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Dosso JA, Kailley JN, Robillard JM. The League: A person-centred approach to the development of social robotics for paediatric anxiety. Health Expect 2024; 27:e13981. [PMID: 39102709 PMCID: PMC10821745 DOI: 10.1111/hex.13981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Social robots are promising tools to improve the quality of life of children and youth living with anxiety and should be developed based on the priorities of end users. However, pathways to include young people in patient-oriented research, particularly in the overlap between technology and mental health, have been historically limited. OBJECTIVE In this work, we describe engagement with experts with lived experiences of paediatric anxiety in a social robotics research programme. We report the experiences of patient advisors in a co-creation process and identify considerations for other research groups looking to involve end users in technology development in the field of youth mental health. DESIGN We engaged individuals with a lived experience of paediatric anxiety (current, recent past, or from a parent perspective) using three different models over the course of three years. Two initial patient partners were involved during project development, eight were engaged as part of an advisory panel ('the League') during study development and data analysis and four contributed as ongoing collaborators in an advisory role. League members completed a preparticipation expectation survey and a postparticipation experience survey. FINDINGS Eight individuals from a range of anxiety-related diagnostic groups participated in the League as patient partners. Members were teenagers (n = 3), young adults aged 22-26 years who had connected with a youth mental health service as children within the past eight years (n = 3) or parents of children presently living with anxiety (n = 2). Preferred methods of communication, expectations and reasons for participating were collected. The League provided specific and actionable feedback on the design of workshops on the topic of social robotics, which was implemented. They reported that their experiences were positive and fairly compensated, but communication and sustained engagement over time were challenges. Issues of ethics and language related to patient-centred brain health technology research are discussed. CONCLUSIONS There is an ethical imperative to meaningfully incorporate the voices of youth and young adults with psychiatric conditions in the development of devices intended to support their mental health and quality of life. PATIENT OR PUBLIC CONTRIBUTION Six young people and two parents with lived experiences of paediatric anxiety participated in all stages of developing a research programme on social robotics to support paediatric mental health in a community context. They also provided input during the preparation of this manuscript.
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Affiliation(s)
- Jill A. Dosso
- Department of Medicine, Division of NeurologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia Children & Women's HospitalVancouverBritish ColumbiaCanada
| | - Jaya N. Kailley
- Department of Medicine, Division of NeurologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia Children & Women's HospitalVancouverBritish ColumbiaCanada
| | - Julie M. Robillard
- Department of Medicine, Division of NeurologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia Children & Women's HospitalVancouverBritish ColumbiaCanada
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2
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Robillard JM, Masellis M, Martin SE, Khachaturian AS, Dixon RA. The Return of Biomarker Results in Research: Balancing Complexity, Precision, and Ethical Responsibility. J Alzheimers Dis 2024; 97:1083-1090. [PMID: 38306053 PMCID: PMC10836546 DOI: 10.3233/jad-230359] [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] [Indexed: 02/03/2024]
Abstract
Recent research aimed at the discovery, integration, and communication of health outcome measures (or "biomarkers") in Alzheimer's disease has raised challenging questions related to whether, how and when results from these investigations should be disclosed to research participants. Reflecting the apparent heterogeneity of many neurodegenerative diseases, biomarker or other risk factor results are often probabilistic, interactive, multi-modal, and selective. Such characteristics make it very complex to summarize and communicate to clinicians, researchers, and research participants. Whereas the format and content of academic literature is well-managed by the peer-review process, reporting individualized results to participants involves complex, sensitive, and ethical considerations. This paper describes three key factors to consider in decisions about the return of results to research participants: complexity, precision, and responsibility. The paper also presents six practical recommendations for implementing meaningful and ethical communication with research participants.
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Affiliation(s)
- Julie M Robillard
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Mario Masellis
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Susanna E Martin
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Ara S Khachaturian
- The Campaign to Prevent Alzheimer's Disease 2020, Inc. Rockville, MD, USA
| | - Roger A Dixon
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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3
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Becker JC, Beer AJ, DeTemple VK, Eigentler T, Flaig MJ, Gambichler T, Grabbe S, Höller U, Klumpp B, Lang S, Pföhler C, Posch C, Prasad V, Schlattmann P, Schneider-Burrus S, Ter-Nedden J, Terheyden P, Thoms K, Vordermark D, Ugurel S. S2k-Leitlinie - Merkelzellkarzinom - Update 2022. J Dtsch Dermatol Ges 2023; 21:305-317. [PMID: 36929546 DOI: 10.1111/ddg.14930_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/09/2022] [Indexed: 03/18/2023]
Affiliation(s)
- Jürgen C Becker
- Translational Skin Cancer Research (TSCR), Deutsches Konsortium für translationale Krebsforschung (DKTK), Partnerstandort Essen, Klinik für Dermatologie, Universitätsmedizin Essen, Deutsches Krebsforschungszentrum, Heidelberg
| | | | - Viola K DeTemple
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden
| | - Thomas Eigentler
- Klinik für Dermatologie, Venerologie und Allergologie, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Thilo Gambichler
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum
| | | | | | | | - Stephan Lang
- Hals-Nasen-Ohren-Klinik am Universitätsklinikum Essen
| | - Claudia Pföhler
- Klinik für Dermatologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Posch
- Hautklinik Campus Biederstein, Technische Universität München
| | - Vikas Prasad
- Klinik für Nuklearmedizin, Universitätsklinikum Ulm
| | | | | | | | - Patrick Terheyden
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Kai Thoms
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen, Göttingen
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Halle
| | - Selma Ugurel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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4
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Becker JC, Beer AJ, DeTemple VK, Eigentler T, Flaig M, Gambichler T, Grabbe S, Höller U, Klumpp B, Lang S, Pföhler C, Posch C, Prasad V, Schlattmann P, Schneider-Burrus S, Ter-Nedden J, Terheyden P, Thoms K, Vordermark D, Ugurel S. S2k Guideline - Merkel cell carcinoma (MCC, neuroendocrine carcinoma of the skin) - Update 2022. J Dtsch Dermatol Ges 2023; 21:305-320. [PMID: 36929552 DOI: 10.1111/ddg.14930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/09/2022] [Indexed: 03/18/2023]
Abstract
Merkel cell carcinoma (MCC, ICD-O M8247/3) is a rare, malignant, primary skin tumor with epithelial and neuroendocrine differentiation. The tumor cells share many morphologic, immunohistochemical, and ultrastructural features with cutaneous Merkel cells. Nevertheless, the cell of origin of MCC is unclear. MCC appears clinically as a reddish to purple spherical tumor with a smooth, shiny surface and a soft to turgid, elastic consistency, usually showing rapid growth. Spontaneous and often complete regressions of the tumor are observed. These likely immunologically-mediated regressions explain the cases in which only lymph node or distant metastases are found at the time of initial diagnosis and why the tumor responds very well to immunomodulatory therapies even at advanced stages. Due to its aggressiveness, the usually given indication for sentinel lymph node biopsy, the indication of adjuvant therapies to be evaluated, as well as the complexity of the necessary diagnostics, clinical management should already be determined by an interdisciplinary tumor board at the time of initial diagnosis.
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Affiliation(s)
- Jürgen C Becker
- Translational Skin Cancer Research (TSCR), Deutsches Konsortium für translationale Krebsforschung (DKTK), Partnerstandort Essen, Department of Dermatology, University Hospital Essen, German Cancer Research Center (DKFZ), Heidelberg
| | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital Ulm
| | - Viola K DeTemple
- Department of Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Klinikum, Minden
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, University Hospital Berlin
| | - Michael Flaig
- Department and Clinic for Dermatology and Allergology, LMU Klinikum Munich
| | - Thilo Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum
| | | | | | | | - Stephan Lang
- Department of Ear, Nose and Throat Medicine, University Hospital Essen
| | - Claudia Pföhler
- Department of Dermatology, University Hospital Saarland, Homburg/Saar
| | - Christian Posch
- Department of Dermatology Campus Biederstein, Technical University Munich
| | - Vikas Prasad
- Department of Nuclear Medicine, University Hospital Ulm
| | | | | | - Jan Ter-Nedden
- Professional Association of German Dermatologists, Hamburg
| | - Patrick Terheyden
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Lübeck
| | - Kai Thoms
- Department of Dermatology, Venereology and Allergology, University Hospital Göttingen, Göttingen
| | | | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen
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Bertorello D, Brichetto G, Folkvord F, Theben A, Zaratin P. A Systematic Review of Patient Engagement Experiences in Brain Disorders. Patient Relat Outcome Meas 2022; 13:259-272. [DOI: 10.2147/prom.s256396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
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Perry J. Challenges of anticipation of future decisions in dementia and dementia research. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:62. [PMID: 36376514 PMCID: PMC9663374 DOI: 10.1007/s40656-022-00541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Anticipation of future decisions can be important for individuals at risk for diseases to maintain autonomy over time. For future treatment and care decisions, advance care planning is accepted as a useful anticipation tool. As research with persons with dementia seems imperative to develop disease-modifying interventions, and with changing regulations regarding research participation in Germany, advance research directives (ARDs) are considered a solution to include persons with dementia in research in an ethically sound manner. However, little is known about what affected people deem anticipatable.This contribution provides a critical reflection of the literature on anticipation and of a qualitative study on the assessment of ARDs with persons with cognitive impairment in Germany. It combines theoretical and empirical reflections to inform the ethical-legal discourse.Anticipation involves the conceptual separation of the past, the present, and the future. Including dimensions such as preparedness, injunction, and optimization helps in establishing a framework for anticipatory decision-making. While dementia may offer a window of time to consider future decisions, individual beliefs about dementia including fears about stigma, loss of personhood, and solitude strongly impact anticipating sentiments. Concepts of anticipation can be useful for the examination of uncertainty, changing values, needs, and preferences interconnected with the dementia trajectory and can serve as a means to make an uncertain future more concrete. However, fears of losing one's autonomy in the process of dementia also apply to possibilities of anticipation as these require cognitive assessment and reassessment of an imagined future with dementia.
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Affiliation(s)
- Julia Perry
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
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Yous ML, Ploeg J, Kaasalainen S, McAiney C. Experiences of caregivers of community-dwelling older persons with moderate to advanced dementia in adapting the Namaste Care program: a qualitative descriptive study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:61. [PMID: 36371288 PMCID: PMC9655803 DOI: 10.1186/s40900-022-00401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Globally many older persons with dementia are living at home to maintain independence within the community. As older persons with dementia transition from early to moderate or advanced stages of dementia they require more support from family members and friends to complete their daily activities. Family and friend caregivers, however, often report a lack of preparation for their caregiving role. There are few psychosocial programs that can be delivered by caregivers of community-dwelling older persons with moderate to advanced dementia. Namaste Care is a psychosocial intervention, predominantly used in long-term care, to improve the quality of life of persons with advanced dementia. Namaste Care provides multisensory stimulation for persons with dementia through meaningful activities such as music, massage, aromatherapy, and nutrition. There have been limited attempts at adapting Namaste Care for use by caregivers in the community.There is a need to involve caregivers in adapting programs and understanding their experiences in research involvement so that strategies can be put in place for a positive experience. The purpose of this study is to explore the experiences of caregivers who participated in workshop sessions to adapt Namaste Care for community-dwelling older persons with moderate to advanced dementia. METHODS A qualitative descriptive design was used. Six caregivers residing in Ontario, Canada attended virtual workshop sessions (i.e., by phone or videoconference) that were guided by the Strategy for Patient-Oriented Research (SPOR) Patient Engagement Framework. Caregivers completed individual post-workshop interviews. Experiential thematic analysis was used to analyze interviews and post-interview researcher notes. RESULTS Key findings were that caregivers had a positive experience in adapting Namaste Care by learning how to improve their caregiving skills and being supported to engage in research through multiple facilitators such as flexible scheduling and an inclusive and respectful environment. Having designated time for discussions between caregivers was perceived as important to forming partnerships within the group to support co-creation of knowledge. CONCLUSION Findings support the need to improve caregiver research engagement processes by ensuring that caregivers can benefit through learning opportunities and discussions and empowering caregivers to value their contributions in adapting interventions.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- Schlegel-UW Research Institute for Aging, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
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8
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Rosen AC, Arias JJ, Ashford JW, Blacker D, Chhatwal JP, Chin NA, Clark L, Denny SS, Goldman JS, Gleason CE, Grill JD, Heidebrink JL, Henderson VW, Lavacot JA, Lingler JH, Menon M, Nosheny RL, Oliveira FF, Parker MW, Rahman-Filipiak A, Revoori A, Rumbaugh MC, Sanchez DL, Schindler SE, Schwarz CG, Toy L, Tyrone J, Walter S, Wang LS, Wijsman EM, Zallen DT, Aggarwal NT. The Advisory Group on Risk Evidence Education for Dementia: Multidisciplinary and Open to All. J Alzheimers Dis 2022; 90:953-962. [PMID: 35938255 PMCID: PMC9901285 DOI: 10.3233/jad-220458] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The brain changes of Alzheimer's disease and other degenerative dementias begin long before cognitive dysfunction develops, and in people with subtle cognitive complaints, clinicians often struggle to predict who will develop dementia. The public increasingly sees benefits to accessing dementia risk evidence (DRE) such as biomarkers, predictive algorithms, and genetic information, particularly as this information moves from research to demonstrated usefulness in guiding diagnosis and clinical management. For example, the knowledge that one has high levels of amyloid in the brain may lead one to seek amyloid reducing medications, plan for disability, or engage in health promoting behaviors to fight cognitive decline. Researchers often hesitate to share DRE data, either because they are insufficiently validated or reliable for use in individuals, or there are concerns about assuring responsible use and ensuring adequate understanding of potential problems when one's biomarker status is known. Concerns include warning people receiving DRE about situations in which they might be compelled to disclose their risk status potentially leading to discrimination or stigma. The Advisory Group on Risk Evidence Education for Dementia (AGREEDementia) welcomes all concerned with how best to share and use DRE. Supporting understanding in clinicians, stakeholders, and people with or at risk for dementia and clearly delineating risks, benefits, and gaps in knowledge is vital. This brief overview describes elements that made this group effective as a model for other health conditions where there is interest in unfettered collaboration to discuss diagnostic uncertainty and the appropriate use and communication of health-related risk information.
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Affiliation(s)
- Allyson C. Rosen
- VA Medical Center-Palo Alto, Palo Alto, CA, USA,Stanford University, School of Medicine, Stanford, CA, USA,Correspondence to: Allyson C. Rosen, PhD, ABPP-CN, Mental Illness Research, Education and Clinical Center (MIRECC), Palo Alto VA Medical Center, 3801 Miranda Ave (151Y), Palo Alto, CA 94304-1207, USA. Tel.: +1 650 279 3949;
| | - Jalayne J. Arias
- School of Public Health Georgia State University, Atlanta, GA, USA
| | - J. Wesson Ashford
- VA Medical Center-Palo Alto, Palo Alto, CA, USA,Stanford University, School of Medicine, Stanford, CA, USA
| | - Deborah Blacker
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Nathan A. Chin
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lindsay Clark
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sharon S. Denny
- The Association for Frontotemporal Degeneration, King of Prussia, PA, USA
| | - Jill S. Goldman
- Columbia University Irving Medical Center, New York, NY, USA
| | - Carey E. Gleason
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Judith L. Heidebrink
- Michigan Alzheimer’s Disease Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Victor W. Henderson
- Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | | | | | | | - Rachel L. Nosheny
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Monica W. Parker
- Emory Goizueta Alzheimer’s Disease Research Center, Atlanta, GA, USA
| | | | | | | | | | - Suzanne E. Schindler
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Leslie Toy
- VA Medical Center-Palo Alto, Palo Alto, CA, USA
| | - Jamie Tyrone
- Beating Alzheimer’s by Embracing Science, Ramona, CA, USA
| | - Sarah Walter
- Alzheimer’s Therapeutic Research Institute/USC, San Diego, CA, USA
| | - Li-san Wang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Bernstein JPK, Dorociak KE, Mattek N, Leese M, Beattie ZT, Kaye JA, Hughes A. Passively-Measured Routine Home Computer Activity and Application Use Can Detect Mild Cognitive Impairment and Correlate with Important Cognitive Functions in Older Adulthood. J Alzheimers Dis 2021; 81:1053-1064. [PMID: 33843682 DOI: 10.3233/jad-210049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Computer use is a cognitively complex instrumental activity of daily living (IADL) that has been linked to cognitive functioning in older adulthood, yet little work has explored its capacity to detect incident mild cognitive impairment (MCI). OBJECTIVE To examine whether routine home computer use (general computer use as well as use of specific applications) could effectively discriminate between older adults with and without MCI, as well as explore associations between use of common computer applications and cognitive domains known to be important for IADL performance. METHODS A total of 60 community-dwelling older adults (39 cognitively healthy, 21 with MCI) completed a neuropsychological evaluation at study baseline and subsequently had their routine home computer use behaviors passively recorded for three months. RESULTS Compared to those with MCI, cognitively healthy participants spent more time using the computer, had a greater number of computer sessions, and had an earlier mean time of first daily computer session. They also spent more time using email and word processing applications, and used email, search, and word processing applications on a greater number of days. Better performance in several cognitive domains, but in particular memory and language, was associated with greater frequency of browser, word processing, search, and game application use. CONCLUSION Computer and application use are useful in identifying older adults with MCI. Longitudinal studies are needed to determine whether decreases in overall computer use and specific computer application use are predictors of incident cognitive decline.
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Affiliation(s)
| | | | - Nora Mattek
- Oregon Center for Aging & Technology, Portland, OR, USA
| | - Mira Leese
- Minneapolis VA Healthcare System, Minneapolis, MN, USA
| | | | | | - Adriana Hughes
- Minneapolis VA Healthcare System, Minneapolis, MN, USA.,University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA
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Tam MT, Gauthier S, Ng KP, Everett F, Robillard JM. Facilitating recruitment for dementia research: Insights from an international panel. DEMENTIA 2021; 20:1182-1186. [PMID: 33342280 PMCID: PMC8044603 DOI: 10.1177/1471301220981241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dementia research is critical to improve dementia care; however, participation in this research remains limited, and recruitment is challenging. During an international panel at the 2018 Alzheimer Disease International Conference in Chicago, presentations were given to raise the profile of dementia research and share the patient experience of research participation. We observed notable shifts in perspectives on research participation from 39 participants who completed a survey before and after the presentations. These findings set the stage for future studies exploring the strength of independent motivations for research participation as well as improving recruitment efforts through education and peer support.
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Affiliation(s)
- Mallorie T Tam
- Division of Neurology, Department of Medicine, The University of British Columbia, and BC Children's & Women's Hospitals, Canada
| | - Serge Gauthier
- 5620The McGill University Research Center for Studies in Aging, Canada
| | - Kok Pin Ng
- Department of Neurology, 54738National Neuroscience Institute, Singapore
| | - Frank Everett
- 5620The McGill University Research Center for Studies in Aging, Canada
| | - Julie M Robillard
- Division of Neurology, Department of Medicine, The University of British Columbia, and BC Children's & Women's Hospitals, Canada
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11
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Götzelmann TG, Strech D, Kahrass H. The full spectrum of ethical issues in dementia research: findings of a systematic qualitative review. BMC Med Ethics 2021; 22:32. [PMID: 33771131 PMCID: PMC8004446 DOI: 10.1186/s12910-020-00572-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When including participants with dementia in research, various ethical issues arise. At present, there are only a few existing dementia-specific research guidelines (Committee for Medicinal Products for Human Use in Clinical investigation of medicines for the treatment Alzheimer's disease (Internet). https://www.ema.europa.eu/en/clinical-investigation-medicines-treatment-alzheimers-disease ; Food and Drug Administration, Early Alzheimer's Disease: Developing Drugs for Treatment Guidance for Industry [Internet]. http://www.fda.gov/regulatory-information/search-fda-guidance-documents/alzheimers-disease-developing-drugs-treatment-guidance-industy ), necessitating a more systematic and comprehensive approach to this topic to help researchers and stakeholders address dementia-specific ethical issues in research. A systematic literature review provides information on the ethical issues in dementia-related research and might therefore serve as a basis to improve the ethical conduct of this research. This systematic review aims to provide a broad and unbiased overview of ethical issues in dementia research by reviewing, analysing, and coding the latest literature on the topic. METHODS We conducted a systematic review in PubMed and Google Scholar (publications in English between 2007 and 2020, no restrictions on the type of publication) of literature on research ethics in dementia research. Ethical issues in research were identified by qualitative text analysis and normative analysis. RESULTS The literature review retrieved 110 references that together mentioned 105 ethical issues in dementia research. This set of ethical issues was structured into a matrix based on the eight major principles from a pre-existing framework on biomedical ethics (Emanuel et al. An Ethical Framework for Biomedical Research. in The Oxford textbook of clinical research ethics, Oxford University Press, Oxford, 2008). Consequently, subcategories were created and further categorized into dementia stages and study phases. CONCLUSIONS The systematically derived matrix helps raise awareness and understanding of the complex topic of ethical issues in dementia research. The matrix can be used as a basis for researchers, policy makers and other stakeholders when planning, conducting and monitoring research, making decisions on the legal background of the topic, and creating research practice guidelines.
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Affiliation(s)
- Tim G Götzelmann
- Institute for History, Ethics and Philosophy in Medicine, OE 5450, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Daniel Strech
- QUEST Center, Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
| | - Hannes Kahrass
- Institute for History, Ethics and Philosophy in Medicine, OE 5450, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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12
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Ludwig C, Graham ID, Lavoie J, Gifford W, Stacey D. Ethical considerations for engaging frail and seriously ill patients as partners in research: sub-analysis of a systematic review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:8. [PMID: 33517912 PMCID: PMC7849091 DOI: 10.1186/s40900-021-00254-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The commitment to engage patients as partners in research has been described as a political, moral and ethical imperative. Researchers feel ill-equipped to deal with potential ethical implications of engaging patients as partners. The aim of this study is to identify the ethical considerations related to engaging frail and seriously ill (FSI) patients as partners in research. METHODS We conducted a sub-analysis of a prior systematic review of 30 studies that engaged FSI patients as partners in research. Studies were included if they reported ethical considerations associated with partnering. We performed deductive content analysis, data were categorized according to Beauchamp and Childress' Principles of Biomedical Ethics (2019): autonomy, non-maleficence, beneficence, and justice. RESULTS Twenty-five studies were included. Common ethical considerations reported in relation to the principles were: autonomy - promoting desired level of involvement, addressing relational and intellectual power, facilitating knowledge and understanding of research; non-maleficence - protection from financial burden, physical and emotional suffering; beneficence - putting things right for others, showing value-added, and supporting patient-partners; and, justice - achieving appropriate representation, mutual respect for contributions, and distributing risks and benefits. CONCLUSIONS When partnering with FSI patients, research teams need to establish shared values and ensure processes are in place to identify and address ethical issues. Researchers and patients should work together to clarify the intent and outcomes of the partnership, actively address power differentials, recognize and minimize the potential for unintended harm, and strive to maximize the benefits of partnership. SYSTEMATIC REVIEW REGISTRATION The protocol for the original systematic review has been registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).
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Affiliation(s)
- Claire Ludwig
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Ian D. Graham
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
- University of Ottawa, Faculty of Medicine, School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, K1G 5Z3 Ontario Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Josee Lavoie
- Geriatric Psychiatry Program, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4 Canada
| | - Wendy Gifford
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Dawn Stacey
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
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Fadda M, Fiordelli M, Amati R, Falvo I, Ibnidris A, Hurst S, Albanese E. Returning individual-specific results of a dementia prevalence study: insights from prospective participants living in Switzerland. Int J Geriatr Psychiatry 2021; 36:207-214. [PMID: 32869397 PMCID: PMC7756381 DOI: 10.1002/gps.5416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore prospective participants' preferences regarding the return of their individual-specific results from a dementia prevalence study (a probabilistic diagnosis of dementia). METHODS/DESIGN We conducted a qualitative study with 22 individuals aged 45 to 86 and resident in the Canton of Ticino (Switzerland). Participants had previously joined the validation phase of an epidemiological study into dementia and its impact. RESULTS We found that individuals welcome the return of their individual-specific results, provided these meet a number of validity, clinical, and personal utility criteria. They justify researchers' duty to return study findings with the principles of beneficence (eg, providing information that can help participants' medical decision-making) and justice (eg, acknowledging participants' efforts to help research by sharing their personal information). Furthermore, individuals anticipate societal benefits of the return of individual specific study findings, including improved interpersonal relationships among individuals and decreased dementia-related stigma. CONCLUSIONS Our findings suggest that researchers should address the return of individual-specific study results early on during study design and involve prospective participants in identifying both the conditions under which results should be offered and the perceived individual and societal benefits returning can have.
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Affiliation(s)
- Marta Fadda
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Maddalena Fiordelli
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland,Institute of Communication and Health, Faculty of Communication SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Ilaria Falvo
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Aliaa Ibnidris
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Samia Hurst
- Institute for Ethics, History and the HumanitiesUniversity of GenevaGenevaSwitzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
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Skelton E, Drey N, Rutherford M, Ayers S, Malamateniou C. Electronic consenting for conducting research remotely: A review of current practice and key recommendations for using e-consenting. Int J Med Inform 2020; 143:104271. [PMID: 32979650 PMCID: PMC7487205 DOI: 10.1016/j.ijmedinf.2020.104271] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Electronic approaches are becoming more widely used to obtain informed consent for research participation. Electronic consent (e-consent) provides an accessible and versatile approach to the consenting process, which can be enhanced with audio-visual and interactive features to improve participant engagement and comprehension of study procedures. Best practice guidance underpinned by ethical principles is required to ensure effective implementation of e-consent for use in research. AIM To identify the key considerations for successful and ethical implementation of e-consent in the recruitment of participants to research projects which are conducted remotely. METHODS Electronic database searches of CINAHL, Medline, Embase, DARE, HTA, PubMed, the Cochrane Library, Scopus, Web of Science, NHS Evidence, and hand-searches of reference lists were performed. Primary research studies of adult (≥ 18 years old) research participants using e-consent, published in English language, peer-reviewed journals between 2010-2020 were eligible for inclusion. RESULTS Of the initial 665 identified studies, 18 met the inclusion criteria: 6 cohort studies, 5 qualitative studies, 4 randomised control trials, 2 mixed-methods studies and one case-control study. Critical appraisal of included studies using Critical Appraisal Skills Program (CASP) tools suggested a low to moderate risk of bias in most studies (n = 15). Key practice recommendations for researchers using e-consent were identified around five primary themes: 1) accessibility and user-friendliness of e-consent, 2) user engagement and comprehension, 3) customisability to participant preferences and demographics, 4) data security and 5) impact on research teams. CONCLUSION E-consenting approaches are generally well received by participants, with most studies reporting user-friendly interfaces and sufficient participant comprehension of consenting documentation. IMPLICATIONS FOR PRACTICE E-consent may facilitate remotely-conducted research by offering a feasible and robust alternative to face-to-face consenting approaches, however paper-based options should still be offered, based on participant preference. Customising e-consenting platforms may improve accessibility for individuals with specific needs, and increase engagement with study information. Research teams must offer prospective participants opportunities to discuss study information in real-time.
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Affiliation(s)
- Emily Skelton
- Division of Radiography and Midwifery, City, University of London, UK; Department of Perinatal Imaging and Health, King's College London, UK.
| | | | - Mary Rutherford
- Department of Perinatal Imaging and Health, King's College London, UK
| | - Susan Ayers
- Division of Radiography and Midwifery, City, University of London, UK
| | - Christina Malamateniou
- Division of Radiography and Midwifery, City, University of London, UK; Department of Perinatal Imaging and Health, King's College London, UK
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Ludwig C, Graham ID, Gifford W, Lavoie J, Stacey D. Partnering with frail or seriously ill patients in research: a systematic review. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:52. [PMID: 32944284 PMCID: PMC7488581 DOI: 10.1186/s40900-020-00225-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND The expectation to include patients as partners in research has steadily gained momentum. The vulnerability of frail and/or seriously ill patients provides additional complexity and may deter researchers from welcoming individuals from this patient population onto their teams. The aim was to synthesize the evidence on the engagement of frail and/or seriously ill patients as research partners across the research cycle. METHODS A systematic review was conducted using PRISMA guidelines. A search strategy included MEDLINE®, EMBASE®, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO from database inception to April, 2019. Eligible studies were peer-reviewed qualitative, quantitative, and mixed methods research reporting on the engagement of frail and/or seriously ill patients as partners on research teams. The Mixed Methods Appraisal Tool was used to appraise study quality. Narrative analysis was conducted. RESULTS Of 8763 citations, 30 were included. Most studies included individuals with cancer on the research team (60%). Barriers included: lack of time and resources (50%), discontinuity in contribution (37%), and concerns for well-being (33%). Facilitators included: trust and mutual respect (60%), structural accessibility (57%), flexibility in timing and methods of engagement (43%), and attention to care and comfort, (33%). Perceived impacts for patients included: renewed personal sense of agency (37%) and emotional/peer support (37%). Impacts for researchers included sensitization to the lived experience of disease (57%) and an increased appreciation of the benefits of patient engagement (23%). Research design, execution, and outcomes, developed with patients, were deemed more suitable, relevant and reflective of patients' priorities. CONCLUSIONS There is emerging evidence to suggest that research partnerships with frail and/or seriously ill patients can be achieved successfully. Patients mostly report benefit from partnering with research teams. Frailty and/or serious illness do present legitimate concerns for their well-being but appear to be successfully mitigated when researchers ensure that the purpose of engagement is well-defined, the timing and methods of engagement are flexible, and the practical and emotional needs of patient partners are addressed throughout the process. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).
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Affiliation(s)
- Claire Ludwig
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Ian D. Graham
- University of Ottawa, Faculty of Medicine, School of Epidemiology and Public Health, Ottawa, Ontario, Canada and Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Wendy Gifford
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Josee Lavoie
- Geriatric Psychiatry Program, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4 Canada
| | - Dawn Stacey
- University of Ottawa, Faculty of Health Sciences, School of Nursing, Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
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16
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Martineau JT, Minyaoui A, Boivin A. Partnering with patients in healthcare research: a scoping review of ethical issues, challenges, and recommendations for practice. BMC Med Ethics 2020; 21:34. [PMID: 32393230 PMCID: PMC7216517 DOI: 10.1186/s12910-020-0460-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partnering with patients in healthcare research now benefits from a strong rationale and is encouraged by funding agencies and research institutions. However, this new approach raises ethical issues for patients, researchers, research professionals and administrators. The main objective of this review is to map the literature related to the ethical issues associated with patient partnership in healthcare research, as well as the recommendations to address them. Our global aim is to help researchers, patients, research institutions and research ethics boards reflecting on and dealing with these issues. METHODS We conducted a scoping review of the ethical issues and recommendations associated with partnering with patients in healthcare research. After our search strategy, 31 peer reviewed articles published between 2007 and 2017 remained and were analyzed. RESULTS We have identified 58 first-order ethical issues and challenges associated with patient partnership in research, regrouped in 18 second-order ethical themes. Most of the issues are transversal to all phases and stages of the research process and a lot of them could also apply to patient-partnership in other spheres of health, such as governance, quality improvement, and education. We suggested that ethical issues and challenges of partnered research can be related to four ethical frameworks: 1) Research ethics; 2) Research integrity; 3) Organizational ethics, and 4) Relational ethics. CONCLUSIONS We have identified numerous ethical issues associated with the recent approach of patient-partnership in research. These issues are more diverse than the issues associated with a more traditional research approach. Indeed, the current discussion on how we address ethical issues in research is anchored in the assumption that patients, as research participants, must be protected from risk. However, doing research with, and not on, the patient involves changes in the way we reflect on the ethical issues associated with this approach to research. We propose to broaden the ethical discussion on partnered research to not only rely on a research ethics framework, but to also frame it within the areas of research integrity, organizational ethics and relational ethics.
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Affiliation(s)
- Joé T Martineau
- Department of Management, HEC Montreal, 3000 chemin de la Cote-Ste-Catherine, Montreal, QC, H3T2A7, Canada.
| | | | - Antoine Boivin
- Canada Research Chair in Patient and Public Partnership, CHUM Research Center (CRCHUM) and University of Montreal, Montreal, Canada
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17
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Milne R, Brayne C. We need to think about data governance for dementia research in a digital era. Alzheimers Res Ther 2020; 12:17. [PMID: 32005135 PMCID: PMC6995068 DOI: 10.1186/s13195-020-0584-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/22/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Research into Alzheimer's disease and other dementias increasingly involves large-scale data-sharing initiatives. The development of novel digital tools and assessments is likely to increase the need for these. This presents ethics and governance challenges to ensure the use of these data is able to maximise the benefit to patients and the public. DISCUSSION We consider the challenges associated with informed consent and governance in the context of dementia research. We set out the potential of novel data governance approaches for the future of data sharing for dementia. The data trust model proposed in discussions of data governance may have potentially valuable application for dementia research. Such inclusive approaches to trustworthy data governance should be considered as data-sharing initiatives are established and develop.
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Affiliation(s)
- Richard Milne
- Society and Ethics Research Group, Wellcome Genome Campus, Hinxton, UK
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
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18
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Ries N, Mansfield E, Sanson-Fisher R. Planning Ahead for Dementia Research Participation: Insights from a Survey of Older Australians and Implications for Ethics, Law and Practice. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:415-429. [PMID: 31297689 DOI: 10.1007/s11673-019-09929-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
People with dementia have commonly been excluded from research. The adverse impacts of this exclusion are now being recognized and research literature, position statements, and ethics guidelines increasingly call for inclusion of people with dementia in research. However, few published studies investigate the views of potential participants on taking part in research should they experience dementia-related cognitive impairment. This cross-sectional survey examined the views of people aged sixty and older (n=174) attending hospital outpatient clinics about clinical research participation if they had dementia and impaired decision-making ability. Over 90 percent of respondents were agreeable to participating in a wide range of research activities, such as cognitive testing, physical measurements, imaging procedures, and blood draws. For drug studies, however, agreement dropped to 60 percent. Altruism was a strong motivator for research participation. In regard to who should be involved in decisions about their participation in research during periods of incapacity, respondents mostly preferred the person they appoint as their substitute decision-maker for healthcare matters (88%) or a doctor or health professional on the research team (78%). Over three-quarters (79%) expressed interest in making an advance research directive. The study findings are discussed in relation to law reforms in Australia that aim to strengthen respect and inclusion for people with impaired decision-making capacity, especially by providing frameworks for advance planning for research participation.
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Affiliation(s)
- Nola Ries
- Faculty of Law, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Elise Mansfield
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Ethical Challenges Related to Patient Involvement in Health Technology Assessment. Int J Technol Assess Health Care 2019; 35:253-256. [DOI: 10.1017/s0266462319000382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIncluding information and values from patients in HTA has the potential to improve both the process and outcomes of health technology policy decisions. Accordingly, funding and structural incentives to include patients in HTA activities have increased over the past several years. Unfortunately, these incentives have not yet been accompanied by a corresponding increase in resources, time, or commitment to responsiveness. In this Perspectives piece, we reflect on our collective experiences participating in, conducting, and overseeing patient engagement activities within HTA to highlight the ethical challenges associated with this area of activity. While we remain committed to the idea that patient engagement activities strengthen the findings, relevance, and legitimacy of health technology policy, we are deeply concerned about the potential for these activities to do ethical harm. We use this analysis to call for action to introduce strong protections against ethical violations that may harm patients participating in HTA engagement activities.
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20
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Becker JC, Eigentler T, Frerich B, Gambichler T, Grabbe S, Höller U, Klumpp B, Loquai C, Krause-Bergmann A, Müller-Richter U, Pföhler C, Schneider-Burrus S, Stang A, Terheyden P, Ugurel S, Veith J, Mauch C. S2k-Leitlinie Merkelzellkarzinom (MZK, MCC, neuroendokrines Karzinom der Haut) - Update 2018. J Dtsch Dermatol Ges 2019; 17:562-577. [PMID: 31115985 DOI: 10.1111/ddg.13841_g] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jürgen C Becker
- Klinik für Dermatologie, Universitätsklinikum Essen.,Translationale Hautkrebsforschung, Deutsches Konsortium für Translationale Krebsforschung (DKTK).,Deutsches Krebsforschungszentrum Heidelberg
| | | | - Bernhard Frerich
- Klinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum Rostock
| | | | | | | | | | | | | | - Urs Müller-Richter
- Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum Würzburg
| | | | | | - Andreas Stang
- Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen
| | | | - Selma Ugurel
- Klinik für Dermatologie, Universitätsklinikum Essen
| | - Johannes Veith
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
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21
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Becker JC, Eigentler T, Frerich B, Gambichler T, Grabbe S, Höller U, Klumpp B, Loquai C, Krause-Bergmann A, Müller-Richter U, Pföhler C, Schneider-Burrus S, Stang A, Terheyden P, Ugurel S, Veith J, Mauch C. S2k guidelines for Merkel cell carcinoma (MCC, neuroendocrine carcinoma of the skin) - update 2018. J Dtsch Dermatol Ges 2019; 17:562-576. [PMID: 31056838 DOI: 10.1111/ddg.13841] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Merkel cell carcinoma (MCC, ICD-O M8247 / 3) is a rare malignant primary skin tumor with epithelial and neuroendocrine differentiation. The neoplastic cells share many morphological, immunohistochemical and ultrastructural characteristics with Merkel cells of the skin. The diagnosis of MCC is rarely made on clinical grounds. Histological and immunohistochemical studies are usually required to confirm the clinical suspicion. Given the frequent occurrence of occult lymph node metastasis, sentinel lymph node biopsy should be performed once distant metastasis has been ruled out by cross-sectional imaging. Primary tumors without evidence of organ metastases are treated with complete surgical excision with appropriate surgical margins. Radiation therapy should be considered at all stages of the disease. For advanced MCC that is no longer amenable to curative treatment by surgery or radiation therapy, there is currently no established systemic therapy for which an improvement in recurrence-free survival or overall survival has been demonstrated in a prospective randomized trial. However, immunotherapy using PD-1/PD-L1 blockade seems to be superior to chemotherapy. Various factors warrant that further diagnostic and therapeutic interventions be determined by an interdisciplinary tumor board. These factors include the tumor's aggressiveness, the frequent indication for sentinel lymph node biopsy along with the frequent occurrence in the head and neck region, the potential indication for adjuvant radiation therapy as well as the complexity of the required diagnostic workup.
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Affiliation(s)
- Jürgen C Becker
- Department of Dermatology, Essen University Medical Center, Essen, Germany.,Translational Skin Cancer Research, German Cancer Consortium (DKTK).,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Eigentler
- Department of Dermatology, Tübingen University Medical Center, Tübingen, Germany
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Plastic Surgery, Rostock University Medical Center, Rostock, Germany
| | - Thilo Gambichler
- Department of Dermatology, Bochum University Medical Center, Bochum, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
| | | | - Bernhard Klumpp
- Department of Radiology, Tübingen University Medical Center, Tübingen, Germany
| | - Carmen Loquai
- Department of Dermatology, Mainz University Medical Center, Mainz, Germany
| | | | - Urs Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, Würzburg University Medical Center, Würzburg, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | | | - Andreas Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Essen University Medical Center, Essen, Germany
| | | | - Selma Ugurel
- Department of Dermatology, Essen University Medical Center, Essen, Germany
| | - Johannes Veith
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Cornelia Mauch
- Department of Dermatology, Cologne University Medical Center, Cologne, Germany
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22
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Tunali S, Catal T, Bolkent S, Yanardag R. The effects of vitamins and selenium mixture against brain tissue induced byd‐galactosamine. J Biochem Mol Toxicol 2019; 33:e22347. [DOI: 10.1002/jbt.22347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/18/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Sevim Tunali
- Department of Chemistry, Faculty of EngineeringIstanbul University‐Cerrahpasa Istanbul Turkey
| | - Tunc Catal
- Department of Molecular Biology and GeneticsUskudar University Istanbul Turkey
- Faculty of Engineering and Natural ScienceIstanbul Protein Research‐Application and Innovation Center (PROMER), Uskudar University Istanbul Turkey
| | - Sehnaz Bolkent
- Department of Biology, Faculty of ScienceIstanbul University Istanbul Turkey
| | - Refiye Yanardag
- Department of Chemistry, Faculty of EngineeringIstanbul University‐Cerrahpasa Istanbul Turkey
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Lee JY, Crooks RE, Pham T, Korngut L, Patten S, Jetté N, Smith EE, Roach P. "If it helps someone, then I want to do it": Perspectives of persons living with dementia on research registry participation. DEMENTIA 2019; 19:2525-2541. [PMID: 30722693 DOI: 10.1177/1471301219827709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Registries are an important platform to which persons with dementia and other cognitive impairments can contribute to research studies. Registries also provide an opportunity for patients to stay informed about current studies. Engaging patients in registry development can increase sustainability of a registry and patient retention in clinical registries. We sought the perspective of persons with dementia and their accompanying family members about their registry participation experiences, barriers and facilitators to participation, and potential avenues for improvement of registry processes such as recruitment, data collection, and knowledge translation. Two semi-structured focus groups with persons with dementia and their family members (n = 18) were conducted and analyzed using thematic content analysis. Participants were recruited from an existing patient registry made up of patients currently being seen in a dementia assessment clinic. The main themes identified included altruistic motives with regards to registry participation; and access to and privacy of personal health information. As electronic health records are becoming more common, understanding barriers and facilitators from the perspectives of people with dementia is essential to inform the future development of cognitive condition-related registries. The results from our focus groups identified engagement strategies and solutions to overcome perceived barriers for individuals experiencing progressive cognitive decline to participate in longitudinal registry projects.
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Affiliation(s)
- Jeanie Yy Lee
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Rachel E Crooks
- Hotchkiss Brain Institute; Department of Clinical Neurosciences; Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Tram Pham
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - L Korngut
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - S Patten
- Pediatric Mental Health; Department of Community Health Sciences; Department of Psychiatry, University of Calgary, Calgary, Canada
| | - N Jetté
- Hotchkiss Brain Institute; Department of Clinical Neurosciences; Department of Community Health Sciences, University of Calgary, Calgary, Canada; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E E Smith
- Hotchkiss Brain Institute; Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Pamela Roach
- Hotchkiss Brain Institute; Department of Clinical Neurosciences; Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Sano M, Egelko S, Zhu CW, Li C, Donohue MC, Ferris S, Kaye J, Mundt JC, Sun CK, Aisen PS, Feldman HH. Participant satisfaction with dementia prevention research: Results from Home-Based Assessment trial. Alzheimers Dement 2018; 14:1397-1405. [PMID: 30297140 DOI: 10.1016/j.jalz.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/04/2018] [Accepted: 05/24/2018] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Little is known about factors affecting motivation and satisfaction of participants in dementia prevention trials. METHODS A Research Satisfaction Survey was administered to 422 nondemented older adults who participated in the Home-Based Assessment trial. RESULTS Overall satisfaction was high, with means of all individual items near to above a value of 3 on a scale from 1 (worst) to 4 (best). Greater satisfaction was associated with staff-administered interviews versus automated technologies. The most liked aspects of research participation were volunteerism, opportunity to challenge and improve mental function, and positive interactions with staff. The least liked aspect was repetitiveness of the assessments. Participants requested more contact with staff and other older adults and more feedback on performance. DISCUSSION Older adults' participation in research was primarily motivated by altruism. Methodologies that facilitate human contact, encourage feedback and novelty of tasks should be incorporated into future trial design.
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Affiliation(s)
- Mary Sano
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J Peters VAMC, Bronx, NY, USA.
| | - Susan Egelko
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn W Zhu
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J Peters VAMC, Bronx, NY, USA; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Clara Li
- Alzheimer Disease Research Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael C Donohue
- Department of Neurology & Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steven Ferris
- Center for Cognitive Neurology, New York University Langone Medical Center (posthumously), New York, NY, USA
| | - Jeffrey Kaye
- Department of Neurology and Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - James C Mundt
- Wisconsin Department of Health Services, Division of Care and Treatment Services, Mauston, WI, USA
| | - Chung-Kai Sun
- Department of Neurology & Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Paul S Aisen
- Department of Neurology & Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Howard H Feldman
- Department of Neurosciences, University of California, San Diego, CA, USA
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Thorogood A, Mäki‐Petäjä‐Leinonen A, Brodaty H, Dalpé G, Gastmans C, Gauthier S, Gove D, Harding R, Knoppers BM, Rossor M, Bobrow M. Consent recommendations for research and international data sharing involving persons with dementia. Alzheimers Dement 2018; 14:1334-1343. [DOI: 10.1016/j.jalz.2018.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Anna Mäki‐Petäjä‐Leinonen
- Faculty of Social Sciences and Business StudiesLaw SchoolUniversity of Eastern FinlandJoensuuFinland
| | - Henry Brodaty
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
| | - Gratien Dalpé
- Centre of Genomics and PolicyMcGill UniversityMontrealCanada
| | - Chris Gastmans
- Interfaculty Centre for Biomedical Ethics and LawKU LeuvenLeuvenBelgium
| | - Serge Gauthier
- McGill Centre for Studies in AgingMcGill UniversityMontrealCanada
| | | | - Rosie Harding
- Birmingham Law SchoolUniversity of BirminghamBirminghamUnited Kingdom
| | | | - Martin Rossor
- UCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Martin Bobrow
- Department of Medical GeneticsUniversity of CambridgeCambridgeUnited Kingdom
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McGowan CR, Houlihan CF, Kingori P, Glynn JR. The Acceptability of Online Consent in a Self-Test Serosurvey of Responders to the 2014-2016 West African Ebola Outbreak. Public Health Ethics 2017; 11:201-212. [PMID: 30135701 PMCID: PMC6093377 DOI: 10.1093/phe/phx027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Online participation in research is used increasingly to recruit geographically dispersed populations. Obtaining online consent is convenient, yet we know little about the acceptability of this practice. We carried out a serostudy among personnel returning to the UK/Ireland following deployment to West Africa during the 2014–2016 Ebola epidemic. We used an online procedure for consenting returnees and designed a small descriptive study to understand: how much of the consent material they read, how informed they felt and if they preferred online to traditional face-to-face consent. Of 261 returnees, 111 (43 per cent) completed the consent survey. Participants indicated a high level of engagement with the consent materials, with 67 per cent reporting having read all and 20 per cent having read ‘most’ of the materials. All participants indicated feeling completely (78 per cent) or mostly (22 per cent) informed about the purpose, methods and intended uses of the research, as well as what participation was required and what risks were involved. Only three participants indicated a preference for face-to-face consent. Free-text comments suggested that online consent may be an acceptable modality for uncomplicated and low-risk studies. The study sample was largely composed of health professionals, suggesting acceptability of online consent within this population.
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Affiliation(s)
- Catherine R McGowan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine and Humanitarian Public Health Technical Unit, Save the Children
| | - Catherine F Houlihan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine and Faculty of Medical Sciences, University College London
| | - Patricia Kingori
- Ethox Centre, Nuffield Department of Population Health, University of Oxford
| | - Judith R Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
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Gauthier S, Robillard J, de Champlain J. Progress in transnational scientific and ethics review: Commentary on the proposal for a single North American review board for research on dementia. Alzheimers Dement 2017; 14:115-116. [PMID: 29111430 DOI: 10.1016/j.jalz.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Johane de Champlain
- Comité central d'éthique de la recherche du ministre des Services de santé et des Services sociaux du Québec, Montréal, Canada
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28
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Forlini C. Patient Preferences May Be Indicative of Normative Issues in Dementia Research. J Alzheimers Dis 2017; 59:11-12. [PMID: 28550265 DOI: 10.3233/jad-170328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robillard and Feng highlight incongruence between patient preferences and the procedural aspects of research ethics as they relate to protocols for dementia research. Their findings break ground for a reassessment of how research ethics, researchers, and participants (including patients and caregivers) approach participation in dementia research. However, it is unclear whether patient preferences may also herald a normative gap between how dementia research is being conducted and how it should be done. This response uses one of Robillard and Feng's findings to illustrate how descriptive empirical data might be reinterpreted into normative questions that reframe current practices in the context of dementia research.
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Affiliation(s)
- Cynthia Forlini
- ARC DECRA Research Fellow, Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, Australia
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