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Cousins S, Huttman M, Blencowe N, Tsang C, Elliott D, Blazeby J, Beard DJ, Campbell MK, Gillies K. Patient information leaflets for placebo-controlled surgical trials: a review of current practice and recommendations for developers. Trials 2024; 25:339. [PMID: 38778336 PMCID: PMC11110406 DOI: 10.1186/s13063-024-08166-x] [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: 04/21/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Informed consent for participation in an RCT is an important ethical and legal requirement. In placebo surgical trials, further issues are raised, and to date, this has not been explored. Patient information leaflets (PILs) are a core component of the informed consent process. This study aimed to investigate the key content of PILs for recently completed placebo-controlled trials of invasive procedures, including surgery, to highlight areas of good practice, identify gaps in information provision for trials of this type and provide recommendations for practice. METHODS PILs were sought from trials included in a recent systematic review of placebo-controlled trials of invasive procedures, including surgery. Trial characteristics and data on surgical and placebo interventions under evaluation were extracted. Directed content analysis was applied, informed by published regulatory and good practice guidance on PIL content and existing research on placebo-controlled surgical trials. Results were analysed using descriptive statistics and presented as a narrative summary. RESULTS Of the 62 eligible RCTs, authors of 59 trials were contactable and 14 PILs were received for analysis. At least 50% of all PILs included content on general trial design. Explanations of how the placebo differs or is similar to the surgical intervention (i.e. fidelity) were reported in 6 (43%) of the included PILs. Over half (57%) of the PILs included information on the potential therapeutic benefits of the surgical intervention. One (7%) included information on potential indirect therapeutic benefits from invasive components of the placebo. Five (36%) presented the known risks of the placebo intervention, whilst 8 (57%) presented information on the known risks of the surgical intervention. A range of terms was used across the PILs to describe the placebo component, including 'control', 'mock' and 'sham'. CONCLUSION Developers of PILs for placebo-controlled surgical trials should carefully consider the use of language (e.g. sham, mock), be explicit about how the placebo differs (or is similar) to the surgical intervention and provide balanced presentations of potential benefits and risks of the surgical intervention separately from the placebo. Further research is required to determine optimal approaches to design and deliver this information for these trials.
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Affiliation(s)
- S Cousins
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - M Huttman
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - N Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - C Tsang
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - D Elliott
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK
- Royal College of Surgeons Surgical Trials Centre Bristol, University of Bristol, Bristol, UK
| | - D J Beard
- Royal College of Surgeons Surgical Trials Centre Oxford, University of Oxford, Oxford, UK
| | - M K Campbell
- Royal College of Surgeons Surgical Trials Centre Aberdeen, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - K Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
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Zemsi A, Nekame LJG, Mohammed N, Batchilly ES, Dabira E, Sillah SO, Sey G, Williams DH, Dondeh BL, Cerami C, Clarke E, D'Alessandro U. Practical Guidelines for Standardised Resolution of Important Protocol Deviations in Clinical Trials Conducted in Sub-Saharan Africa. Ther Innov Regul Sci 2024; 58:395-403. [PMID: 38285370 PMCID: PMC11043146 DOI: 10.1007/s43441-023-00604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
A clinical trial is any research on human subjects that involves an investigational medicinal product or device. Investigational medicinal products include unlicensed drugs or drugs used outside the product license (e.g. for a new indication) (ICH-GCP). As per the internationally accepted ICH-GCP guidelines, clinical trials should be conducted strictly per the approved protocol. However, during the lifecycle of a trial, protocol deviations may occur. Under ICH efficacy guidelines, protocol deviations are divided into non-important (minor) or important (major), and the latter can jeopardise the participant's rights, safety or the quality of data generated by the study. Existing guidelines on protocol deviation management do not detail or standardise actions to be taken for participants, investigational products, data or samples as part of a holistic management of important protocol deviations. Herein, we propose guidelines to address the current literature gap and promote the standardisation of actions to address important protocol deviations in clinical trials. The advised actions should complement the existing local institutional review board and national regulatory authority requirements.
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Affiliation(s)
- Armel Zemsi
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia.
| | | | - Nuredin Mohammed
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | | | - Edgard Dabira
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Sheikh Omar Sillah
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Gibbi Sey
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Daisy H Williams
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Bai-Lamin Dondeh
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Carla Cerami
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Ed Clarke
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
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Cuddihy L, Howick J, Murphy E, Shiely F. When describing harms and benefits to potential trial participants, participant information leaflets are inadequate. Trials 2024; 25:292. [PMID: 38693579 PMCID: PMC11061982 DOI: 10.1186/s13063-024-08087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/02/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Providing informed consent for trials requires providing trial participants with comprehensive information about the trial, including information about potential risks and benefits. It is required by the ethical principle of respecting patient autonomy. Our study examines the variation in the way information about potential trial benefits and harms is shared in participant information leaflets (PILs). METHODS A total of 214 PILs and informed consent forms from clinical trials units (CTUs) and Clinical Research Facilities (CRFs) in Ireland and the UK were assessed by two authors independently, to check the extent to which they adhered to seven recently developed principles. Discrepancies were resolved by a third. RESULTS Usage of the seven principles varied widely between PILs regardless of the intended recipient or trial type. None of the PILs used more than four principles, and some (4%) used none. Twenty-seven per cent of PILs presented information about all known potential harms, whereas 45% presented information on all known potential benefits. Some PILs did not provide any potential harms or potential benefits (8%). There was variation in the information contained in adult and children PILs and across disease areas. CONCLUSION Significant variation exists in how potential trial benefits and harms are described to potential trial participants in PILs in our sample. Usage of the seven principles of good practice will promote consistency, ensure informed ethical decision-making and invoke trust and transparency. In the long term, a standardised PIL template is needed.
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Affiliation(s)
- Laura Cuddihy
- Oncology Day Ward, St. James's Hospital, James Street, Dublin 8, Ireland
- Trials Research and Methodologies Unit (TRAMS), HRB Clinical Research Facility and School of Public Health, 4th Floor Western Gateway Building, University College Cork, Cork, Ireland
| | - Jeremy Howick
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, George Davies Centre, Lancaster Rd., Leicester, LE1 7HA, UK
| | - Ellen Murphy
- Trials Research and Methodologies Unit (TRAMS), HRB Clinical Research Facility and School of Public Health, 4th Floor Western Gateway Building, University College Cork, Cork, Ireland
- Medical School, Stoneygate Centre for Excellence in Empathic Healthcare, University of Leicester, George Davies Centre, Lancaster Rd., Leicester, LE1 7HA, UK
| | - Frances Shiely
- Trials Research and Methodologies Unit (TRAMS), HRB Clinical Research Facility and School of Public Health, 4th Floor Western Gateway Building, University College Cork, Cork, Ireland.
- School of Public Health, University College Cork, Cork, Ireland.
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L'Heureux J, McTaggart-Cowan H, Johns G, Chen L, Steiner T, Tocher P, Sun H, Zhang W. How to present work productivity loss results from clinical trials for patients and caregivers? A mixed methods approach. Soc Sci Med 2023; 328:115999. [PMID: 37276772 DOI: 10.1016/j.socscimed.2023.115999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES From the perspectives of patients and caregivers, the objectives were: identifying which result presentations, describing work productivity loss (WPL) outcomes, are most understandable; measuring which presentations are important to report; and investigating which WPL outcomes are viewed as important alongside clinical trials results. METHODS We used a four phased, sequential mixed methods design, guided by patient-oriented research engaging one patient partner. We conducted think-aloud interviews, in British Columbia/Canada, to review WPL results and our survey measuring the understandability and importance of the results, and importance of each WPL outcome. We surveyed a sample representing working Canadians. The findings were summarized and analyzed using linear and logistic regression. We conducted sub-group analyses; one was gender based. All regressions were conducted using generalized estimating equations. RESULTS In our qualitative phases, 20 patients and caregivers were interviewed. Participants recommended for the results to be brief, simple, and represented visually. Then, 118 patients and 120 caregivers were surveyed. The results presented in days or cost yielded the highest understandability and importance to report. All WPL outcomes were identified as important to somewhat important to report by most. The associations indicated that the more understandable the result presentation was, the more likely it was to be rated as important. Age was the only factor significantly associated with selecting days or cost as the most important result. CONCLUSION Presenting WPL results in days and cost, using lay terms and visual supports, were viewed as easiest to understand and most important to report in clinical trials by patients and caregivers. Our findings are supportive of clinical trials standardizing the measurement of WPL to include all of its outcomes (absenteeism, presenteeism, employment status changes and total work productivity loss), in addition to tools assessing the comprehensiveness of WPL results to be provided to patients and caregivers.
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Affiliation(s)
- Jacynthe L'Heureux
- School of Population and Public Health, University of British Columbia; 2206 E Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Helen McTaggart-Cowan
- Faculty of Health Sciences, Simon Fraser University; Blusson Hall, Room, 11300, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada; British Columbia Cancer Research Centre, 675 W 10th Avenue; Vancouver, British Columbia, V5Z 1L3, Canada.
| | - Gary Johns
- Sauder School of Business, University of British Columbia; 2053 Main Mall, Vancouver, British Columbia, V6T 1Z2, Canada; John Molson School of Business, Concordia University, 1450 Guy Street, Montreal, Quebec, H3H 0A1, Canada.
| | - Lin Chen
- Patient Voices Network, 201-750 Pender Street, Vancouver, British Columbia, V6C 2T8, Canada
| | - Theodore Steiner
- Division of Infectious Diseases, Vancouver General Hospital, 2733 Heather Street, Rm C328 HP East, Vancouver, British Columbia, V5Z 3J5, Canada.
| | - Paige Tocher
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Huiying Sun
- Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| | - Wei Zhang
- School of Population and Public Health, University of British Columbia; 2206 E Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Centre for Health Evaluation and Outcome Sciences, 570-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia; 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
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Eng C, Chen EY, Rogers J, Lewis M, Strosberg J, Thota R, Krishnamurthi S, Oberstein P, Govindarajan R, Buchschacher G, Patel S, Sohal D, Al-Toubah T, Philip P, Dasari A, Kennecke H, Stein S. Moving Beyond the Momentum: Innovative Approaches to Clinical Trial Implementation. JCO Oncol Pract 2021; 17:607-614. [PMID: 33534616 PMCID: PMC8791825 DOI: 10.1200/op.20.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Despite efforts to enhance enrollment and the merger of national cooperative groups, < 5% of patients with cancer will enroll into a clinical trial. Additionally, clinical trials are affected by a lack of diversity inclusive of minority patients, rural residents, or low-income individuals. COVID-19 further exacerbated known barriers of reduced physician-patient interaction, physician availability, trial activation and enrollment, financial resources, and capacity for conducting research. Based on the cumulative insight of academic and community clinical researchers, we have created a white paper identifying existing challenges in clinical trial conduct and have provided specific recommendations of sustainable modifications to improve efficiency in the activation and conduct of clinical trials with an overarching goal of providing improved access and care to our patients with cancer.
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Affiliation(s)
- Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN,Cathy Eng, MD, Vanderbilt-Ingram Cancer Center, Gastrointestinal Cancer Research Program, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN 37232; e-mail:
| | - Emerson Y. Chen
- Division of Hematology and Oncology, Oregon Health and Science University, Knight Cancer Institute, Portland, OR
| | - Jane Rogers
- University of Texas MD Anderson Cancer Center Pharmacy Clinical Programs, Houston, TX
| | | | | | | | | | | | - Rang Govindarajan
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas, Little Rock, AR
| | | | - Sandip Patel
- Moores Cancer Center, UC San Diego Health, La Jolla, CA
| | - Davendra Sohal
- University of Cincinnati Health Barrett Cancer Center, Cincinnati, OH
| | | | | | - Arvind Dasari
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Stacey Stein
- Smilow Cancer Center, Yale School of Medicine, New Haven, CT
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