1
|
Fitzer K, Haeuslschmid R, Blasini R, Altun FB, Hampf C, Freiesleben S, Macho P, Prokosch HU, Gulden C. Patient Recruitment System for Clinical Trials: Mixed Methods Study About Requirements at Ten University Hospitals. JMIR Med Inform 2022; 10:e28696. [PMID: 35442203 PMCID: PMC9069280 DOI: 10.2196/28696] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/25/2021] [Accepted: 12/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical trials are the gold standard for advancing medical knowledge and improving patient outcomes. For their success, an appropriately sized cohort is required. However, patient recruitment remains one of the most challenging aspects of clinical trials. Information technology (IT) support systems-for instance, patient recruitment systems-may help overcome existing challenges and improve recruitment rates, when customized to the user needs and environment. OBJECTIVE The goal of our study is to describe the status quo of patient recruitment processes and to identify user requirements for the development of a patient recruitment system. METHODS We conducted a web-based survey with 56 participants as well as semistructured interviews with 33 participants from 10 German university hospitals. RESULTS We here report the recruitment procedures and challenges of 10 university hospitals. The recruitment process was influenced by diverse factors such as the ward, use of software, and the study inclusion criteria. Overall, clinical staff seemed more involved in patient identification, while the research staff focused on screening tasks. Ad hoc and planned screenings were common. Identifying eligible patients was still associated with significant manual efforts. The recruitment staff used Microsoft Office suite because tailored software were not available. To implement such software, data from disparate sources will need to be made available. We discussed concrete technical challenges concerning patient recruitment systems, including requirements for features, data, infrastructure, and workflow integration, and we contributed to the support of developing a successful system. CONCLUSIONS Identifying eligible patients is still associated with significant manual efforts. To fully make use of the high potential of IT in patient recruitment, many technical and process challenges have to be solved first. We contribute and discuss concrete technical challenges for patient recruitment systems, including requirements for features, data, infrastructure, and workflow integration.
Collapse
Affiliation(s)
- Kai Fitzer
- Core Unit Data Integration Center, University Medicine Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Renate Haeuslschmid
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Romina Blasini
- Institute of Medical Informatics, University of Giessen, Giessen, Germany
| | - Fatma Betül Altun
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
| | - Christopher Hampf
- Core Unit Data Integration Center, University Medicine Greifswald, Greifswald, Germany
| | - Sherry Freiesleben
- Core Unit Data Integration Center, University Medicine Greifswald, Greifswald, Germany
| | - Philipp Macho
- Medical Informatics, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hans-Ulrich Prokosch
- Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Gulden
- Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
2
|
Pung J, Rienhoff O. Key components and IT assistance of participant management in clinical research: a scoping review. JAMIA Open 2020; 3:449-458. [PMID: 33215078 PMCID: PMC7660951 DOI: 10.1093/jamiaopen/ooaa041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 01/05/2023] Open
Abstract
Objectives Managing participants and their data are fundamental for the success of a clinical trial. Our review identifies and describes processes that deal with management of trial participants and highlights information technology (IT) assistance for clinical research in the context of participant management. Methods A scoping literature review design, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, was used to identify literature on trial participant-related proceedings, work procedures, or workflows, and assisting electronic systems. Results The literature search identified 1329 articles of which 111 were included for analysis. Participant-related procedures were categorized into 4 major trial processes: recruitment, obtaining informed consent, managing identities, and managing administrative data. Our results demonstrated that management of trial participants is considered in nearly every step of clinical trials, and that IT was successfully introduced to all participant-related areas of a clinical trial to facilitate processes. Discussion There is no precise definition of participant management, so a broad search strategy was necessary, resulting in a high number of articles that had to be excluded. Nevertheless, this review provides a comprehensive overview of participant management-related components, which was lacking so far. The review contributes to a better understanding of how computer-assisted management of participants in clinical trials is possible.
Collapse
Affiliation(s)
- Johannes Pung
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
3
|
Jurczak W, Długosz-Danecka M, Rivas Navarro F. The rationale for combination therapy in patients with aggressive B-cell non-Hodgkin lymphoma: ten questions. Future Oncol 2019; 15:305-317. [DOI: 10.2217/fon-2018-0388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy remains standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). High-dose chemotherapy and stem cell transplantation is offered to most relapsing/refractory patients who respond to salvage therapy. This Q&A review evaluates recommended management strategies for second and subsequent lines of therapy in patients with DLBCL, outlining the relative efficacies of currently available options including novel agents such as ibrutinib and CAR-T cells. The combination of pixantrone and rituximab is currently under investigation as a second-line treatment for patients ineligible for stem cell transplantation, while pixantrone monotherapy is the only therapeutic option approved for multiply relapsed and refractory DLBCL beyond the second line at this time.
Collapse
Affiliation(s)
- Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Kraków 31-501, Poland
| | | | | |
Collapse
|
4
|
Barrios CH, Reinert T, Werutsky G. Global Breast Cancer Research: Moving Forward. Am Soc Clin Oncol Educ Book 2018; 38:441-450. [PMID: 30231347 DOI: 10.1200/edbk_209183] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Breast cancer is a major global health problem and major cause of mortality. Although mortality trends are declining in high-income countries, trends are increasing in low- and middle-income countries (LMICs). Addressing global breast cancer research is a challenging endeavor, as notable disparities and extremely heterogeneous realities exist in different regions across the world. Basic global cancer health care needs have been addressed by the World Health Organization's (WHO) proposed list of essential medicines and by resource-stratified guidelines for screening and treatment. However, specific strategies are needed to address disparities in access to health care, particularly access to new therapies. Discussions about global research in breast cancer should take into account the ongoing globalization of clinical trials. Collaboration fostered by well-established research organizations in North America and Europe is essential for the development of infrastructure and human resources in LMICs so that researchers in these countries can begin to address regional questions. Specific challenges that impact the future of global breast cancer research include increasing the availability of trials in LMICs, developing strategies to increase patient participation in clinical trials, and creation of clear guidelines for the development of real-world evidence-based research. The main objective of this review is to encourage the discussion of challenges in global breast cancer research with the hope that collectively we will be able to generate workable proposals to advance the field.
Collapse
Affiliation(s)
- Carlos H Barrios
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Tomás Reinert
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Gustavo Werutsky
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| |
Collapse
|
5
|
Kessel KA, Vogel MME, Kessel C, Bier H, Biedermann T, Friess H, Herschbach P, von Eisenhart-Rothe R, Meyer B, Kiechle M, Keller U, Peschel C, Bassermann F, Schmid R, Schwaiger M, Combs SE. Cancer clinical trials - Survey evaluating patient participation and acceptance in a university-based Comprehensive Cancer Center (CCC). Clin Transl Radiat Oncol 2018; 13:44-49. [PMID: 30345398 PMCID: PMC6192009 DOI: 10.1016/j.ctro.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/23/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
>50% of patients are willing to participate in clinical trials, only 18% are currently enrolled. The top reason to participate in trials was to serve medical progress and cancer research. Reasons for refusing were extensive travel time, no therapeutic advantage and too time-consuming. Good information strategies need to be implemented, and doctors need to be aware of running trials. Trial concepts must include patients’ needs, e.g. number of appointments, risk-benefit profile.
Introduction Prospective clinical trials are essential to translate new therapy concepts or rather any scientific development into the medical routine. Besides a sophisticated trial protocol, the success of clinical trials depends on patient recruitment and participation. Patient recruitment remains a challenge and depends on several factors. To get a current picture of the patients’ attitude, we conducted the present survey. Methods We designed a survey with seven questions, which was given to all oncological patients treated within a timeframe of three months between Mai and July 2017. Participation was voluntary and anonymous. The questionnaire mainly inquires patients’ participation in clinical trials in a university-based setting, their attitude towards clinical trials regarding risks and benefits, and their source of information in this context. Results 771 patients (1:1 male/female) participated with a median age of 61 years (range 18–91 years) with a response rate of 71.5%. Of all, 17.8% (137/771) were participating in a clinical trial. The most mentioned reason was to serve medical progress and cancer research. Out of the patients not currently participating in a trial, 79 (12.7%, 79/623) refusers named the following main reasons: extensive travel time to the clinic, no therapeutic advantage, and too time-consuming. Out of the patients not offered to take part in a trial, 265 (51.0%, 265/520) would participate if offered. Of all patients, 8.3% (64/771) used the clinics' homepage as a source of information, of those 79.7% (51/64) were satisfied with its content. To enhance patient recruitment strategies, we asked how patients wish to be informed about possible trials: More than half (52.0%) of the questioned patients preferred an individual medical consultation with their physician. We further analyzed the trial participation depending on age, gender, unit, and tumor entity. We could show a significant influence of age (p < 0.001) but not for gender (p = 0.724). The trial participation was also significantly associated with the treating unit (p < 0.001) and tumor entity (p = 0.001). Conclusion Patients are willing to participate in clinical trials. Better information strategies need to be implemented. Physicians need to be aware of running trials within their department and must counseling counsel patients effectively to improve recruitment. Trial concepts should keep in mind patients’ needs including an adequate number of appointments, positive risk-benefit profiles, and information material.
Collapse
Affiliation(s)
- Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Carmen Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| | - Henning Bier
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Otorhinolaryngology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Tilo Biedermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Dermatology and Allergy Biederstein, Technical University of Munich (TUM), Biedersteiner Straße 29, Munich, Germany
| | - Helmut Friess
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Peter Herschbach
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Roman Herzog Comprehensive Cancer Center (RHCCC), Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich (TUM), Trogerstraße 26, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Orthopedic Surgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Bernhard Meyer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Neurosurgery, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Marion Kiechle
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gynecology and Obstetrics, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Ulrich Keller
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Christian Peschel
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Florian Bassermann
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,3rd Department of Internal Medicine (Hematology and Oncology), Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Roland Schmid
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Gastroentereology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Markus Schwaiger
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany.,Department of Nuclear Medicine, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Onkologisches Zentrum im RHCCC am Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Germany
| |
Collapse
|
6
|
Sommer C, Zuccolin D, Arnera V, Schmitz N, Adolfsson P, Colombo N, Gilg R, McDowell B. Building clinical trials around patients: Evaluation and comparison of decentralized and conventional site models in patients with low back pain. Contemp Clin Trials Commun 2018; 11:120-126. [PMID: 30094387 PMCID: PMC6072894 DOI: 10.1016/j.conctc.2018.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/07/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022] Open
Abstract
Clinical trials are slow and costly, built around the research centers that study local participants. Building clinical trials around patients in their homes and community through remote visits and monitoring could enhance recruitment and increase convenience for participants. This study evaluated different trial settings, a decentralized arm via telemedicine center (virtual study conduct), a conventional arm via health clinic (onsite study conduct) and a mixed model arm. Acute low-back pain patients (20-65 years) were recruited to this non-interventional trial in Switzerland. The study consisted of a screening period and a 2-week data collection period using direct data capture (eSource), electronic informed consent form (eICF), electronic diary (eDiary) and wearable actigraphy sensor. A higher number of patients were enrolled in the decentralized arm (N = 18) compared to the conventional arm (N = 5) and none in the mixed model arm. The decentralized arm consisted of a diverse population with increased participation from rural areas. In the decentralized arm 89% of enrolled patients completed the study compared to 60% in the conventional arm. All the patients reported satisfaction with the use of eICF, eDiary and remote visits; whereas patients reported a lower level of satisfaction with the wearable sensor. The decentralized setting was operationally feasible and well accepted by patients. Faster recruitment and improved access to patients was observed in the decentralized arm. This study supports broader adoption of the decentralized model in clinical trials, though further investigations in larger interventional trials are needed to confirm the benefits from this patient-centric approach.
Collapse
|