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Ray Chaudhuri K, Podlewska A, Hui Lau Y, Gonde C, McIntosh A, Qamar M, O'Donoghue S, Larcombe K, Adeeko M, Gupta A, Bajwah S, Lafond S, Awogbemila O, van Coller R, Murtagh A, Ocloo J. Addressing the gap for racially diverse research involvement: The King's Model for minority ethnic research participant recruitment. Public Health Pract (Oxf) 2023; 6:100426. [PMID: 37744301 PMCID: PMC10511795 DOI: 10.1016/j.puhip.2023.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/30/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Ethnic minorities (EM) are still underrepresented in research recruitment. Despite wide literature outlining the barriers, enablers and recommendations for driving inclusion and diversity in research, there is still little evidence for successful diversity in research participation, which has a direct impact on the quality of care provided to ethnically diverse individuals. A new, comprehensive approach to recruitment strategies is therefore necessary. Study design service improvement initiative. Methods In the light of the Covid-19 pandemic and the key public health need to address the disparity in care provided to non-white populations, we used a novel, comprehensive approach (The King's Model) comprising of local and community actions to promote inclusive research recruitment. We then compared rates of diverse recruitment in studies where the novel approach, was applied to studies which had been closed to recruitment at the time of analysis and where ethnicity data was available. Results Our results demonstrate that following the introduction of the King's Model for diverse recruitment, commercial interventional study diverse recruitment increased from 6.4% to 16.1%, and for non-commercial studies, from 30.2% to 41.0% and 59.2% in the selected studies. Conclusions King's Model is potentially a useful tool in enhancing non-Caucasian recruitment to clinical research. Enriched by additional recommendations based on our experiences during the Covid-19 research recruitment drive, we propose the King's Model is used to support ethnically diverse research recruitment. Further evidence is needed to replicate our findings, although this preliminary evidence provides granular details necessary to address the key unmet need of validating clinical research outcomes in non-white populations.
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Affiliation(s)
- K. Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - A. Podlewska
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Yue Hui Lau
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - C. Gonde
- Institute of Liver Studies, King's College Hospital, NHS Trust Foundation, London, United Kingdom
| | - A. McIntosh
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - M.A. Qamar
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - S. O'Donoghue
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
- King's Health Partners, London, SE1 9RT, United Kingdom
| | - K. Larcombe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - M. Adeeko
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - A. Gupta
- Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom
| | - S. Bajwah
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - S. Lafond
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - O. Awogbemila
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - R. van Coller
- Department of Neurology, Faculty of Health Sciences, University of Pretoria, South Africa
| | - A.M. Murtagh
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - J.E. Ocloo
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration South London (NIHR ARC South London), King's College Hospital NHS Foundation Trust, London, United Kingdom
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Lovell N, Etkind SN, Bajwah S, Maddocks M, Higginson IJ. What influenced people with chronic or refractory breathlessness and advanced disease to take part and remain in a drug trial? A qualitative study. Trials 2020; 21:215. [PMID: 32087745 PMCID: PMC7036259 DOI: 10.1186/s13063-020-4129-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Recruitment and retention in clinical trials remains an important challenge, particularly in the context of advanced disease. It is important to understand what affects retention to improve trial quality, minimise attrition and reduce missing data. We conducted a qualitative study embedded within a randomised feasibility trial and explored what influenced people to take part and remain in the trial. METHODS We conducted a qualitative study embedded within a double-blind randomised trial (BETTER-B[Feasibility]: BETter TreatmEnts for Refractory Breathlessness) designed using a person-centred approach. Participants with cancer, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), or chronic heart failure (CHF), with a modified Medical Research Council dyspnoea scale grade of 3/4 were recruited from three UK sites. A convenience subsample completed qualitative interviews after the trial. Interviews were analysed using thematic analysis. Results were considered in relation to the core elements of person-centred care and our model of the person-centred trial. RESULTS In the feasibility trial 409 people were screened for eligibility, and 64 were randomised. No participant was lost to follow-up. Twenty-two participants took part in a qualitative interview. Eleven had a diagnosis of COPD, 8 ILD, 2 CHF and 1 lung cancer. The participants' median age was 71 years (range 56-84). Sixteen were male. Twenty had completed the trial, and two withdrew due to adverse effects. The relationship between patient and professional, potential for benefit, trial processes and the intervention all influenced the decision to participate in the trial. The relationship with the research team and continuity, perceived benefit, and aspects relating to trial processes and the intervention influenced the decision to remain in the trial. CONCLUSIONS In this feasibility trial recruitment targets were met, attrition levels were low, and aspects of the person-centred approach were viewed positively by trial participants. Prioritisation of the relationship between the patient and professional; person-centred processes, including home visits, assistance with questionnaires, and involvement of the carer; and enabling people to participate by having processes in line with individual capabilities appear to support recruitment and retention in clinical trials in advanced disease. We recommend the integration of a person-centred approach in all clinical trials. TRIAL REGISTRATION ISRCTN Registry, ISRCTN32236160. Registered on 13 June 2016.
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Affiliation(s)
- N. Lovell
- 0000 0001 2322 6764grid.13097.3cCicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - S. N. Etkind
- 0000 0001 2322 6764grid.13097.3cCicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - S. Bajwah
- 0000 0001 2322 6764grid.13097.3cCicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - M. Maddocks
- 0000 0001 2322 6764grid.13097.3cCicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
| | - I. J. Higginson
- 0000 0001 2322 6764grid.13097.3cCicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, Bessemer Road, London, SE5 9PJ UK
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Lovell N, Wilcock A, Bajwah S, Etkind SN, Jolley CJ, Maddocks M, Higginson IJ. Mirtazapine for chronic breathlessness? A review of mechanistic insights and therapeutic potential. Expert Rev Respir Med 2019; 13:173-180. [PMID: 30596298 DOI: 10.1080/17476348.2019.1563486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic breathlessness is a common and distressing symptom of advanced disease with few effective treatments. Central nervous system mechanisms are important in respiratory sensation and control. Consequently, drugs which may modify processing and perception of afferent information in the brain may have a role. Antidepressants have been proposed; however, current evidence is limited. Of potentially suitable antidepressants, mirtazapine is an attractive option given its tolerability profile, low cost, and wide availability, along with additional potential benefits. Areas covered: The paper provides an overview of the physiology of breathlessness, with an emphasis on central mechanisms, particularly the role of fear circuits and the associated neurotransmitters. It provides a potential rationale for how mirtazapine may improve chronic breathlessness and quality of life in patients with advanced disease. The evidence was identified by a literature search performed in PubMed through to October 2018. Expert opinion: Currently, there is insufficient evidence to support the routine use of antidepressants for chronic breathlessness in advanced disease. Mirtazapine is a promising candidate to pursue, with definitive randomized controlled trials required to determine its efficacy and safety in this setting.
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Affiliation(s)
- N Lovell
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - A Wilcock
- b University of Nottingham, Palliative Medicine, Hayward House Specialist Palliative Care Unit , Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - S Bajwah
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - S N Etkind
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - C J Jolley
- c Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine , King's College London , UK
| | - M Maddocks
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
| | - I J Higginson
- a Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation , King's College London , London , UK
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Reigada C, Papadopoulos A, Boland JW, Yorke J, Ross J, Currow DC, Hart S, Bajwah S, Grande G, Wells A, Johnson MJ. Implementation of the Needs Assessment Tool for patients with interstitial lung disease (NAT:ILD): facilitators and barriers. Thorax 2017; 72:1049-1051. [PMID: 28219955 PMCID: PMC5738535 DOI: 10.1136/thoraxjnl-2016-209768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/07/2017] [Accepted: 01/18/2017] [Indexed: 11/23/2022]
Abstract
A Needs Assessment Tool (NAT) was developed previously to help clinicians identify the supportive/palliative needs of people with interstitial lung disease (ILD) (NAT:ILD). This letter presents barriers and facilitators to clinical implementation. Data from (1) a focus group of respiratory clinicians and (2) an expert consensus group (respiratory and palliative clinicians, academics, patients, carers) were analysed using Framework Analysis. Barriers related to resources and service reconfiguration, and facilitators to clinical need, structure, objectiveness, flexibility and benefits of an ‘aide-memoire’. Identified training needs included communication skills and local service knowledge. The NAT:ILD was seen as useful, necessary and practical in everyday practice.
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Affiliation(s)
- C Reigada
- Hull York Medical School, University of Hull, Hull, UK
| | - A Papadopoulos
- Kent Business School, University of Kent, Canterbury, Kent, UK
| | - J W Boland
- Hull York Medical School, University of Hull, Hull, UK
| | - J Yorke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - J Ross
- St Christopher's Hospice, Sydenham, Kent, UK
| | - D C Currow
- Hull York Medical School, University of Hull, Hull, UK.,University of Technology, Sydney, Australia
| | - S Hart
- Hull York Medical School, University of Hull, Hull, UK
| | - S Bajwah
- Cicely Saunders Institute, King's College London, London, UK
| | - G Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - A Wells
- Royal & Harefield Trust Foundation, London, UK
| | - M J Johnson
- Hull York Medical School, University of Hull, Hull, UK
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Reigada C, Fairhurst C, Yorke J, Ross J, Boland J, Hart S, Currow D, Grande G, Bajwah S, Wells A, Macleod U, Bland M, Johnson M. M16 Construct validity of the needs assessment tool progressive diseases for interstitial lung disease (NAT: PD-ILD) patients. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Reigada C, Bajwah S, Ross J, Boland J, Wells A, Yorke J, Grande G, Hart S, Currow D, Papadopoulos T, Macleod U, Johnson M. ADAPTATION, FACE AND CONTENT VALIDATION OF A PALLIATIVE CARE NEEDS ASSESSMENT TOOL FOR PEOPLE WITH INTERSTITIAL LUNG DISEASE. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bajwah S, Ross JR, Peacock JL, Higginson IJ, Wells AU, Patel A, Koffman J, Riley J. P131 What is the Evidence For Pharmacological and Non-Pharmacological Interventions in Improving Dyspnoea, Other Symptoms and Quality of Life in Progressive Idiopathic Fibrotic Interstitial Lung Disease?- A Systematic Review of the Literature. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bajwah S, Koffman J, Higginson IJ, Ross JR, Wells AU, Birring SS, Patel A, Riley J. P87 The needs and experiences of progressive idiopathic fibrotic interstitial lung disease patients, informal caregivers and health professionals: a qualitative study. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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