care, academic, and governmental institutions, have a pivotal role in reducing cancer disparities and improving outcomes in the 21st century.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego/Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego, CA
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, CA
| | - Lena E. Winestone
- Department of Pediatrics, Division of Allergy, Immunology, and Blood & Marrow Transplantation, University of California San Francisco Benioff Children’s Hospitals, San Francisco, CA
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Puja Umaretiya
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kira Bona
- Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
- Division of Pediatric Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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11
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Aristizabal P, Ma AK, Kumar NV, Perdomo BP, Thornburg CD, Martinez ME, Nodora J. Assessment of Factors Associated With Parental Perceptions of Voluntary Decisions About Child Participation in Leukemia Clinical Trials. JAMA Netw Open 2021; 4:e219038. [PMID: 33944924 PMCID: PMC8097494 DOI: 10.1001/jamanetworkopen.2021.9038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
IMPORTANCE Obtaining voluntary informed consent prior to enrollment in clinical trials is a fundamental ethical requirement. OBJECTIVE To assess whether health literacy, contextual factors, or sociodemographic characteristics are associated with perception of voluntariness among parents who had consented for their child's participation in a leukemia therapeutic clinical trial. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study prospectively enrolled 97 parents of children diagnosed as having leukemia at Rady Children's Hospital San Diego, a large tertiary academic center in California, from 2014 to 2017. Health literacy, contextual factors (acculturation, decisional regret, and satisfaction with informed consent), sociodemographic characteristics, and perception of voluntariness after consenting for a therapeutic clinical trial were measured. Univariable and multivariable regression were used to determine significant associations. The analyses for the present study were conducted from May 2019 to May 2020. EXPOSURES Informed consent for a therapeutic leukemia clinical trial. MAIN OUTCOMES AND MEASURES The primary outcome of interest was perception of voluntariness and its associations with health literacy and other contextual factors (acculturation, decisional regret, and satisfaction with informed consent) and sociodemographic characteristics, including age, race/ethnicity, parental language, educational level, insurance type, marital status, and socioeconomic status. RESULTS Of 97 parents included, the majority were women (65 [67%]), married (71 [73%]), and of self-reported Hispanic ethnicity (50 [52%]). Lower perception of voluntariness was significantly associated with lower health literacy (r = 0.30; 95% CI, 0.11-0.47; P = .004), Spanish language (x̅ = -4.50, P = .05), lower acculturation if of Hispanic ethnicity (r = 0.30; 95% CI, 0.02-0.54; P = .05), greater decisional regret (r = -0.54; 95% CI, -0.67 to -0.38; P < .001), and lower satisfaction with informed consent (r = 0.39; 95% CI, 0.21-0.54; P < .001) in univariable analysis. Lower health literacy remained significantly associated with lower perception of voluntariness in multivariable analysis after adjustment for contextual factors and sociodemographic characteristics (β = 4.06; 95% CI, 1.60-6.53; P = .001). Lower health literacy was significantly associated with Hispanic ethnicity (mean, 4.16; 95% CI, 3.75-4.57; P < .001), Spanish language spoken at home (mean, 3.17; 95% CI, 1.94-4.40; P < .001), high school or less educational level (mean, 3.41; 95% CI, 2.83-3.99; P < .001), public insurance (mean, 4.00; 95% CI, 3.55-4.45; P < .001), and unmarried status (mean, 3.71; 95% CI, 2.91-4.51; P = .03). CONCLUSIONS AND RELEVANCE Among parents of children with newly diagnosed leukemia who had consented for their child's participation in a therapeutic clinical trial, lower perception of voluntariness was significantly associated with lower health literacy. These results suggest that parents with low health literacy may perceive external influences in their decision for their child's participation in clinical trials. This finding highlights the potential role of recruitment interventions tailored to the participant's health literacy level to improve voluntary informed consent in underserved populations.
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Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
| | - Arissa K. Ma
- School of Medicine, University of California San Diego, La Jolla
- Now with MemorialCare Health System, Fountain Valley, California
| | - Nikhil V. Kumar
- School of Medicine, University of California San Diego, La Jolla
| | - Bianca P. Perdomo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
| | - Courtney D. Thornburg
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California San Diego, La Jolla
- Peckham Center for Cancer and Blood Disorders, Rady Children’s Hospital San Diego, San Diego
| | - Maria Elena Martinez
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Jesse Nodora
- Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
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12
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Sisk BA, Friedrich AB, Kaye EC, Baker JN, Mack JW, DuBois JM. Multilevel barriers to communication in pediatric oncology: Clinicians' perspectives. Cancer 2021; 127:2130-2138. [PMID: 33598930 DOI: 10.1002/cncr.33467] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/08/2020] [Accepted: 12/26/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Communication serves several functions in pediatric oncology, but communication deficiencies persist. Little is known about the broad spectrum of barriers contributing to these deficiencies. Identifying these barriers will support new strategies to improve communication. METHODS The authors performed 10 focus groups on perceived communication barriers with nurses, nurse practitioners, physicians, and psychosocial professionals across 2 academic institutions. They analyzed transcripts by adapting a multilevel framework from organizational psychology. RESULTS The authors identified 6 levels of barriers to communication from the clinicians' perspectives: individual, team, organization, collaborating hospital, community, and policy. Individual barriers were subdivided into clinician characteristics, family characteristics, or characteristics of the clinician-family interaction. Within each level and sublevel, several manifestations of barriers were identified. Some barriers, such as a lack of comfort with difficult topics (individual), cultural differences (individual), a lack of a shared team mental model (team), and time pressure (organization), manifested similarly across professions and institutions. Other barriers, such as a need for boundaries (individual), intimidation or embarrassment of family (individual), unclear roles and authority (team), and excessive logistical requirements (policy), manifested differently across professions. With the exception of collaborating hospitals, participants from all professions identified barriers from each level. Physicians did not discuss collaborating hospital barriers. CONCLUSIONS Nurses, nurse practitioners, physicians, and psychosocial professionals experience communication barriers at multiple levels, which range from individual- to policy-level barriers. Yet their unique clinical roles and duties can lead to different manifestations of some barriers. This multilevel framework might help clinicians and researchers to identify targets for interventions to improve communication experiences for families in pediatric oncology. LAY SUMMARY Clinicians and families experience many barriers to communication in pediatric oncology. The authors performed 10 focus groups with 59 clinicians who cared for children with cancer. In these focus groups, barriers to effective communication were discussed. In this article, the authors report on an analysis of the responses. Six levels of barriers to communication were found: individual, team, organization, collaborating hospital, community, and policy. With an understanding of these barriers, interventions can be developed to target these barriers in hopes of improving communication for parents and patients in pediatric oncology.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Annie B Friedrich
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - James M DuBois
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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13
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Peng W, Morgan SE, Mao B, McFarlane SJ, Occa A, Grinfeder G, Byrne MM. Ready to Make A Decision: A Model of Informational Aids to Improve Informed Participation in Clinical Trial Research. JOURNAL OF HEALTH COMMUNICATION 2019; 24:865-877. [PMID: 31663824 PMCID: PMC9617566 DOI: 10.1080/10810730.2019.1680773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Enrollment rates for cancer clinical trials remain low, affecting the generalizability of new treatments. Research shows that many patients face significant challenges in understanding basic clinical trial vocabulary and making informed decisions about participation. Informational aids (IA) are developed to address these challenges and support decision making of cancer clinical trial participation. The present study proposed and tested a structural path model to explain the efficacy of three (i.e., interactive, non-interactive, non-cancer control) IAs. The results revealed that clinical trial participation intention was associated with attitudes and social constructs (i.e., social norm, social sharing, and cues to action). Ease of use, rather than knowledge, was the primary communication feature of IA that influenced the outcome variables. The path relations linking messages features, mediators, and outcome variables were different across all three IAs. The results therefore provide theoretical and practical implications for the use and development of IAs to support clinical trial accrual.
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Affiliation(s)
- Wei Peng
- School of Communication, University of Miami, Coral Gables, Florida
| | - Susan E. Morgan
- School of Communication, University of Miami, Coral Gables, Florida
| | - Bingjing Mao
- School of Communication, University of Miami, Coral Gables, Florida
| | | | - Aurora Occa
- Department of Communication, University of Kentucky, Lexington, Kentucky
| | - Gilles Grinfeder
- School of Communication, University of Miami, Coral Gables, Florida
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14
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Kaye EC, Kiefer A, Zalud K, Gattas M, Snyder I, Spraker-Perlman H, Baker JN. Advancing the field of communication research in pediatric oncology: A systematic review of the literature analyzing medical dialogue. Pediatr Blood Cancer 2018; 65:e27378. [PMID: 30070015 PMCID: PMC6192838 DOI: 10.1002/pbc.27378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/11/2022]
Abstract
Historically, communication research in pediatric oncology has relied on surveys and interviews, resulting in cross-sectional and retrospective studies constrained by selection, recognition, and recall biases. This systematic review identifies and synthesizes the published literature analyzing primary data from recorded conversations between pediatric oncologists, patients with cancer, and their families, with the following objectives: (1) to identify the extent and content of the evidence base, (2) to describe methodological strategies utilized in the analysis of recorded medical dialogue, (3) to aggregate salient findings, and (4) to generate recommendations for future prospective research related to analysis of medical dialogue in pediatric oncology.
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Affiliation(s)
| | - Ashley Kiefer
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Ian Snyder
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
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15
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Kazak AE, Hwang WT, Chen FF, Askins MA, Carlson O, Argueta-Ortiz F, Vega G, Barakat LP. Validation of the Spanish Version of the Psychosocial Assessment Tool (PAT) in Pediatric Cancer. J Pediatr Psychol 2018; 43:1104-1113. [PMID: 29982606 DOI: 10.1093/jpepsy/jsy046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Family psychosocial risk screening is an important initial step in delivering evidence-based care and in addressing health disparities. There is currently no validated measure of family psychosocial risk in Spanish. The Psychosocial Assessment Tool (PAT) is a brief parent report screener based on the trilevel Pediatric Preventative Psychosocial Risk Model (PPPHM; Universal, Targeted, and Clinical). The current article validates a Spanish version of the PAT (Version 3.0) in pediatric oncology. Method Spanish-speaking Hispanic primary caregivers of 79 children newly diagnosed with cancer participated in this 4-institution multisite investigation, completing Spanish versions of the PAT and validation measures using REDCap. Results Over 60% of the sample had a high school or lower level of education and they primarily identified as Hispanic in terms of acculturation. Internal consistency for the total score (KR20 = 0.76) and the Social Support, Child Problems, Sibling Problems, and Family Problems subscales was strong (KR20 = 0.69-0.79). Stress Reactions, Family Structure, and Family Beliefs subscales were lower (KR20 = 0.43-0.55). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Nearly two-thirds of the sample scored in the Targeted or Clinical range of the PPPHM. The PAT was successful in identifying clinical cases. Conclusions The Spanish version of the PAT can be used with families of children newly diagnosed with cancer. Elevated psychosocial risks were found and warrant particular attention in providing psychosocial care attentive to the needs of Spanish-speaking families.
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Affiliation(s)
- Anne E Kazak
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | - Fang Fang Chen
- Nemours Children's Health System.,Sidney Kimmel Medical School, Thomas Jefferson University
| | | | | | | | | | - Lamia P Barakat
- Perelman School of Medicine, University of Pennsylvania.,The Children's Hospital of Philadelphia
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16
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Shader RI, Livingston CH. Informed Consent and Assent in Pediatric Oncology Trials. Clin Ther 2017; 39:231-234. [DOI: 10.1016/j.clinthera.2017.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
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17
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Day E, Jones L, Langner R, Bluebond-Langner M. Current understanding of decision-making in adolescents with cancer: A narrative systematic review. Palliat Med 2016; 30:920-934. [PMID: 27160700 PMCID: PMC5117127 DOI: 10.1177/0269216316648072] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance. AIMS To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research. DESIGN A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings. DATA SOURCES The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13-19 years) with cancer. RESULTS Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making. CONCLUSION Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory.
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Affiliation(s)
- Emma Day
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
| | - Louise Jones
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, UK
| | - Richard Langner
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
| | - Myra Bluebond-Langner
- Louis Dundas Centre for Children's Palliative Care, Institute of Child Health, University College London (UCL), London, UK
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18
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Zamora ER, Kaul S, Kirchhoff AC, Gwilliam V, Jimenez OA, Morreall DK, Montenegro RE, Kinney AY, Fluchel MN. The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer. Pediatr Blood Cancer 2016; 63:2173-2180. [PMID: 27442596 DOI: 10.1002/pbc.26150] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND An increasing proportion of pediatric cancer patients in the United States are Latino and many have Spanish-speaking immigrant parents with limited English proficiency (LEP). Little is known about how language or undocumented immigration status impacts their care experience. PROCEDURE A cross-sectional survey was administered to English (N = 310) and Spanish-speaking LEP (N = 56) caregivers of pediatric cancer patients. To assess differences in healthcare experiences between the language groups, t-tests and chi-square statistics were used. Multivariable logistic regression evaluated associations between primary language and knowledge of clinical trial status. RESULTS Spanish-speaking caregivers were more likely to report higher rates of quitting or changing jobs as a direct result of their child's cancer, and their children were more likely to experience a delay in education. Although Spanish-speaking caregivers reported higher satisfaction with care, 32% reported feeling that their child would have received better care if English was their primary language. Spanish-speaking caregivers were more likely to incorrectly identify whether their child was on a clinical trial compared with English-speaking caregivers. The majority of Spanish-speaking caregivers reported at least one undocumented caregiver in the household and 11% of them avoided or delayed medical care for their child due to concerns over their undocumented immigration status. CONCLUSIONS Language barriers and undocumented immigration status may negatively impact the quality of informed decision-making and the care experience for Spanish-speaking LEP caregivers of pediatric cancer patients. These families may benefit from culturally appropriate Spanish language resources to improve communication and open a dialogue regarding undocumented immigration status.
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Affiliation(s)
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | - Deborah K Morreall
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico.,Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Mark N Fluchel
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.,Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, Utah
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19
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Munet-Vilaró F. Delivery of Culturally Competent Care to Children With Cancer and Their Families—The Latino Experience. J Pediatr Oncol Nurs 2016; 21:155-9. [PMID: 15296045 DOI: 10.1177/1043454204264405] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article discusses selected cultural factors such as language and interpretation services, beliefs, health care practices, and communication styles of Latino families that can increase and enhance the ability of nurses to work with a child with cancer and his or her family. Suggestions for research and clinical intervention are presented.
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Affiliation(s)
- Frances Munet-Vilaró
- School of Nursing, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
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20
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Ethical issues of clinical trials in paediatric oncology from 2003 to 2013: a systematic review. Lancet Oncol 2016; 17:e187-97. [DOI: 10.1016/s1470-2045(16)00142-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/05/2016] [Accepted: 02/18/2016] [Indexed: 11/20/2022]
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21
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Aristizabal P, Singer J, Cooper R, Wells KJ, Nodora J, Milburn M, Gahagan S, Schiff DE, Martinez ME. Participation in pediatric oncology research protocols: Racial/ethnic, language and age-based disparities. Pediatr Blood Cancer 2015; 62:1337-44. [PMID: 25755225 PMCID: PMC4482802 DOI: 10.1002/pbc.25472] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Survival rates in pediatric oncology have improved dramatically, in part due to high patient participation in clinical trials. Although racial/ethnic inequalities in clinical trial participation have been reported in adults, pediatric data and studies comparing participation rates by socio-demographic characteristics are scarce. The goal of this study was to assess differences in research protocol participation for childhood cancer by age, sex, race/ethnicity, parental language, cancer type, and insurance status. PROCEDURE Data on enrollment in any protocol, biospecimen, or therapeutic protocols were collected and analyzed for newly diagnosed pediatric patients with cancer from 2008-2012 at Rady Children's Hospital. RESULTS Among the 353 patients included in the analysis, 304 (86.1%) were enrolled in any protocol. Enrollment in biospecimen and therapeutic protocols was 84.2% (261/310) and 81.1% (206/254), respectively. Logistic regression analyzes revealed significant enrollment underrepresentation in any protocol for Hispanics compared to Non-Hispanic whites (81% vs. 91%; Odds Ratio [OR], 0.43; 95% Confidence Interval [CI], 0.21-0.90; P = 0.021) and among children of Spanish-speaking vs. English-speaking parents (78% vs. 89%; OR, 0.45; 95%CI, 0.23-0.87; P = 0.016). Compared to patients aged 0-4 years, significant underrepresentation was also found among patients 15-21 years old (92% vs.72%; OR, 0.21; 95% CI, 0.09-0.48; P < 0.001). Similar trends were observed when analyzing enrollment in biospecimen and therapeutic protocols separately. CONCLUSIONS There was significant underrepresentation in protocol participation for Hispanics, children of Spanish-speaking parents, and patients ages 15-21. Research is needed to understand barriers to research participation among these groups underrepresented in pediatric oncology clinical trials.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, University of California San Diego, San Diego, CA,Division of Pediatric Hematology/Oncology, Rady Children’s Hospital San Diego, San Diego, CA,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Jenelle Singer
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Renee Cooper
- Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Kristen J. Wells
- Department of Psychology, San Diego State University, San Diego, CA,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
| | - Jesse Nodora
- Moores Cancer Center, University of California San Diego, La Jolla, CA,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
| | - Mehrzad Milburn
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Sheila Gahagan
- Department of Pediatrics, University of California San Diego, San Diego, CA,Division of Pediatric Hematology/Oncology, Rady Children’s Hospital San Diego, San Diego, CA
| | - Deborah E. Schiff
- Department of Pediatrics, University of California San Diego, San Diego, CA,Division of Pediatric Hematology/Oncology, Rady Children’s Hospital San Diego, San Diego, CA
| | - Maria Elena Martinez
- Moores Cancer Center, University of California San Diego, La Jolla, CA,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
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22
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Tam NT, Huy NT, Thoa LTB, Long NP, Trang NTH, Hirayama K, Karbwang J. Participants' understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis. Bull World Health Organ 2015; 93:186-98H. [PMID: 25883410 PMCID: PMC4371493 DOI: 10.2471/blt.14.141390] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/29/2014] [Accepted: 11/26/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To estimate the proportion of participants in clinical trials who understand different components of informed consent. METHODS Relevant studies were identified by a systematic review of PubMed, Scopus and Google Scholar and by manually reviewing reference lists for publications up to October 2013. A meta-analysis of study results was performed using a random-effects model to take account of heterogeneity. FINDINGS The analysis included 103 studies evaluating 135 cohorts of participants. The pooled proportion of participants who understood components of informed consent was 75.8% for freedom to withdraw at any time, 74.7% for the nature of study, 74.7% for the voluntary nature of participation, 74.0% for potential benefits, 69.6% for the study's purpose, 67.0% for potential risks and side-effects, 66.2% for confidentiality, 64.1% for the availability of alternative treatment if withdrawn, 62.9% for knowing that treatments were being compared, 53.3% for placebo and 52.1% for randomization. Most participants, 62.4%, had no therapeutic misconceptions and 54.9% could name at least one risk. Subgroup and meta-regression analyses identified covariates, such as age, educational level, critical illness, the study phase and location, that significantly affected understanding and indicated that the proportion of participants who understood informed consent had not increased over 30 years. CONCLUSION The proportion of participants in clinical trials who understood different components of informed consent varied from 52.1% to 75.8%. Investigators could do more to help participants achieve a complete understanding.
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Affiliation(s)
- Nguyen Thanh Tam
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Nguyen Tien Huy
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Le Thi Bich Thoa
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Nguyen Phuoc Long
- Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | | | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki, Japan
| | - Juntra Karbwang
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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23
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Barakat LP, Schwartz LA, Reilly A, Deatrick JA, Balis F. A Qualitative Study of Phase III Cancer Clinical Trial Enrollment Decision-Making: Perspectives from Adolescents, Young Adults, Caregivers, and Providers. J Adolesc Young Adult Oncol 2014; 3:3-11. [PMID: 24669354 DOI: 10.1089/jayao.2013.0011] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The mortality reduction rate for adolescents and young adults (AYAs) with cancer has not demonstrated the same rate of improvement as for children, due partly to insufficient phase III cancer clinical trial enrollment. This study describes three key components of phase III cancer clinical trial enrollment-family decision-making patterns, factors that influence AYAs' involvement, and attitudes (perceived barriers and benefits) toward trial participation-and evaluated a measure of attitudes. Methods: Participants were AYAs (15-23 years old at study) diagnosed with cancer and offered a phase III cancer clinical trial within the past 3-21 months, their primary caregivers, and their healthcare providers. Interviews assessed: (a) phase III clinical trial decision-making experiences and (b) relevance of the Pediatric Research Participation Questionnaire (PRPQ) in the assessment of AYAs' attitudes toward enrollment on phase III cancer clinical trials. Results: Thirteen AYAs, 16 caregivers, and 11 providers were interviewed. Four decision-making patterns were identified, with AYA abdicates to caregiver and caregiver-based and AYA-endorsed the most commonly described, but with variation across respondents. Distress and reduced health-related quality of life limited AYAs' involvement in the enrollment decision, while developmental and emotional maturity facilitated involvement. Perceived barriers and benefits to enrollment were reported, and the PRPQ was deemed relevant with minor modifications. Conclusions: Findings suggest that AYAs may not be fully involved in phase III cancer clinical trial enrollment decision-making, and caregivers and providers are challenged to overcome factors that limit their involvement. The PRPQ shows promise as a tool for systematically evaluating clinical trial attitudes.
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Affiliation(s)
- Lamia P Barakat
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Anne Reilly
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Janet A Deatrick
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Frank Balis
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
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Gupta S, Wilejto M, Pole JD, Guttmann A, Sung L. Low socioeconomic status is associated with worse survival in children with cancer: a systematic review. PLoS One 2014; 9:e89482. [PMID: 24586813 PMCID: PMC3935876 DOI: 10.1371/journal.pone.0089482] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/21/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While low socioeconomic status (SES) has been associated with inferior cancer outcome among adults, its impact in pediatric oncology is unclear. Our objective was therefore to conduct a systematic review to determine the impact of SES upon outcome in children with cancer. METHODS We searched Ovid Medline, EMBASE and CINAHL from inception to December 2012. Studies for which survival-related outcomes were reported by socioeconomic subgroups were eligible for inclusion. Two reviewers independently assessed articles and extracted data. Given anticipated heterogeneity, no quantitative meta-analyses were planned a priori. RESULTS Of 7,737 publications, 527 in ten languages met criteria for full review; 36 studies met final inclusion criteria. In low- and middle-income countries (LMIC), lower SES was uniformly associated with inferior survival, regardless of the measure chosen. The majority of associations were statistically significant. Of 52 associations between socioeconomic variables and outcome among high-income country (HIC) children, 38 (73.1%) found low SES to be associated with worse survival, 15 of which were statistically significant. Of the remaining 14 (no association or high SES associated with worse survival), only one was statistically significant. Both HIC studies examining the effect of insurance found uninsured status to be statistically associated with inferior survival. CONCLUSIONS Socioeconomic gradients in which low SES is associated with inferior childhood cancer survival are ubiquitous in LMIC and common in HIC. Future studies should elucidate mechanisms underlying these gradients, allowing the design of interventions mediating socioeconomic effects. Targeting the effect of low SES will allow for further improvements in childhood cancer survival.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marta Wilejto
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason D. Pole
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Program in Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health, Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND Making major treatment decisions with life-altering consequences is a significant challenge faced by parents of children with cancer. The unique experience of parents is not well represented in the growing literature on cancer treatment decision making (TDM). OBJECTIVE The objective of this study was to describe the process of parents making major treatment decisions for their children with cancer. METHODS Using grounded theory methods, we interviewed 15 parents of 13 children with cancer facing major treatment decisions. RESULTS Parents' determination to make the right decision was both a demanding responsibility and a natural extension of the parental role. Everything parents encountered and undertook during the TDM process was in the service of making the right decision for their child. All parents expressed conviction that they had made the right decision, but conviction was tempered by doubts triggered by the pervasive uncertainty of the childhood cancer experience. Parents described limited TDM participation by extended family members and the affected children themselves, asserting their primary responsibility to act as their child's surrogate in partnership with the child's medical team. CONCLUSIONS Making the right decision for one's child under challenging conditions is an extension of the parental obligation to act in the child's best interest and a responsibility that parents claim as their own. IMPLICATIONS FOR PRACTICE The findings from this study can serve as the foundation for future studies to refine the conceptualization of TDM in childhood cancer, which will in turn ground the development and evaluation of interventions to support parents in their critical TDM role.
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Information-seeking behaviours and decision-making process of parents of children with cancer. Eur J Oncol Nurs 2013; 17:176-83. [DOI: 10.1016/j.ejon.2012.03.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 03/08/2012] [Accepted: 03/11/2012] [Indexed: 11/22/2022]
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Petersen I, Spix C, Kaatsch P, Graf N, Janka G, Kollek R. Parental informed consent in pediatric cancer trials: a population-based survey in Germany. Pediatr Blood Cancer 2013; 60:446-50. [PMID: 23015470 DOI: 10.1002/pbc.24330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 08/23/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ensuring adequate parental consent is a key issue of ethical practice in pediatric oncology. In Germany, however, knowledge about parental comprehension and satisfaction with the informed consent procedure is limited, and representative data on parents' perspectives are still missing. Based on data collected by means of a population-based survey, we evaluated the parental recall of the informed consent process for pediatric clinical trials, and how they rated the consent process retrospectively. PROCEDURE A standardized survey was carried out among 1,465 parents whose children were first diagnosed in 2005 with a disease defined by ICCC-3 in the German Childhood Cancer Registry (response: 55.1%). The survey's primary objective was to assess how well parents were able to recall of the informed consent process. To evaluate the results, we set up a second survey among 581 parents who had given consent recently for their child's participation in a clinical trial (response: 53.5%). RESULTS Approximately 81% of the parents in the population-based survey correctly remembered whether or not their child had been enrolled in a clinical trial or treated off-trial. The ability to recall accurately is significantly lower if the parents have a migration background or if their child was not a trial participant. However, parents who recalled the child's trial participation status incorrectly felt as adequately informed as parents who recalled it correctly. CONCLUSIONS Our results identified weak points and vulnerable subgroups in the parental consent process in pediatric oncology in Germany.
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Affiliation(s)
- Imme Petersen
- University of Hamburg, Research Centre for Biotechnology, Society and the Environment, 22529 Hamburg, Germany.
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Marshall PA, Magtanong RV, Leek AC, Hizlan S, Yamokoski AD, Kodish ED. Negotiating decisions during informed consent for pediatric Phase I oncology trials. J Empir Res Hum Res Ethics 2012; 7:51-9. [PMID: 22565583 DOI: 10.1525/jer.2012.7.2.51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During informed consent conferences (ICCs) for Phase I trials, oncologists must present complex information while addressing concerns. Research on communication that evolves during ICCs remains largely unexplored. We examined communication during ICCs for pediatric Phase I cancer trials using a stratified random sample from six pediatric cancer centers. A grounded theory approach identified key communication steps and factors influencing the negotiation of decisions for trial participation. Analysis suggests that during ICCs, families, patients, and clinicians exercise choice and control by negotiating micro-decisions in two broad domains: drug logic and logistics, and administration/scheduling. Micro-decisions unfold in a four-step communication process: (1) introduction of an issue; (2) response; (3) negotiation of the issue; and (4) resolution and decision. Negotiation over smaller micro-decisions is prominent in ICCs and merits further study.
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Affiliation(s)
- Patricia A Marshall
- Center for Genetic Research Ethics and Law, Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
OBJECTIVE The aim of the current study was to examine demographic and contextual correlates of voluntariness in parents making research or treatment decisions for their children with cancer. METHODS Participants included 184 parents of children with cancer who made a decision about enrolling the child in a research or treatment protocol within the previous 10 days. Parents completed questionnaires that assessed voluntariness, external influence by others, concern that the child's care would be negatively affected if the parent did not agree, time pressure, information adequacy, and demographics. RESULTS Lower perceived voluntariness was associated with lower education, male gender, minority status, and not having previous experience with a similar decision. Parents who reported lower voluntariness also perceived more external influence and time pressure, had more concern about the child's care being negatively affected if they declined, and perceived that they had either too much or not enough information about the decision. In a multivariate regression, education, minority status, gender, external influence, and too little information remained significantly associated with voluntariness. CONCLUSIONS Several groups of parents appear to be at risk for decreased voluntariness when making research or treatment decisions for their seriously ill children, including fathers, nonwhite parents, and those with less education. Parental voluntariness may be enhanced by helping parents to mitigate the effects of unhelpful or unwanted influences by others and ensuring that their information needs are met.
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Affiliation(s)
- Victoria A. Miller
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Robert M. Nelson
- Office of Pediatric Therapeutics, Office of the Commissioner, Food and Drug Administration, Rockville, Maryland
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Wulf F, Krasuska M, Bullinger M. Determinants of decision-making and patient participation in paediatric clinical trials: A literature review. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojped.2012.21001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Childhood cancer requires families to deal with many stressors, including decision making in terms of their child's treatment. Adding to the stress of families is that most children participate in clinical research trials. Minimal research has been done to explore parents' decisions related to involving their child in childhood cancer clinical trials. Especially missing is a description of Canadian parents' perspectives. This article describes a qualitative study that sought to understand Canadian parents' participation in decisions about childhood cancer clinical trials. Person-centered, individual, open-ended interviews were conducted with 31 parents of children with cancer. The parents ranged in age between 27 and 51 years. Data analyzed by the constant comparative method revealed that parents found their participation in decisions about childhood cancer clinical trials as a difficult and extraordinary experience that included 6 themes: (1) living a surreal event, (2) wanting the best for my child, (3) helping future families of children with cancer, (4) coming to terms with my decision, (5) making one decision among many, and (6) experiencing a sense of trust. This study indicates that parents need more support not only during the initial decision-making period but also throughout the entire time their child is enrolled in a clinical trial.
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Ward FR. Parents' views of involvement in concurrent research with their neonates. J Empir Res Hum Res Ethics 2010; 5:47-55. [PMID: 20569149 DOI: 10.1525/jer.2010.5.2.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It would be useful to researchers and bioethicists to know more about parents' decision processes and emotional state during the time they are deciding whether to enroll their infant in a clinical trial. The aim of this research study was to discover whether parents who had been previously asked to enroll their neonates in clinical trials would have found concurrent research about their decision-making overly burdensome. Twenty-seven parents of critically ill neonates who had been approached for their child's research participation in a clinical trial were asked what they believed about the potential burden or value of being interviewed during the time of research decision-making about their infant's participation. For this qualitative descriptive study, interviews were audio-recorded, transcribed, and analyzed using content analysis techniques. Participants considered concurrent research acceptable for them but potentially problematic for others. Theories of risk preferences and social comparison might explain these findings.
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Affiliation(s)
- Frances Rieth Ward
- University of Medicine and Dentistry of New Jersey, NJMS-UH Cancer Center, 205 South Orange Ave., Room C-1243, Newark, NJ 07103, USA.
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Raymond TT, Carroll TG, Sales G, Morris MC. Effectiveness of the informed consent process for a pediatric resuscitation trial. Pediatrics 2010; 125:e866-75. [PMID: 20231185 DOI: 10.1542/peds.2009-2427] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE When prospective informed consent is not feasible, clinical research that presents more than minimal risk can proceed only with an exception from informed consent. Our objectives were (1) to describe the in-hospital community consultation and public disclosure process for a clinical trial and (2) to evaluate our in-hospital public disclosure process. METHODS Community consultation included parents, providers, and administrators in a PICU via focus groups, conferences, and other methods. Public disclosure consisted of a brochure and a poster in all PICU waiting rooms. These materials described risks and benefits of the trial, that no consent would be sought, how to "opt out," and how to provide feedback. A verbal questionnaire was administered to parents of potential patients during the trial to evaluate the public disclosure process. RESULTS Eighty-one percent of 93 parents were aware of the ongoing trial. Seventy-six of 93 remembered seeing the brochure; of these, 26% did not read, 39% read quickly, and 35% read carefully. Thirty-seven of 93 parents remembered seeing the poster; of these, 51% did not read, 32% read quickly, and 17% read carefully. Sixty-seven percent reported that they would want to participate in the study, 9% would not, and 24% were undecided. Of the 7 parents who did not want to participate, 3 had opted out and 4 were unaware that they could opt out. CONCLUSIONS Parents endorsed resuscitation research with an exception from informed consent. Public disclosure yielded >80% parental awareness. Efforts should be made to ensure awareness of the ability to opt out.
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Affiliation(s)
- Tia Tortoriello Raymond
- Department of Pediatrics, Division of Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas, USA.
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Knapp CA, Madden VL, Curtis C, Sloyer PJ, Shenkman EA. Assessing non-response bias in pediatric palliative care research. Palliat Med 2010; 24:340-7. [PMID: 20123943 DOI: 10.1177/0269216309351466] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
National experts have recognized a need for increased research in pediatric palliative care. However, when conducting research it is important to use rigorous methods, report significant and non-significant findings, and include information on responders and non-responders. Most studies do not present information on non-responders, yet this is critical as the results many not be generalizable if there are inherent differences between the two groups. Using survey data from parents whose children with life-limiting illnesses were enrolled in Florida's publicly funded pediatric palliative care program called Partners in Care: Together for Kids; this study investigates whether non-response bias exists, and if so, what characteristics are associated with non-response. Bivariate and multivariate analyses were conducted to determine whether individual characteristics differed between responders and non-responders. Throughout our analyses, we conducted the analyses using different ways in which 'non-response' can be defined. Our results suggest that regardless of how non-response is defined, Black, non-Hispanic parents were less likely to participate than White non-Hispanic parents. However, we also found that of the Black, non-Hispanic parents who did not participate, their primary reason for doing so was that they had non-working or disconnected phone numbers. Only 3% of the Black, non-Hispanic parents who did not participate flatly refused. Information from this study can be used to design interventions aimed at increasing minority participation in pediatric palliative care research.
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Affiliation(s)
- Caprice A Knapp
- Departments of Epidemiology and Health Policy Research, University of Florida, Gainesville FL, USA.
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Shilling V, Young B. How do parents experience being asked to enter a child in a randomised controlled trial? BMC Med Ethics 2009; 10:1. [PMID: 19220889 PMCID: PMC2652490 DOI: 10.1186/1472-6939-10-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 02/16/2009] [Indexed: 11/22/2022] Open
Abstract
Background As the number of randomised controlled trials of medicines for children increases, it becomes progressively more important to understand the experiences of parents who are asked to enrol their child in a trial. This paper presents a narrative review of research evidence on parents' experiences of trial recruitment focussing on qualitative research, which allows them to articulate their views in their own words. Discussion Parents want to do their best for their children, and socially and legally their role is to care for and protect them yet the complexities of the medical and research context can challenge their fulfilment of this role. Parents are simultaneously responsible for their child and cherish this role yet they are dependent on others when their child becomes sick. They are keen to exercise responsibility for deciding to enter a child in a trial yet can be fearful of making the 'wrong' decision. They make judgements about the threat of the child's condition as well as the risks of the trial yet their interpretations often differ from those of medical and research experts. Individual parents will experience these and other complexities to a greater or lesser degree depending on their personal experiences and values, the medical situation of their child and the nature of the trial. Interactions at the time of trial recruitment offer scope for negotiating these complexities if practitioners have the flexibility to tailor discussions to the needs and situation of individual parents. In this way, parents may be helped to retain a sense that they have acted as good parents to their child whatever decision they make. Summary Discussing randomised controlled trials and gaining and providing informed consent is challenging. The unique position of parents in giving proxy consent for their child adds to this challenge. Recognition of the complexities parents face in making decisions about trials suggests lines for future research on the conduct of trials, and ultimately, may help improve the experience of trial recruitment for all parties.
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Affiliation(s)
- Valerie Shilling
- Division of Clinical Psychology, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, UK.
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Baker JN, Rai S, Liu W, Srivastava K, Kane JR, Zawistowski CA, Burghen EA, Gattuso JS, West N, Althoff J, Funk A, Hinds PS. Race does not influence do-not-resuscitate status or the number or timing of end-of-life care discussions at a pediatric oncology referral center. J Palliat Med 2009; 12:71-6. [PMID: 19284266 PMCID: PMC2941671 DOI: 10.1089/jpm.2008.0172] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND End-of-life care (EOLC) discussions and decisions are common in pediatric oncology. Interracial differences have been identified in adult EOLC preferences, but the relation of race to EOLC in pediatric oncology has not been reported. We assessed whether race (white, black) was associated with the frequency of do-not-resuscitate (DNR) orders, the number and timing of EOLC discussions, or the timing of EOLC decisions among patients treated at our institution who died. METHODS We reviewed the records of 380 patients who died between July 1, 2001 and February 28, 2005. Chi(2) and Wilcoxon rank-sum tests were used to test the association of race with the number and timing of EOLC discussions, the number of DNR changes, the timing of EOLC decisions (i.e., DNR order, hospice referral), and the presence of a DNR order at the time of death. These analyses were limited to the 345 patients who self-identified as black or white. RESULTS We found no association between race and DNR status at the time of death (p = 0.57), the proportion of patients with DNR order changes (p = 0.82), the median time from DNR order to death (p = 0.51), the time from first EOLC discussion to DNR order (p = 0.12), the time from first EOLC discussion to death (p = 0.33), the proportion of patients who enrolled in hospice (p = 0.64), the time from hospice enrollment to death (p = 0.2) or the number of EOLC discussions before a DNR decision (p = 0.48). CONCLUSION When equal access to specialized pediatric cancer care is provided, race is not a significant factor in the presence or timing of a DNR order, enrollment in or timing of enrollment in hospice, or the number or timing of EOLC discussions before death.
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Affiliation(s)
- Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
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Gibson F. The cultural context of communicating complex information to parents of children with cancer—not just a linguistic obstacle. Eur J Oncol Nurs 2008; 12:2-3. [DOI: 10.1016/j.ejon.2008.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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A review of the literature surrounding the provision of interpreters in health care, focusing on their role in translating information for non-English-speaking cancer patients and issues relating to informed consent. JOURNAL OF RADIOTHERAPY IN PRACTICE 2007. [DOI: 10.1017/s1460396907006152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractInformed consent is a fundamental principle of health care ethics. All patients should have equal opportunities in accessing information to help them make informed decisions about their treatments.Literature on informed consent, translators in health care, non-English-speaking patients and the importance of communication and information, most specifically in radiotherapy, were reviewed. Western studies published between 1995 and 2005 were accessed and filtered though two eligibility screens and a critique framework to assess quality.The evidence suggested that many non-English-speaking patients are not in a position to give true informed consent due to lack of interpreters. This may lead to health care professionals giving treatment without full consent. Written information for radiotherapy patients was often only available in English, apart from inner city areas.There appears to be a scarcity of professional interpreters used in the health care setting; the most common practice is to use family members and friends to interpret. This practice results in breach of patient confidentiality, extra pressure on family members and filtration of information.This patient group is often excluded from certain treatment opportunities such as clinical trials. Ideally, a fully accessible professional interpreting service should be available to allow non-English patients equal rights in accessing appropriate health care options and treatments.
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Abrams AN, Hazen EP, Penson RT. Psychosocial issues in adolescents with cancer. Cancer Treat Rev 2007; 33:622-30. [PMID: 17434265 DOI: 10.1016/j.ctrv.2006.12.006] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Accepted: 12/28/2006] [Indexed: 10/23/2022]
Abstract
Cancer in adolescents is uncommon and when it occurs raises a number of unique challenges for both the patient and their families. Adolescence is a period of time of significant physical and emotional changes and a diagnosis of cancer during this time has a major impact on their psychological and physical development. In this review we will look at the psychosocial issues facing adolescents who have cancer. We will address adolescent development, issues related to informed consent and assent, initial responses to the diagnosis of cancer, quality of life and the experience of the adolescent with cancer, psychological adjustment, support systems, body image issues, sexuality, education, hope, and treatment compliance.
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Affiliation(s)
- Annah N Abrams
- Department of Child Psychiatry and Pediatric Hematology-Oncology, Massachusetts General Hospital, Boston, MA 02114, United States.
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Hunt LM, de Voogd KB. Are good intentions good enough? Informed consent without trained interpreters. J Gen Intern Med 2007; 22:598-605. [PMID: 17443367 PMCID: PMC1855271 DOI: 10.1007/s11606-007-0136-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 08/10/2006] [Accepted: 01/18/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the informed consent process when trained language interpreters are unavailable. BACKGROUND Ensuring sufficient patient understanding for informed consent is especially challenging for patients with Limited English Proficiency (LEP). While US law requires provision of competent translation for LEP patients, such services are commonly unavailable. DESIGN AND PARTICIPANTS Qualitative data was collected in 8 prenatal genetics clinics in Texas, including interviews and observations with 16 clinicians, and 30 Latina patients. Using content analysis techniques, we examined whether the basic criteria for informed consent (voluntariness, discussion of alternatives, adequate information, and competence) were evident for each of these patients, contrasting LEP patients with patients not needing an interpreter. We present case examples of difficulties related to each of these criteria, and compare informed consent scores for consultations requiring interpretation and those which did not. RESULTS We describe multiple communication problems related to the use of untrained interpreters, or reliance on clinicians' own limited Spanish. These LEP patients appear to be consistently disadvantaged in each of the criteria we examined, and informed consent scores were notably lower for consultations which occurred across a language barrier. CONCLUSIONS In the absence of adequate Spanish interpretation, it was uncertain whether these LEP patients were provided the quality and content of information needed to assure that they are genuinely informed. We offer some low-cost practice suggestions that might mitigate these problems, and improve the quality of language interpretation, which is essential to assuring informed choice in health care for LEP patients.
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Affiliation(s)
- Linda M Hunt
- Department of Anthropology, Michigan State University, East Lansing, MI 48824, USA.
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Franck LS, Winter I, Oulton K. The quality of parental consent for research with children: A prospective repeated measure self-report survey. Int J Nurs Stud 2007; 44:525-33. [PMID: 16712850 DOI: 10.1016/j.ijnurstu.2006.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Revised: 03/20/2006] [Accepted: 03/24/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Researchers have ethical and legal responsibilities to ensure that individuals give informed consent to participate in research. The few studies of parental consent for paediatric research suggest there may be inadequate competence, information, understanding, or voluntariness for valid consent to occur. OBJECTIVES To determine parents' level of understanding of the research study requirements and satisfaction with the informed consent process. PARTICIPANTS English literate parents of children actively involved in research studies. METHODS A repeated measures self-report survey was conducted to measure parent understanding (actual and perceived) of the study consented for and satisfaction with the informed consent process. Relationships between parents understanding of the research and their satisfaction with the consent process were explored and changes in parent understanding or satisfaction over time were described. RESULTS Questionnaires from 109 parents were returned, representing 25 different studies. Parents demonstrated a high level of knowledge of information essential for informed consent, such as the purpose, benefits, and participant rights. Nervousness or inability to concentrate, and reading ease of the information sheet were found to relate to parents' knowledge and their perceptions of the adequacy of the consent. Parents overall reported high satisfaction with the consent process. CONCLUSIONS These findings support and extend previous research on parental consent for research with children. They suggest areas where further research is indicated, including: the value and use of information and consent documents given to parents, the views and concerns of parents for whom English is not their first language, and further exploration of the concerns of the few dissatisfied parents. Current practices of obtaining informed consent for research lack supporting research evidence and may not be ethically justifiable.
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White DB, Engelberg RA, Wenrich MD, Lo B, Curtis JR. Prognostication during physician-family discussions about limiting life support in intensive care units. Crit Care Med 2007; 35:442-8. [PMID: 17205000 DOI: 10.1097/01.ccm.0000254723.28270.14] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prognostic information is important to the family members of incapacitated, critically ill patients, yet little is known about what prognostic information physicians provide. Our objectives were to determine the types of prognostic information provided to families of critically ill patients when making major end-of-life treatment decisions and to identify factors associated with more physician prognostication. DESIGN Multiple-center, cross-sectional study. SETTING ICUs of four hospitals. SUBJECTS Thirty-five physicians, 51 patients, and 169 family members. INTERVENTIONS We audiotaped 51 physician-family conferences in which there were deliberations about major end-of-life treatment decisions at four hospitals in 2000-2002. Conferences were coded to identify the types of prognostic information provided by physicians. We used a mixed-effects regression model to identify factors associated with more prognostication by physicians. MEASUREMENTS AND MAIN RESULTS The mean number of prognostic statements per conference was 9.4+/-6.4 (range 0-29). Eighty-six percent of conferences contained discussion of the patient's anticipated functional status or quality of life, compared with 63% in which the chances for survival were discussed (p=.01). There were significantly more statements about prognosis for functional outcomes per conference compared with statements about prognosis for survival (median 4 [interquartile range 2-8] vs. 1 [interquartile range 0-3]; p<.001). Increasing educational level of the family was independently associated with more prognostic statements by physicians (p<.001) as was the degree of physician-family conflict about withdrawing life support (p<.001) and the physician's race being white (p=.009). CONCLUSIONS Prognostication occurred frequently during physician-family deliberations about whether to forego life support, but physicians did not discuss the patient's prognosis for survival in more than one third of conferences. Less educated families received less information about prognosis. Future studies should address whether these observations partially explain the high prevalence of family misunderstandings about prognosis in intensive care units.
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Affiliation(s)
- Douglas B White
- Division of Pulmonary and Critical Care Medicine, Program in Medical Ethics, Department of Medicine, University of California, San Francisco, USA
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Kalauokalani D, Franks P, Oliver JW, Meyers FJ, Kravitz RL. Can Patient Coaching Reduce Racial/Ethnic Disparities in Cancer Pain Control? Secondary Analysis of a Randomized Controlled Trial. PAIN MEDICINE 2007; 8:17-24. [PMID: 17244100 DOI: 10.1111/j.1526-4637.2007.00170.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Minority patients with cancer experience worse control of their pain than do their white counterparts. This disparity may, in part, reflect more miscommunication between minority patients and their physicians. Therefore, we examined whether patient coaching could reduce disparities in pain control in a secondary analysis of a randomized controlled trial. METHODS Sixty-seven English-speaking adult cancer outpatients, including 15 minorities, with moderate pain over the prior 2 weeks were randomly assigned to the experimental (N = 34) or control group (N = 33). Experimental patients received a 20-minute individualized education and coaching session to increase knowledge of pain self-management, to redress personal misconceptions about pain treatment, and to rehearse an individually scripted patient-physician dialog about pain control. The control group received standardized information on controlling pain. Data on average pain (0-10 scale) were collected at enrollment and 2-week follow-up. RESULTS At enrollment, minority patients had significantly more pain than their white counterparts (6.0 vs 5.0, P = 0.05). At follow-up, minorities in the control group continued to have more pain (6.4 vs 4.7, P = 0.01), whereas in the experimental group, disparities were eliminated (4.0 vs 4.3, P = 0.71). The effect of the intervention on reducing disparities was significant (P = 0.04). CONCLUSIONS Patient coaching offers promise as a means of reducing racial/ethnic disparities in pain control. Larger studies are needed to validate these findings and to explore possible mechanisms.
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Affiliation(s)
- Donna Kalauokalani
- Department of Anesthesiology and Pain Medicine, Division of Pain Medicine, University of California, Davis, California, USA.
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Abbe M, Simon C, Angiolillo A, Ruccione K, Kodish ED. A survey of language barriers from the perspective of pediatric oncologists, interpreters, and parents. Pediatr Blood Cancer 2006; 47:819-24. [PMID: 16615062 DOI: 10.1002/pbc.20841] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oncologists in the US increasingly face the challenge of communicating with non-English speaking parents of children with cancer. This study explores this challenge from the perspectives of a sample of pediatric oncologists, interpreters, and Spanish-speaking parents of children with newly diagnosed leukemia. PROCEDURE Thirty-seven oncologists and 17 professional language interpreters based at two non-profit pediatric hospitals in the US were surveyed on the topic of language barriers in pediatric care. Seventeen parents who communicated with their child's oncologist through an interpreter were also surveyed. RESULTS All groups expressed considerable concern over the process of communicating across a language barrier. For oncologists, these concerns included the accuracy and completeness of interpretations, complexity of information, and loss of confidence and control over the communication process. For interpreters, they included complexity of information, information overload, and lack of clinician sensitivity toward the cultural and socioeconomic backgrounds of limited English proficiency (LEP) families. Parent concerns included difficulties comprehending information and anxiety over the possibility of missing out on important information. All groups provided multiple suggestions for improving communication across a language barrier. CONCLUSIONS Oncologists, interpreters, and parents expressed considerable concern over the process of communicating across a language barrier. Some of these concerns could be minimized through efforts to boost interpreter accuracy and completeness, including the use of more simple, easy to understand language. Other issues, such as differences in culture and socioeconomic background, warrant consideration of the intercultural knowledge and skills of interpreters.
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Affiliation(s)
- Marisa Abbe
- Department of Anthropology, Case Western Reserve University, Cleveland, OH 44106-4976, USA
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Pyke-Grimm KA, Stewart JL, Kelly KP, Degner LF. Parents of children with cancer: factors influencing their treatment decision making roles. J Pediatr Nurs 2006; 21:350-61. [PMID: 16980135 DOI: 10.1016/j.pedn.2006.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examined the factors that parents identified as influencing their role in treatment decision making (TDM) for their child with cancer. Content analysis of qualitative data from semistructured interviews with 36 parents as part of a mixed-methods study revealed numerous themes related to parents' TDM roles. Factors that were frequently identified included: relationship with the physician, nature of communication, trust in the physician, parents' and physician's knowledge and experience, and importance of parental role. Parents acknowledged a strong sense of responsibility and feeling of "ownership" of their child. Parents initially lacked knowledge and experience, but acquiring these over time contributed to a more active participation in TDM.
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Abstract
OBJECTIVES To provide an overview of issues raised by conducting research in the area of chronic childhood illness, using the example of childhood cancer. METHODS This literature review used informal methods. RESULTS Children with cancer and their families may participate in a wide variety of studies in different research traditions, including social science studies, epidemiological, biological and genetic research, and clinical trials. Different concerns about research participation have been raised in these different contexts. Sociological debate has tended to characterize exclusion from research as a manifestation of assumptions of poor competence on the part of children, and to see inclusion in research as a means of restoring proper balance in power relations and giving children a voice. The ethical imperative within clinical research, on the other hand, has been in favour of protection of individuals from risk or direct harm. Lack of consensus on issues such as the status of children's consent for research participation persists, in part because debates have taken place within rather than across disciplinary boundaries, and in part because of a tendency to debate issues as ethical principles in an empirical vacuum. The lack of research on the experiences and views of those asked to take part in childhood cancer research is striking. DISCUSSION It is important that debates about the involvement of children in research are informed by high-quality social science research and by interdisciplinary dialogue.
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Affiliation(s)
- Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK.
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Simon CM, Zyzanski SJ, Durand E, Jimenez XF, Jimenez X, Kodish ED. Interpreter accuracy and informed consent among Spanish-speaking families with cancer. JOURNAL OF HEALTH COMMUNICATION 2006; 11:509-22. [PMID: 16846951 DOI: 10.1080/10810730600752043] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Language interpreters mediate a growing number of health care communication events, including the informed consent process, which underlies the ethical conduct of clinical research. This article explores a key interpretive outcome, accuracy, in 21 Spanish/English informed consent consultations. Discussions were transcribed, translated, and coded according to established techniques. Most (74%) discussion was accurately interpreted (range: 47%-98%; std. deviation: .137). Accuracy was lower in the more technical portions of the discussion when compared with nontechnical portions such as discussion of coping and quality-of-life issues (p = .024). The concept of "randomization" often was poorly communicated and interpreted. These differences may be due in part to the use of long, uninterrupted, and jargon-filled sentences by clinicians explaining research, among other factors. The article concludes that accuracy may be promoted if clinicians used less technical language and shorter sentences, and are more "process driven." Interpreters may need to be better informed about research-related concepts such as randomization. Further research is needed to determine the effects of interpretive accuracy on the informed consent process, the decision to participate in research, and other outcomes.
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Affiliation(s)
- Christian M Simon
- Bioethics Department, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
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Abstract
Research protocols frequently necessitate procedures or design elements that differ from those used in routine clinical care. An example is the inclusion of a placebo arm in many randomized clinical trials. Because there are risks to taking a placebo when one has a chronic disorder such as schizophrenia, ascertaining how well people with severe mental illness understand placebos is an important task for empirical research ethics. We investigated whether schizophrenia patients' understanding of placebo controls could be improved with a brief educational intervention. We randomized 49 middle-aged and older patients with schizophrenia or schizoaffective disorder to receive either (1) a routine explanation of placebos in the context of consent for a hypothetical double-blind placebo-controlled clinical trial, or (2) the consent for the hypothetical trial plus a brief educational module explaining placebos in more depth. Understanding of placebos was assessed with a 12-item questionnaire, and we examined demographic, clinical, neurocognitive, and decision-making correlates of understanding of placebos. Those participants who received the intervention obtained higher scores on the placebo post-test compared to those who received the standard information alone. Performance on the placebo post-test was positively correlated with measures of decisional capacity and neurocognitive abilities and negatively correlated with severity of negative symptoms, but it showed no relationship with positive or general symptoms. Some participants interpreted the common phrase "sugar pill" as relating somehow to diabetes. We conclude that the level of understanding of important research design-related information is not static but may be influenced by how investigators approach the consent process.
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Affiliation(s)
- Laura B Dunn
- Department of Psychiatry, University of California, San Diego, USA.
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Jung KW, Hyun I. Oocyte and somatic cell procurement for stem cell research: the South Korean experience. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:W19-22. [PMID: 16423766 DOI: 10.1080/15265160500395025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Revenson TA, Pranikoff JR. A contextual approach to treatment decision making among breast cancer survivors. Health Psychol 2005; 24:S93-8. [PMID: 16045426 DOI: 10.1037/0278-6133.24.4.s93] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents a contextual model of adjustment to cancer that frames research inquiry on treatment decision making among long-term breast cancer survivors. Psychosocial adaptation, of which treatment decision making is a part, is viewed within a social ecological framework (T. A. Revenson, 1990, 2003) that encompasses 4 contexts: the situational context, the interpersonal context, the sociocultural context, and the temporal context. Examples of how each context may influence decision-making processes are described, and guidelines for future research are provided.
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Affiliation(s)
- Tracey A Revenson
- Graduate Center, City University of New York, New York, NY 10016-4309, USA.
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