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Metlock FE, Addison S, McKoy A, Yang Y, Hope A, Joseph JJ, Zhang J, Williams A, Gray DM, Gregory J, Nolan TS. More than Just a Number: Perspectives from Black Male Participants on Community-Based Interventions and Clinical Trials to Address Cardiovascular Health Disparities. Int J Environ Res Public Health 2024; 21:449. [PMID: 38673360 PMCID: PMC11050149 DOI: 10.3390/ijerph21040449] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Black Americans remain significantly underrepresented and understudied in research. Community-based interventions have been increasingly recognized as an effective model for reckoning with clinical trial participation challenges amongst underrepresented groups, yet a paucity of studies implement this approach. The present study sought to gain insight into Black male participants' perception of clinical trials before and after participating in a community-based team lifestyle intervention in the United States. METHODS Black Impact, a 24-week community-based lifestyle intervention, applied the American Heart Association's Life's Simple 7 (LS7) framework to assess changes in the cardiovascular health of seventy-four Black male participants partaking in weekly team-based physical activities and LS7-themed education and having their social needs addressed. A subset of twenty participants completed an exit survey via one of three semi-structured focus groups aimed at understanding the feasibility of interventions, including their perceptions of participating in clinical trials. Data were transcribed verbatim and analyzed using a content analysis, which involved systematically identifying, coding, categorizing, and interpreting the primary patterns of the data. RESULTS The participants reported a positive change in their perceptions of clinical trials based on their experience with a community-based lifestyle intervention. Three prominent themes regarding their perceptions of clinical trials prior to the intervention were as follows: (1) History of medical abuse; (2) Lack of diversity amongst research teams and participants; and (3) A positive experience with racially concordant research teams. Three themes noted to influence changes in their perception of clinical trials based on their participation in Black Impact were as follows: (1) Building trust with the research team; (2) Increasing awareness about clinical trials; and (3) Motivating participation through community engagement efforts. CONCLUSIONS Improved perceptions of participating in clinical trials were achieved after participation in a community-based intervention. This intervention may provide a framework by which to facilitate clinical trial participation among Black men, which must be made a priority so that Black men are "more than just a number" and no longer "receiving the short end of the stick".
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Affiliation(s)
- Faith E. Metlock
- Johns Hopkins School of Nursing (Formerly The Ohio State University College of Nursing), Baltimore, MD 21205, USA;
| | - Sarah Addison
- Washington University School of Medicine (Formerly The Ohio State University College of Medicine), St. Louis, MO 63110, USA;
| | - Alicia McKoy
- OhioHealth (Formerly The Ohio State University Center for Cancer Health Equity), Columbus, OH 43202, USA;
| | - Yesol Yang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.Y.); (J.Z.)
| | - Aarhea Hope
- Nell Hodgson Woodruff School of Nursing (Formerly The Ohio State University College of Nursing), Atlanta, GA 30322, USA;
| | - Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH 43210, USA; (J.J.J.); (A.W.)
| | - Jing Zhang
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (Y.Y.); (J.Z.)
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, OH 43210, USA; (J.J.J.); (A.W.)
| | - Darrell M. Gray
- Gray Area Strategies LLC (Formerly The Ohio State University College of Medicine), Columbus, OH 43210, USA;
| | - John Gregory
- The African American Male Wellness Agency, National Center for Urban Solutions, Columbus, OH 43205, USA;
| | - Timiya S. Nolan
- University of Alabama at Birmingham Heersink School of Medicine (Formerly The Ohio State University College of Nursing and The Ohio State University Comprehensive Cancer Center), Birmingham, AL 35233, USA
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Onyeaka H, Weber DB, Chido-Amajuoyi O, Muoghalu C, Amonoo HL. The influence of political ideology on clinical trial knowledge, invitation, and participation among adults in the United States. Clin Trials 2023; 20:708-713. [PMID: 37345562 PMCID: PMC10741248 DOI: 10.1177/17407745231178790] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Clinical trials remain a critical component of medical innovation. Evidence suggests that individuals' political ideologies may impact their health behaviors. However, there is a paucity of literature examining the relationship between political ideologies and clinical trial knowledge and participation. METHODS Study data were derived from Health Information National Trends Survey 5 Cycle 4 (n = 3300), which was conducted from February to June 2020. We used participants' characteristics to estimate the prevalence of clinical trial knowledge and participation. We used multivariable logistic regressions to investigate whether political ideology had a significant impact on clinical trial knowledge and participation. Jack-knife replicate weights were applied for population-level estimates. RESULTS Most participants were White (64.2%), earned above US$50,000 (62.4%), and lived in urban areas (88.0%). About 59.2% reported having some knowledge of clinical trials, and only 8.9% had ever been invited to participate in clinical trials. A total of 37.0%, 29.5%, and 33.5% of the population endorsed moderate, liberal, and conservative political viewpoints respectively. In the adjusted logistic regression analysis, compared to conservatives, liberals (adjusted odds ratio, 1.92; 95% confidence interval, 1.31-2.80) and moderates (adjusted odds ratio, 1.43; 95% confidence interval, 1.09-1.88) had significantly greater odds of having knowledge of clinical trials. Also, liberals had higher odds of receiving invitations to participate in clinical trials (odds ratio, 1.76; 95% confidence interval, 1.08-2.85; p = 0.023) and greater odds of trial participation (odds ratio, 3.90; 95% confidence interval, 1.47-10.33; p = 0.007) compared to moderates. CONCLUSIONS The mechanism underlying the higher rates of clinical trial invitations to liberals is unclear and requires further comprehensive investigation. Similarly, further qualitative studies are needed to understand the attributes that promote knowledge and increased likelihood of clinical trial participation among liberals. This will provide crucial insight to help design interventions that further involve conservatives and moderates in clinical trials and scientific enterprise.
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Affiliation(s)
- Henry Onyeaka
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Daniel B Weber
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Onyema Chido-Amajuoyi
- Department of Internal Medicine, Texas A&M School of Medicine/Christus Health, Longview, TX, USA
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chioma Muoghalu
- Department of Pediatrics, Plains Regional Medical Center, Clovis, NM, USA
| | - Hermioni L Amonoo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
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Kirkpatrick CE, Hu S, Lee N, Hong Y, Lee S, Hinnant A. Overcoming Black Americans' Psychological and Cognitive Barriers to Clinical Trial Participation: Effects of News Framing and Exemplars. Health Commun 2023; 38:2663-2675. [PMID: 35924326 PMCID: PMC10809270 DOI: 10.1080/10410236.2022.2105619] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This study examines how news features (framing and the use of exemplars) can help overcome two common barriers (psychological and cognitive) impeding Black American participation in clinical trials. In an online experiment, Black participants (N = 390) viewed social media news posts varying in framing (focus on psychological vs. cognitive barriers) and use of an exemplar (present vs. absent and White vs. Black) and then responded to outcome measures including perceived message effectiveness, message attitudes, and intention to participate in clinical trials. The findings illustrate that including a racially matched (i.e. Black) exemplar improves attitudes toward clinical trial messages. Most notably, featuring a race-matched exemplar increases intention to participate in a trial when the messages discuss psychological barriers. These findings enhance our understanding of how messages can be better designed to increase Black American participation in clinical trials, thereby contributing to reducing health inequities and improving health outcomes.
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Affiliation(s)
- Ciera E. Kirkpatrick
- Advertising & Public Relations, College of Journalism & Mass Communications, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Sisi Hu
- Advertising, School of Journalism and Strategic Media, University of Arkansas, Fayetteville, Arkansas, USA
| | - Namyeon Lee
- Department of Mass Communication, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
| | - Yoorim Hong
- Strategic Communication, School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Sungkyoung Lee
- Strategic Communication, School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Amanda Hinnant
- Journalism Studies, School of Journalism, University of Missouri, Columbia, Missouri, USA
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4
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An J, Ferrante JM, Macenat M, Ganesan S, Hudson SV, Omene C, Garcia H, Kinney AY. Promoting informed approaches in precision oncology and clinical trial participation for Black patients with cancer: Community-engaged development and pilot testing of a digital intervention. Cancer 2023. [PMID: 37837177 DOI: 10.1002/cncr.35049] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Black patients with cancer are less likely to receive precision cancer treatments than White patients and are underrepresented in clinical trials. To address these disparities, the study aimed to develop and pilot-test a digital intervention to improve Black patients' knowledge about precision oncology and clinical trials, empower patients to increase relevant discussion, and promote informed decision-making. METHODS A community-engaged approach, including a Community Advisory Board and two rounds of key informant interviews with Black patients with cancer, their relatives, and providers (n = 48) was used to develop and refine the multimedia digital intervention. Thematic analysis was conducted for qualitative data. The intervention was then pilot-tested with 30 Black patients with cancer to assess feasibility, acceptability, appropriateness, knowledge, decision self-efficacy, and patient empowerment; Wilcoxon matched pairs signed-rank test was used to analyze quantitative data. RESULTS The digital tool was found to be feasible, acceptable, and culturally appropriate. Key informants shared their preferences and recommendations for the digital intervention and helped improve cultural appropriateness through user and usability testing. In the pilot test, appreciable improvement was found in participants' knowledge about precision oncology (z = -2.04, p = .052), knowledge about clinical trials (z = -3.14, p = .001), and decisional self-efficacy for targeted/immune therapy (z = -1.96, p = .0495). CONCLUSIONS The digital intervention could be a promising interactive decision-support tool for increasing Black patients' participation in clinical trials and receipt of precision treatments, including immunotherapy. Its use in clinical practice may reduce disparities in oncology care and research. PLAIN LANGUAGE SUMMARY We developed a digital interactive decision support tool for Black patients with cancer by convening a Community Advisory Board and conducting interviews with Black patients with cancer, their relatives, and providers. We then pilot-tested the intervention with newly diagnosed Black patients with cancer and found appreciable improvement in participants' knowledge about precision oncology, knowledge about clinical trials, and confidence in making decisions for targeted/immune therapy. Our digital tool has great potential to be an affordable and scalable solution for empowering and educating Black patients with cancer to help them make informed decisions about precision oncology and clinical trials and ultimately reducing racial disparities.
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Affiliation(s)
- Jinghua An
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Jeanne M Ferrante
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Myneka Macenat
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Shridar Ganesan
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Coral Omene
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Harold Garcia
- Lawrence Herbert School of Communication, Hofstra University, Hempstead, New York, USA
| | - Anita Y Kinney
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
- School of Public Health, The State University of New Jersey, New Brunswick, New Jersey, USA
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Yang P, Dickert NW, Haczku A, Spainhour C, Auld SC. Trend in Clinical Trial Participation During COVID-19: A Secondary Analysis of the I-SPY COVID Clinical Trial. Crit Care Explor 2023; 5:e0930. [PMID: 37346229 PMCID: PMC10281328 DOI: 10.1097/cce.0000000000000930] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
To analyze the temporal trend in enrollment rates in a COVID-19 platform trial during the first three waves of the pandemic in the United States. DESIGN Secondary analysis of data from the I-SPY COVID randomized controlled trial (RCT). SETTING Thirty-one hospitals throughout the United States. PATIENTS Patients who were approached, either directly or via a legally authorized representative, for consent and enrollment into the I-SPY COVID RCT. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 1,338 patients approached for the I-SPY COVID trial from July 30, 2020, to February 17, 2022, the number of patients who enrolled (n = 1,063) versus declined participation (n = 275) was used to calculate monthly enrollment rates. Overall, demographic and baseline clinical characteristics were similar between those who enrolled versus declined. Enrollment rates fluctuated over the course of the COVID-19 pandemic, but there were no significant trends over time (Mann-Kendall test, p = 0.21). Enrollment rates were also comparable between vaccinated and unvaccinated patients. In multivariable logistic regression analysis, age, sex, region of residence, COVID-19 severity of illness, and vaccination status were not significantly associated with the decision to decline consent. CONCLUSIONS In this secondary analysis of the I-SPY COVID clinical trial, there was no significant association between the enrollment rate and time period or vaccination status among all eligible patients approached for clinical trial participation. Additional studies are needed to better understand whether the COVID-19 pandemic has altered clinical trial participation and to develop strategies for encouraging participation in future COVID-19 and critical care clinical trials.
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Affiliation(s)
- Philip Yang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA
| | - Neal W Dickert
- Division of Cardiology, Emory University, Atlanta, GA
- Emory Health Services Research Center, Departments of Medicine & Surgery, Emory University, Atlanta, GA
| | - Angela Haczku
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California Davis, Sacramento, CA
| | - Christine Spainhour
- Emory Critical Care Center, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Sara C Auld
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, GA
- Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
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Nguyen OT, Turner K, Lee J, Hong YR, Al-Jumayli M, Alishahi Tabriz A. Clinical trial knowledge among U.S. adults aged 65 years and up: Findings from a 2020 national survey. J Am Geriatr Soc 2023; 71:1917-1922. [PMID: 36715227 DOI: 10.1111/jgs.18255] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/23/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Older adults are underrepresented in most clinical trials. As the United States observes growth in the number of older adults over time, it will be critical to include them in clinical trials to improve the generalizability of results across age groups. Although clinical trial participation requires clinical trial knowledge, no study has assessed clinical trial knowledge among older adults. Using a national survey, this study aims to identify the prevalence and determinants of clinical trial knowledge among older adults. METHODS We used the 2020 Health Information National Trends Survey for secondary data analysis. We restricted the sample to older adults (aged 65 years and up). Our outcome variable was whether respondents reported having any clinical trial knowledge. We controlled for demographics, social determinants of health, healthcare utilization, and comorbidities through multivariable logistic regression models. RESULTS Using a weighted sample of 27,574,958 adults, we estimated that 61.1% of older adults reported having at least some knowledge of clinical trials. After controlling for other factors, those with one to two (OR = 1.80, 95% CI:1.14-2.84) or three to five (OR = 2.93, 95% CI:1.74-4.95) portal visits compared with no portal visits, those with cancer (OR = 1.92, 95% CI:1.22-3.02), and those with depression (OR = 2.27, 95% CI:1.23-4.20) had greater odds of having clinical trial knowledge. Inversely, those with hypertension (OR = 0.62, 95% CI:0.42-0.92) had lower odds of clinical trial knowledge. CONCLUSIONS Patient portal recruitment may be a supplemental intervention to improve clinical trial knowledge among older adults. Further research on additional interventions for identifying eligible participants is needed to minimize the burden among clinicians amidst other competing demands during clinic visits.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Oncologic Science, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Juhan Lee
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, Gainesville, Florida, USA
| | - Mohammed Al-Jumayli
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Oncologic Science, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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Abstract
Background The decentralised clinical trial (DCT) model has been popularised given its remote or virtual design, permitting expanded participant enrolment into community settings. Clinical research nurses (CRNs) are specially trained in the management of clinical trials; however, the utilisation of the research nurse role relating to decentralised trial conduct is not well-established. Aims A literature review was conducted to describe the role of the research nurse in the conduct of DCTs and the current utilisation of this nurse specialty for decentralised trial management. Methods Use of keywords 'DCT' or 'virtual trial' and 'nursing' were used to identify full-text, peer-reviewed literature in the English language and published within the last 10 years that described the clinical research nursing role. Results Of the 102 pre-screened articles identified across five databases, 11 articles were eligible for full-text analysis. Thematic groupings of common discussion elements included Variance in Decentralised Clinical Trial Model Implementation, CRN Involvement in Decentralised Trial Conduct and Reporting and Shared Challenges of Decentralised Trial Implementation Affecting the CRN Role. Conclusions Implications of this literature review include expanded trial sponsor awareness of the support requirements to facilitate research nurse utilisation and optimal decentralised trial conduct.
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Affiliation(s)
- Elizabeth Johnson
- Assistant Professor, Mark & Robyn Jones College of Nursing, Montana State University, Bozeman, MT, USA
| | - Lisa Marsh
- Adjunct Faculty, Buntain College of Nursing, Northwest University, Kirkland, WA, USA
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Sabo S, Lee N, Sears G, Jiménez DJ, Tutt M, Santos J, Gomez O, Teufel-Shone N, Bennet M, Nashio JTN, Flores F, Baldwin J. Community Health Representatives as Trusted Sources for Increasing Representation of American Indian Communities in Clinical Research. Int J Environ Res Public Health 2023; 20:4391. [PMID: 36901401 PMCID: PMC10001500 DOI: 10.3390/ijerph20054391] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Indigenous and American Indian Alaskan Native (AI/AN) community members are systematically underrepresented in clinical trial research. This paper focuses on exploratory steps to partner with Native Nations of Arizona to engage Community Health Representatives (CHR) as a trusted source for building COVID-19 clinical trial research, including vaccine trials awareness. CHRs are frontline public health workers who apply a unique understanding of the experience, language, and culture of the population served. This workforce has entered the spotlight as essential to the prevention and control of COVID-19. METHODS Three Tribal CHR programs were engaged to develop and refine culturally centered educational materials and a pre-post survey using a consensus-based decision-making approach. CHRs used these materials in brief education sessions during regular client home visits and community events. RESULTS At 30 days post CHR intervention, participants (N = 165) demonstrated significantly increased awareness about and ability to enroll in COVID-19 treatment and vaccine trials. Participants also described a significant increase in trust in researchers, decreased perceived barriers related to cost for participation in a clinical trial, and improved belief that participation in a COVID-19 clinical trial for treatment was considered a benefit to American Indian and Alaskan Native people. CONCLUSION CHRs as trusted sources of information, coupled with culturally centered education materials designed by CHRs for CHR clients, demonstrated a promising approach to improved awareness of clinical trial research generally and COVID-19 trials specifically among Indigenous and American Indian community members of Arizona.
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Affiliation(s)
- Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Naomi Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Grant Sears
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Dulce J. Jiménez
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Marissa Tutt
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Jeffersson Santos
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Omar Gomez
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | - Nicolette Teufel-Shone
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
| | | | | | | | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ 86011, USA
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Nolan TS, McKoy A, Gray DM, Metlock F, Addison S, Ogonuwe SS, Gregory J, Lavender D, Reopell L, Joseph JJ. Virtual Community Engagement for Retention of Black Men in Clinical Research. Am J Mens Health 2023; 17:15579883221147767. [PMID: 36627859 PMCID: PMC9837285 DOI: 10.1177/15579883221147767] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Black American men have worse cardiovascular health compared with their White counterparts, yet are highly underrepresented in clinical trials. In 2020, Black men were recruited to participate in Black Impact, a community-based lifestyle intervention to increase cardiovascular health. Due to the research pause during the Coronavirus Disease (COVID-19) pandemic, a virtual community engagement (VCE) process was co-designed with community stakeholders and evaluated for its effect on retention for the clinical trial. VCE via weekly virtual video conference sessions occurred for 9 weeks as a run-in phase prior to in-person research activities. Data collected during sessions included attendance, anecdotes on acceptability, and topical requests for subsequent weeks. Content analysis was performed on scribe notes from sessions to ascertain themes describing the implementation and participant perceptions of the VCE. Descriptive statistics were used to analyze quantitative data. The VCE provided opportunities to co-create a safe atmosphere in small groups, discuss mental health, foster trust, capitalize on the power of spirituality, and establish a brotherhood. Following the VCE run-in phase, 74 of 100 participants remained engaged for participation in the Black Impact study. The VCE described provides a framework that can be used to retain Black men during study delays or disruptions through fostering engagement and building community among participants and researchers.
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Affiliation(s)
- Timiya S. Nolan
- The Ohio State University College of Nursing, Columbus, OH, USA,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA,Timiya S. Nolan, The Ohio State University College of Nursing, 354 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Alicia McKoy
- Center for Cancer Health Equity, The Ohio State University, Columbus, OH, USA
| | | | - Faith Metlock
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Sarah Addison
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - John Gregory
- African American Male Wellness Agency, Columbus, OH, USA
| | - Dana Lavender
- African American Male Wellness Agency, Columbus, OH, USA
| | - Luiza Reopell
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH, USA,Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, OH, USA
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Sankaran H, Finnigan SR, McShane LM, Best AF, Seibel NL. Enrollment of adolescent and young adult patients newly diagnosed with cancer in NCI CTEP-sponsored clinical trials before and after launch of the NCI National Clinical Trials Network. Cancer 2022; 128:3843-3849. [PMID: 36089859 PMCID: PMC9826149 DOI: 10.1002/cncr.34402] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Participation of adolescents and young adults (AYAs) in oncology clinical trials is important to ensure adequate opportunities for AYA patients to contribute to, and benefit from, advances in cancer treatment. METHODS Accrual data for National Cancer Institute (NCI) Cancer Therapy Evaluation Program (CTEP) cooperative group-led treatment trials were examined to assess enrollment of newly diagnosed AYA patients (15-39 years) during the period 2004-2019, with particular interest in comparing enrollment before launch of the NCI National Clinical Trials Network (NCTN) to after. All phase 2, 2/3, and 3 trials activated during the period between January 1, 2004, and December 31, 2019, were identified (n = 1568) and reduced to a set of 304 that met predetermined criteria to focus on cooperative group-led trials that involved therapy for newly diagnosed cancer and had age eligibility overlapping the AYA range. The proportion of AYA patients relative to total accrual, along with 95% bootstrapped CI was calculated for patients enrolled pre-NCTN and post-NCTN. RESULTS AYA accrual comprised 9.5% (95% CI, 7.6-11.8) pre-NCTN compared with 14.0% (95% CI, 9.9-18.3) post-NCTN. The mean difference in proportions post-NCTN compared with pre-NCTN was 4.4% (0.7%-8.3%). CONCLUSIONS These results indicate an increase in AYA participation in trials conducted within the NCTN relative to the pre-NCTN period. This suggests an awareness and utilization of NCTN trials for AYAs with cancer.
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Affiliation(s)
- Hari Sankaran
- Biometric Research Program, Division of Cancer Treatment and DiagnosisNational Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Shanda R. Finnigan
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and DiagnosisNational Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Lisa M. McShane
- Biometric Research Program, Division of Cancer Treatment and DiagnosisNational Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Ana F. Best
- Biometric Research Program, Division of Cancer Treatment and DiagnosisNational Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Nita L. Seibel
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and DiagnosisNational Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
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Lillard JW, Moses KA, Mahal BA, George DJ. Racial disparities in Black men with prostate cancer: A literature review. Cancer 2022; 128:3787-3795. [PMID: 36066378 PMCID: PMC9826514 DOI: 10.1002/cncr.34433] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 01/11/2023]
Abstract
Black men are disproportionately affected by prostate cancer (PCa), with earlier presentation, more aggressive disease, and higher mortality rates versus White men. Furthermore, Black men have less access to PCa treatment and experience longer delays between diagnosis and treatment. In this review, the authors discuss the factors contributing to racial disparities and present solutions to improve access to care and increase clinical trial participation among Black men with PCa. Racial disparities observed among Black men with PCa are multifaceted, evolving from institutional racism. Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information on PCa and treatment options, fear of PCa diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time, and cancer debt, play an important role in racial disparities observed in PCa treatment and outcomes. Racial diversity is often lacking in genomic and precision medicine studies. Black men are largely underrepresented in key phase 3 PCa trials and may be less willing to enroll in clinical trials due to lack of awareness, lack of diversity in clinical trial research teams, and bias of health care providers to recommend clinical research. The authors propose solutions to address these factors that include educating clinicians and institutions on the barriers Black men experience, increasing the diversity of health care providers and clinical research teams, and empowering Black men to be involved in their treatment, which are keys to creating equity for Black men with PCa. LAY SUMMARY: Prostate cancer negatively affects Black men more than men of other races. The history of segregation and mistreatment in the health care system may contribute to mistrust among Black men. Outcomes are worse for Black men because they are less likely to be screened or to receive treatment for prostate cancer. Black men also are unlikely to participate in clinical research, making it difficult for investigators to understand how Black men are affected by prostate cancer. Suggestions for addressing these differences include teaching physicians and nurses about the issues Black men experience getting treatment and improving how Black men get information on prostate cancer.
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Affiliation(s)
- James W. Lillard
- Department of MicrobiologyBiochemistry, and Immunology, Morehouse School of MedicineAtlantaGeorgiaUSA
| | - Kelvin A. Moses
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brandon A. Mahal
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Daniel J. George
- Duke Cancer InstituteUniversity School of MedicineDurhamNorth CarolinaUSA
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12
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Addison S, Yang Y, Metlock F, King M, McKoy A, Williams A, Gregory J, Gray DM, Joseph JJ, Nolan TS. The Role of Social Support in Cardiovascular Clinical Trial Participation among Black Men: Black Impact. Int J Environ Res Public Health 2022; 19:12041. [PMID: 36231354 PMCID: PMC9566142 DOI: 10.3390/ijerph191912041] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Attainment of the American Heart Association's Life's Simple 7 (LS7) metrics reduces cardiovascular disease (CVD) risk; yet, Black Americans have the lowest LS7 attainment among all communities, the highest rate of CVD mortality, and low clinical trial participation. Social support is positively correlated with chronic disease self-management. Here, we describe the role of social support in a single-arm pilot clinical trial of a community-based lifestyle intervention among Black American men. METHODS The 24-week intervention featured weekly team-based physical activity and LS7-themed education. Seventy-four Black men participated in the intervention; twenty agreed to participate in exit surveys via one of three semi-structured focus groups. Data were transcribed verbatim and analyzed using content analysis framed by House's social support framework. RESULTS Participants reported support from both peers and health coaches. The sub-themes of social support among peers were: (1) acknowledgement, understanding, and validation, (2) inspiration, (3) sense of community, (4) fear of disappointing fellow participants, and (5) group synergy. The sub-themes of social support from the health coaches and study team staff included: (1) contemplation of current health status, (2) racial concordance of health coaches and study team staff, (3) investment of the research team, (4) incentives, (5) access to healthcare providers, and (6) the COVID-19 pandemic. Emotional support was the most frequently discussed theme. CONCLUSIONS Social support, especially emotional support, from peers and health coaches was a driver of clinical trial participation among participants. The intervention created a positive social environment and decreased medical mistrust. This intervention may provide a framework by which to facilitate clinical trial participation among Black men.
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Affiliation(s)
- Sarah Addison
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Yesol Yang
- Comprehensive Cancer Center, The Ohio State University, 460 W 10th Ave, Columbus, OH 43210, USA
| | - Faith Metlock
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
| | - Mikayla King
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
| | - Alicia McKoy
- Center for Cancer Health Equity, The Ohio State University, 460 W 10th Ave, Columbus, OH 43210, USA
| | - Amaris Williams
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - John Gregory
- National Center for Urban Solutions, The African American Male Wellness Agency, 2780 Airport Drive, Suite 333, Columbus, OH 43230, USA
| | - Darrell M. Gray
- Anthem, Inc. (Formerly The Ohio State University College of Medicine), 1310 G Street, Washington, DC 20005, USA
| | - Joshua J. Joseph
- College of Medicine, The Ohio State University, 370 W 9th Ave, Columbus, OH 43210, USA
| | - Timiya S. Nolan
- Comprehensive Cancer Center, The Ohio State University, 460 W 10th Ave, Columbus, OH 43210, USA
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, USA
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13
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Rodriguez L, Murray-Krezan C, Regino L, Tellez M, Vasquez C, Sandoval V, Perez Rodriguez D, Pedigo B, Page-Reeves J. A Study of a Culturally and Contextually Situated Multimedia Approach to Recruit a Hard-to-Reach Spanish-Speaking Population for a Randomized Control Trial (RCT). J Empir Res Hum Res Ethics 2022; 17:461-470. [PMID: 35585705 DOI: 10.1177/15562646221102682] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Study designs involving randomization can be difficult to communicate to participants, especially those with low literacy. The literature on strategies to explain research concepts is limited, especially for non-English speakers. We measured the effectiveness of a culturally and contextually situated multimedia approach to recruit a cohort of 60 female Mexican immigrants (FMI) to a randomized control trial (RCT) to reduce social isolation and depression. This strategy was designed to explain the concept of randomization, explain what participating in the research study entailed, and ensure informed consent. Potential participants viewed a presentation explaining the study and a video including animation with voice-over explaining the concept of randomization. We administered a pre/post survey. Respondents (N = 59) reported an increase in their understanding of randomization, intention to enroll, and attitude towards participating in research. We conclude that a culturally and contextually situated multimedia approach is an effective model when recruiting underrepresented populations with low literacy for RCTs.
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Affiliation(s)
- Larimar Rodriguez
- 12288University of New Mexico School of Medicine, Albuquerque, NM, USA
| | | | - Lidia Regino
- Office for Community Health, University of New Mexico, Albuquerque, NM, USA
| | - Maria Tellez
- One Hope Centro de Vida Health Center, East Central Ministries, Albuquerque, NM, USA
| | | | - Virginia Sandoval
- One Hope Centro de Vida Health Center, East Central Ministries, Albuquerque, NM, USA
| | | | - Blanca Pedigo
- One Hope Centro de Vida Health Center, East Central Ministries, Albuquerque, NM, USA
| | - Janet Page-Reeves
- Office for Community Health, University of New Mexico, Albuquerque, NM, USA.,Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
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14
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Ousseine YM, Bouhnik AD, Mancini J. Health Literacy and Clinical Trial Participation in French Cancer Patients: A National Survey. Curr Oncol 2022; 29:3118-3129. [PMID: 35621643 PMCID: PMC9140004 DOI: 10.3390/curroncol29050253] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have explored the relationship between health literacy (HL) and trial participation. In this context, we aimed to study this relationship in French cancer patients. We used data from the French national VIe après le CANcer (VICAN) survey. Two questionnaire items focused on previous invitations to participate in clinical trials and subsequent enrollment. The Single Item Literacy Screener was used to measure functional HL. In total, 1954 cancer patients responded to both VICAN surveys (two and five years after diagnosis). Mean age was 54.1 ± 12.7 years at diagnosis, and 37.6% were classified as having limited HL. One in ten (10.3%) respondents reported having been previously invited to participate in a clinical trial. Of these, 75.5% had enrolled. Limited HL was associated with fewer trial invitations but not with enrollment once invited. Multivariate analysis confirmed the negative effect of limited HL on clinical trial invitation (adjOR = 0.55 (0.39 to 0.77), p < 0.001) after adjustment for multiple characteristics. Patients with limited HL received fewer invitations to participate in trials but were likely to enroll when asked. Addressing HL is necessary to create a more inclusive health system and to reduce inequalities not only in access to innovative cancer care, but to health inequalities in general.
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Affiliation(s)
- Youssoufa M. Ousseine
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille University, 13009 Marseille, France; (Y.M.O.); (A.-D.B.)
- Santé Publique France, French National Public Health Agency, CEDEX, 94415 Saint-Maurice, France
| | - Anne-Déborah Bouhnik
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Aix Marseille University, 13009 Marseille, France; (Y.M.O.); (A.-D.B.)
| | - Julien Mancini
- APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe CANBIOS Labellisée Ligue Contre le Cancer, Hop Timone, BioSTIC, Biostatistique et Technologies de l’Information et de la Communication, Aix Marseille University, 13005 Marseille, France
- Correspondence: ; Tel.: +33-4-91-22-35-02
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15
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Jiang S, Hong YA. Clinical trial participation in America: The roles of eHealth engagement and patient-provider communication. Digit Health 2021; 7:20552076211067658. [PMID: 34925874 PMCID: PMC8679028 DOI: 10.1177/20552076211067658] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Public participation in a clinical trial is the foundation of clinical
research and the cornerstone for the discovery of new treatment and
improving health outcomes. This study aims to examine how eHealth
engagement, patient–provider communication, and clinical trial knowledge are
associated with clinical trial participation in the United States. Methods Data were drawn from the Health Information National Trends Survey Iteration
5 Cycle 4 conducted in 2020. The sample included 3865 American adults aged
18 years and above. Path analysis using structural equation modeling and
hierarchical linear regression was performed to examine the effects of
eHealth engagement and patient–provider communication on clinical trial
participation. Results About 5% of American adults have ever participated in a clinical trial.
Younger adults, males, minorities, and people with lower education, less
clinical trial knowledge, and less eHealth engagement were less likely to
participate. After controlling for demographic variables, we found that more
eHealth engagement led to a better knowledge of clinical trials, which was
strongly associated with participation. Further, patient-centered
communication did not directly lead to clinical trial participation;
instead, it positively moderated the relationship between clinical trial
knowledge and participation. Conclusions The national survey data indicate that American participation in clinical
trials remains low and a significant disparity exists. Within the context of
the eHealth movement, it is critical to implement targeted interventions to
improve clinical trial knowledge, address the digital divide, and enhance
patient-centered communication.
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Affiliation(s)
- Shaohai Jiang
- Department of Communications and New Media, National University of Singapore, Singapore.,Both authors contribute equally
| | - Y Alicia Hong
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA.,Both authors contribute equally
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16
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Patterson P, Allison KR, Bibby H, Thompson K, Lewin J, Briggs T, Walker R, Osborn M, Plaster M, Hayward A, Henney R, George S, Keuskamp D, Anazodo A. The Australian Youth Cancer Service: Developing and Monitoring the Activity of Nationally Coordinated Adolescent and Young Adult Cancer Care. Cancers (Basel) 2021; 13:cancers13112675. [PMID: 34071622 PMCID: PMC8198716 DOI: 10.3390/cancers13112675] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 04/21/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022] Open
Abstract
Adolescents and young adults (aged 15-25 years) diagnosed with cancer have unique medical and psychosocial experiences and care needs, distinct from those of paediatric and older adult patients. Since 2011, the Australian Youth Cancer Services have provided developmentally appropriate, multidisciplinary and comprehensive care to these young patients, facilitated by national service coordination and activity data collection and monitoring. This paper reports on how the Youth Cancer Services have conceptualised and delivered quality youth cancer care in four priority areas: clinical trial participation, oncofertility, psychosocial care and survivorship. National activity data collected by the Youth Cancer Services between 2016-17 and 2019-20 are used to illustrate how service monitoring processes have facilitated improvements in coordination and accountability across multiple indicators of quality youth cancer care, including clinical trial participation, access to fertility information and preservation, psychosocial screening and care and the transition from active treatment to survivorship. Accounts of both service delivery and monitoring and evaluation processes within the Australian Youth Cancer Services provide an exemplar of how coordinated initiatives may be employed to deliver, monitor and improve quality cancer care for adolescents and young adults.
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Affiliation(s)
- Pandora Patterson
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Correspondence:
| | - Kimberley R. Allison
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
| | - Helen Bibby
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
| | - Kate Thompson
- Victoria/Tasmania Youth Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (K.T.); (J.L.)
- ONTrac at PeterMac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Jeremy Lewin
- Victoria/Tasmania Youth Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (K.T.); (J.L.)
- ONTrac at PeterMac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Taia Briggs
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW 2031, Australia; (T.B.); (A.A.)
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Rick Walker
- Queensland Youth Cancer Service, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia; (R.W.); (R.H.)
- Oncology Services Group, Children’s Health Queensland, Brisbane, QLD 4000, Australia
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Michael Osborn
- South Australia/Northern Territory Youth Cancer Service, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (M.O.); (A.H.)
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, SA 5006, Australia
| | - Meg Plaster
- Western Australia Youth Cancer Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (M.P.); (S.G.)
- Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Allan Hayward
- South Australia/Northern Territory Youth Cancer Service, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; (M.O.); (A.H.)
| | - Roslyn Henney
- Queensland Youth Cancer Service, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia; (R.W.); (R.H.)
| | - Shannyn George
- Western Australia Youth Cancer Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (M.P.); (S.G.)
| | - Dominic Keuskamp
- Research, Evaluation and Policy Unit, CanTeen, Sydney, NSW 2042, Australia; (K.R.A.); (H.B.); (D.K.)
| | - Antoinette Anazodo
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW 2031, Australia; (T.B.); (A.A.)
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- School of Women and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW 2031, Australia
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17
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Vazquez J, Abdelrahman S, Byrne LM, Russell M, Harris P, Facelli JC. Using supervised machine learning classifiers to estimate likelihood of participating in clinical trials of a de-identified version of ResearchMatch. J Clin Transl Sci 2020; 5:e42. [PMID: 33948264 DOI: 10.1017/cts.2020.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Lack of participation in clinical trials (CTs) is a major barrier for the evaluation of new pharmaceuticals and devices. Here we report the results of the analysis of a dataset from ResearchMatch, an online clinical registry, using supervised machine learning approaches and a deep learning approach to discover characteristics of individuals more likely to show an interest in participating in CTs. Methods: We trained six supervised machine learning classifiers (Logistic Regression (LR), Decision Tree (DT), Gaussian Naïve Bayes (GNB), K-Nearest Neighbor Classifier (KNC), Adaboost Classifier (ABC) and a Random Forest Classifier (RFC)), as well as a deep learning method, Convolutional Neural Network (CNN), using a dataset of 841,377 instances and 20 features, including demographic data, geographic constraints, medical conditions and ResearchMatch visit history. Our outcome variable consisted of responses showing specific participant interest when presented with specific clinical trial opportunity invitations (‘yes’ or ‘no’). Furthermore, we created four subsets from this dataset based on top self-reported medical conditions and gender, which were separately analysed. Results: The deep learning model outperformed the machine learning classifiers, achieving an area under the curve (AUC) of 0.8105. Conclusions: The results show sufficient evidence that there are meaningful correlations amongst predictor variables and outcome variable in the datasets analysed using the supervised machine learning classifiers. These approaches show promise in identifying individuals who may be more likely to participate when offered an opportunity for a clinical trial.
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18
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Guinn D, Wilhelm EE, Shoulson I. Reasons for Premature Conclusion of Late Phase Clinical Trials: An Analysis of ClinicalTrials.gov Registered Phase III Trials. Ther Innov Regul Sci 2020; 54:232-239. [PMID: 32008239 DOI: 10.1007/s43441-019-00050-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Confirmatory phase III trials aim to provide decisive evidence about a medical product's safety and efficacy. Although these trials are planned and conducted based on accumulated knowledge, they are not without risk or uncertainty. A trial prematurely concluding contributes to great loss in both financial and human research resources. METHODS We categorized and evaluated trials concluded prematurely after recruitment had begun, as registered in Clinical Trials.gov between January 2013 and August 2017. RESULTS We found 9828 registered interventional phase III trials; of those, 320 were concluded prematurely. Many clinical trials were concluded prematurely for reasons related to reducing participant risk, such as interim stopping for safety, efficacy, or futility. Yet, 70% trials were halted for other reasons, such as insufficient recruitment (the most often cited reason) or unspecified business decisions. Of all prematurely concluded trials, 102 trials evaluated 72 different novel therapeutics; in 66.7% of these trials, the clinical development program was stopped entirely. Most of the prematurely concluded trials (78%) had not provided results to ClinicalTrials.gov at the time of this analysis. CONCLUSIONS Evaluation of the factors that influence premature conclusion could inform solutions for improving research participation and help ensure trial completion. Registering and reporting results acknowledges the voluntary contribution and consent expectations of research participants.
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Affiliation(s)
- Daphne Guinn
- Program for Regulatory Science & Medicine, Georgetown University, 2115 Wisconsin Ave NW, Suite 603, Washington, DC, 20007, USA. .,Department of Pharmacology and Physiology, Georgetown University, Washington, DC, USA.
| | - Erin E Wilhelm
- Department of Pharmacology and Physiology, Georgetown University, Washington, DC, USA
| | - Ira Shoulson
- Program for Regulatory Science & Medicine, Georgetown University, 2115 Wisconsin Ave NW, Suite 603, Washington, DC, 20007, USA.,Department of Pharmacology and Physiology, Georgetown University, Washington, DC, USA.,Department of Neurology, Georgetown University, Washington, DC, USA
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19
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Lim BT, Butow P, Sze ML, Girgis A, Jefford M, Goldstein D, Costa D. Impact of migrancy on cancer clinical trial participation: Factors associated with approach and consent in Australian-born versus migrant groups. Asia Pac J Clin Oncol 2020; 16:115-122. [PMID: 31957344 DOI: 10.1111/ajco.13290] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/26/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIMS This study compared rates of clinical trial participation and perceived adequacy of information provided prior to consent in migrant and Australian-born cancer patients, and explored factors associated with being approached and agreeing to participate. METHODS We utilized data from a larger cross-sectional survey assessing disparities in patient-reported outcomes in Chinese, Arabic, or Greek migrant versus English-speaking Australian-born cancer patients. Participants completed a questionnaire eliciting demographic and disease details, communication challenges, whether invited and consented to a clinical trial, and if so, adequacy of information received. RESULTS A total of 566 migrants (142 Arabic, 251 Chinese, and 173 Greek) and 270 English-speaking Australian-born patients participated. Overall, 25% were approached to participate in clinical trials, and of these, 74% consented. Migrants were significantly less likely to consent if asked to participate in clinical trials (P = .009), and fewer migrants (67.2%) reported receiving sufficient information prior to deciding on trial participation (82.1%; P = .04). Perceived understanding of the health system (odds ratio [OR] = 0.71), confidence in speaking (OR = 0.75), ability to understand English (OR = 0.80), and communicate with doctors in English (OR = 0.81) were significantly related to patients' likelihood of being approached to participate in clinical trials. Perceived understanding of the health system (OR = 0.66) was significantly associated with patients agreeing to take part in cancer clinical trials. CONCLUSIONS Our findings identified that barriers to migrants' self-reported participation in clinical trials include perceived lack of understanding of the health system and low English proficiency. Strategies that address these barriers are needed to increase migrant patients' participation in cancer clinical trials.
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Affiliation(s)
- Bee Teng Lim
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis Butow
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Ming Lo Sze
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Afaf Girgis
- Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Daniel Costa
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
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20
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Cowdery JE, Powell JH, Fleming YA, Brown DL. Effectiveness of a short video-based educational intervention on factors related to clinical trial participation in adolescents and young adults: a pre-test/post-test design. Trials 2019; 20:7. [PMID: 30606224 PMCID: PMC6318898 DOI: 10.1186/s13063-018-3097-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/25/2018] [Accepted: 12/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor clinical trial enrollment continues to be pervasive and is especially problematic among young adults and youth, and among minorities. Efforts to address barriers to enrollment have been predominantly focused on adult diseased populations. Because older adults may already have established attitudes, it is imperative to identify strategies that target adolescents and young adults. The purpose of this study was to test the effectiveness of an educational video on factors related to clinical trial participation among a healthy adolescent and young adult population. METHODS Participants completed a 49-item pre-test, viewed a 10-min video, and completed a 45-item post-test to assess changes in attitudes, knowledge, self-efficacy, receptivity to, and intention to participate (primary outcome) in clinical trials. Descriptive statistics, paired samples t-tests, and Wilcoxon signed-rank tests were conducted. RESULTS The final analyses included 935 participants. The mean age was 20.7 years, with almost 70% aged 18 to 20 years. The majority were female (73%), non-Hispanic (92.2%), white (70%), or African American (20%). Participants indicated a higher intention to participate in a clinical trial (p < 0.0001) and receptivity to hearing more about a clinical trial (p < 0.0001) after seeing the video. Intention to participate (definitely yes and probably yes) increased by an absolute 18% (95% confidence interval 15-22%). There were significant improvements in attitudes, knowledge, and self-efficacy scores for all participants (p < 0.0001). CONCLUSIONS The results of this study showed strong evidence for the effectiveness of a brief intervention on factors related to participation in clinical trials. This supports the use of a brief intervention, in a traditional educational setting, to impact the immediate attitudes, knowledge, self-efficacy, and intention to participate in clinical trial research among diverse, healthy adolescents and young adults.
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Affiliation(s)
- Joan E Cowdery
- School of Health Promotion and Human Performance, Eastern Michigan University, Ypsilanti, MI, 48197, USA
| | - James H Powell
- Strategic Medical Associates, Cincinnati, OH, 45249, USA.,National Medical Association, Project I.M.P.A.C.T, Silver Spring, MD, 20910, USA
| | - Yolanda A Fleming
- National Medical Association, Project I.M.P.A.C.T, Silver Spring, MD, 20910, USA
| | - Devin L Brown
- Stroke Program, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5855, USA.
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Fletcher FE, Fisher C, Buchberg MK, Floyd B, Hotton A, Ehioba A, Donenberg G. "Where Did This [PrEP] Come From?" African American Mother/Daughter Perceptions Related to Adolescent Preexposure Prophylaxis (PrEP) Utilization and Clinical Trial Participation. J Empir Res Hum Res Ethics 2018; 13:173-184. [PMID: 29471706 DOI: 10.1177/1556264618755919] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 11/16/2022]
Abstract
Despite the demonstrated effectiveness of preexposure prophylaxis (PrEP) to reduce incident HIV infections, PrEP's potential as an HIV prevention strategy for adolescent populations is unknown. This study assessed perceptions of adolescent PrEP use and clinical trial participation among African American women and their adolescent daughters. We conducted focus group discussions with 15 African American mother/daughter pairs ( N = 30). Findings suggest a general lack of PrEP awareness, favorable attitudes toward adolescent PrEP use, altruistic attitudes regarding research participation among daughters, and less favorable attitudes toward adolescent clinical trial participation among mothers. Study findings have the potential to inform strategies that provide equitable access to HIV scientific advances among African American women and girls and promote informed parent-child research decision making.
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Moke DJ, Oberley MJ, Bhojwani D, Parekh C, Orgel E. Association of clinical trial enrollment and survival using contemporary therapy for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26788. [PMID: 28876513 PMCID: PMC7553364 DOI: 10.1002/pbc.26788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 11/07/2022]
Abstract
While early studies reported superior survival for cancer patients enrolled on clinical trials, recent findings are inconclusive. We investigated the association between enrollment on contemporary trials and event-free survival (EFS) in pediatric B-cell acute lymphoblastic leukemia (B-ALL). In a retrospective cohort of 274 children (1-21 years) treated for B-ALL from 2008 to 2015, 55.5% enrolled with no disparity in enrollment by age, sex, or ethnicity. Three-year EFS was similar for enrolled and not enrolled patients (90.1% [95% CI, 82.5-94.5] versus 86.5% [95% CI, 77.7-92.0]). Clinical trial enrollment did not affect pediatric B-ALL survival, albeit in a limited-size cohort treated at a single academic institution.
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Affiliation(s)
- Diana J. Moke
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California
| | - Matthew J. Oberley
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Deepa Bhojwani
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Chintan Parekh
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Etan Orgel
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California
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Baummer-Carr A, Nicolau DP. The challenges of patient satisfaction: influencing factors and the patient - provider relationship in the United States. Expert Rev Anti Infect Ther 2017; 15:955-962. [PMID: 28893115 DOI: 10.1080/14787210.2017.1378097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/18/2022]
Abstract
INTRODUCTION Patient satisfaction is a phenomenon that has become influential in the inpatient setting with the introduction of the Hospital Consumer Assessment of Healthcare Practitioners and Systems (HCAHPS) survey in the United States. Patient satisfaction is a key goal of healthcare organizations and presents some challenges to providing quality patient care. Areas covered: This review will focus on the challenges patient satisfaction presents in the healthcare field, with a key focus on factors that influence patient satisfaction, the common problem of inappropriate antibiotic prescriptions and the importance of the patient-provider relationship. Expert commentary: While it is apparent that focused efforts to better understand patient satisfaction are necessary and that implementation of processes to enhance satisfaction are warranted, attention must be directed so that these interventions do not adversely influence the efficiency or quality of care. Continuous long-term relationships with healthcare providers encourage patient loyalty, effective healthcare and good lifestyle habits.
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Affiliation(s)
| | - David P Nicolau
- a Center for Anti-Infective Research and Development , Hartford , CT , USA .,b Division of Infectious Diseases , Hartford Hospital , Hartford , CT , USA
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Abstract
OBJECTIVES The aim of the study was to explore women's motivations for participating in a clinical trial and to evaluate how financial compensation impacts women's explanations for participation. DESIGN, SETTING AND PARTICIPANTS Semistructured interviews were conducted face to face or by telephone with 25 of 220 women who participated in a pragmatic randomised trial for app-administered self-care acupressure for dysmenorrhoea (AKUD). Of these 25 women, 10 had entered AKUD knowing they would receive a financial compensation of €30. A purposive sampling strategy was used. RESULTS Women had a long history of seeking help and were unsatisfied with the options available, namely painkillers and oral contraceptives. While interviewees were open to painkillers, they were uneasy about taking them on a monthly basis. The AKUD trial offered the possibility to find an alternative solution. A second reason for participation was the desire to add a new treatment to routine medical care, for which the interviewees considered randomised trials a prerequisite. The financial incentive was a subsidiary motivation in the interviewees' narratives. CONCLUSIONS Our results contribute to the ongoing discussion of the impact of financial compensation on research participants' assessment of risk. The interviewed women considered all research participants able to make their own choices regarding trial participation, even in the face of financial compensation or payment of study participants. Furthermore, the importance of clinical trials providing new treatments that could change medical practice might be an overlooked reason for trial participation and could be used in future recruitment strategies.
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Affiliation(s)
- Susanne Blödt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Christine Holmberg
- Institute of Public Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
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25
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Nelson AM, Martin IG, Getz KA. Generational Value Differences Affecting Public Perceptions of and Willingness to Participate in Clinical Trials. Ther Innov Regul Sci 2015; 49:940-946. [PMID: 30222373 DOI: 10.1177/2168479015583727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/16/2022]
Abstract
BACKGROUND It is widely acknowledged that patient recruitment is a significant challenge and represents one of the primary reasons for drug development delays. Data from the Center for Information and Study on Clinical Research Participation (CISCRP) "Perceptions & Insights" study indicate that the 18- to 34-year-old Generation Y subgroup was the least willing to participate in a clinical trial. METHODS The willingness of Generation Y to participate in clinical studies was compared to that of older groups in the CISCRP study. These results were then compared to data from earlier studies. RESULTS Statistically significant differences existed between the willingness of Generation Y to participate in clinical studies when compared to older age groups. Generational perceptions and value differences were explored via corporate and sociological research findings to determine why disparities existed among age groups regarding the willingness for clinical trial participation. CONCLUSIONS Preliminary results indicate that members of Generation Y are less willing to participate in clinical studies and that these differences are truly generational and not simply age related.
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Affiliation(s)
| | | | - Kenneth A Getz
- 2 Center for the Study of Drug Development, Tufts University School of Medicine, Boston, MA, USA.,3 Center for Information and Study on Clinical Research Participation (CISCRP), Boston, MA, USA
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26
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Bhatt VR, Dhakal P, Dahal S, Giri S, Pathak R, Bociek RG, Silberstein PT, Armitage JO. Demographic and other characteristics of nodal non-Hodgkin's lymphoma managed in academic versus non-academic centers. Ther Adv Hematol 2015; 6:223-7. [PMID: 26425335 DOI: 10.1177/2040620715592568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/16/2022] Open
Abstract
BACKGROUND Cancer therapy and outcomes are known to be affected by various demographic features and hospital types. We aimed to identify the characteristics of non-Hodgkin's lymphoma (NHL) patients associated with receipt of care at academic centers. METHOD This is a retrospective study of all patients diagnosed with nodal NHL between 2000 and 2011 in the National Cancer Database (NCDB), who received the diagnosis, and all or part of their initial therapy in the reporting hospital (n = 243,436). Characteristics of patients receiving care in academic versus nonacademic centers were compared using the Chi-square test. RESULTS Approximately 27% received care in academic centers. Patients receiving care in nonacademic centers, compared with academic centers, were more likely to be ⩾60 years (69% versus 58%, p < .0001), White (89% versus 80%, p < .0001) and have lower educational attainment (>12% without high school diploma: 72% versus 69%, p < .0001) and economic status (household income <$49,000: 66% versus 61%, p < 0.0001). Patients receiving care in nonacademic centers were less likely to travel ⩾25 miles (21% versus 26%, p < 0.0001). White patients, compared with non-Whites, were more likely to be ⩾60 years (70% versus <50%, p < 0.0001), which probably explains less care in academic centers. CONCLUSIONS Patients ⩾60 years and those with poorer educational attainment and economic status were less likely to receive care in academic centers. Care in academic centers required a longer commute. Elderly patients frequently have inferior outcomes and may benefit from clinical trials with novel agents and expertise at academic centers.
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Affiliation(s)
- Vijaya Raj Bhatt
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, USA
| | - Prajwal Dhakal
- Department of Medicine, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Sumit Dahal
- Department of Internal Medicine, Interfaith Medical Center, NY, USA
| | - Smith Giri
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ranjan Pathak
- Department of Medicine, Reading Health System, Reading, PA, USA
| | - R Gregory Bociek
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peter T Silberstein
- Department of Internal Medicine, Division of Hematology-Oncology, Creighton University Medical Center, Omaha, NE, USA
| | - James O Armitage
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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Barakat LP, Schwartz LA, Reilly A, Deatrick JA, Balis F. A Qualitative Study of Phase III Cancer Clinical Trial Enrollment Decision-Making: Perspectives from Adolescents, Young Adults, Caregivers, and Providers. J Adolesc Young Adult Oncol 2014; 3:3-11. [PMID: 24669354 DOI: 10.1089/jayao.2013.0011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 11/12/2022] Open
Abstract
Purpose: The mortality reduction rate for adolescents and young adults (AYAs) with cancer has not demonstrated the same rate of improvement as for children, due partly to insufficient phase III cancer clinical trial enrollment. This study describes three key components of phase III cancer clinical trial enrollment-family decision-making patterns, factors that influence AYAs' involvement, and attitudes (perceived barriers and benefits) toward trial participation-and evaluated a measure of attitudes. Methods: Participants were AYAs (15-23 years old at study) diagnosed with cancer and offered a phase III cancer clinical trial within the past 3-21 months, their primary caregivers, and their healthcare providers. Interviews assessed: (a) phase III clinical trial decision-making experiences and (b) relevance of the Pediatric Research Participation Questionnaire (PRPQ) in the assessment of AYAs' attitudes toward enrollment on phase III cancer clinical trials. Results: Thirteen AYAs, 16 caregivers, and 11 providers were interviewed. Four decision-making patterns were identified, with AYA abdicates to caregiver and caregiver-based and AYA-endorsed the most commonly described, but with variation across respondents. Distress and reduced health-related quality of life limited AYAs' involvement in the enrollment decision, while developmental and emotional maturity facilitated involvement. Perceived barriers and benefits to enrollment were reported, and the PRPQ was deemed relevant with minor modifications. Conclusions: Findings suggest that AYAs may not be fully involved in phase III cancer clinical trial enrollment decision-making, and caregivers and providers are challenged to overcome factors that limit their involvement. The PRPQ shows promise as a tool for systematically evaluating clinical trial attitudes.
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Affiliation(s)
- Lamia P Barakat
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Anne Reilly
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Janet A Deatrick
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania
| | - Frank Balis
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania. ; Perelman School of Medicine of the University of Pennsylvania , Philadelphia, Pennsylvania
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Omondi NA, Ferguson SE, Majhail NS, Denzen EM, Buchanan GR, Haight AE, Labotka RJ, Rizzo JD, Murphy EA. Barriers to hematopoietic cell transplantation clinical trial participation of african american and black youth with sickle cell disease and their parents. J Pediatr Hematol Oncol 2013; 35:289-98. [PMID: 23612380 DOI: 10.1097/MPH.0b013e31828d5e6a] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
African Americans and Blacks have low participation rates in clinical trials and reduced access to aggressive medical therapies. Hematopoietic cell transplantation (HCT) is a high-risk but potentially curative therapy for sickle cell disease (SCD), a disorder predominantly seen in African Americans. We conducted focus groups to better understand participation barriers to HCT clinical trials for SCD. Nine focus groups of youth with SCD (n=10) and parents (n=41) were conducted at 3 sites representing the Midwest, South Atlantic, and West South Central US. Main barriers to clinical trial participation included gaps in knowledge about SCD, limited access to SCD/HCT trial information, and mistrust of medical professionals. For education about SCD/HCT trials, participants highly preferred one-on-one interactions with medical professionals and electronic media as a supplement. Providers can engage with sickle cell camps to provide information on SCD/HCT clinical trials to youth and local health fairs for parents/families. Youth reported learning about SCD through computer games; investigators may find this medium useful for clinical trial/HCT education. African Americans affected by SCD face unique barriers to clinical trial participation and have unmet HCT clinical studies education needs. Greater recognition of these barriers will allow targeted interventions in this community to increase their access to HCT.
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Lake JE, Friedman RK, Cunha CB, Cardoso SW, Veloso VG, Currier JS, Grinsztejn B. Participation of women in HIV clinical trials: the IPEC-FIOCRUZ experience. HIV AIDS (Auckl) 2011; 3:61-8. [PMID: 22096408 PMCID: PMC3218707 DOI: 10.2147/hiv.s18667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Fifty percent of people living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) worldwide are female. In Brazil, for example, 240,000 women are infected with HIV, rates of infection in women have increased over the last two decades, and addressing HIV prevention and treatment for women at risk for, or living with, HIV/AIDS remains a challenge. To better address the needs of women living with HIV in Brazil, the Instituto de Pesquisa Clínica Evandro Chagas – Fundação Oswaldo Cruz (IPEC-FIOCRUZ) HIV Women’s Cohort was established in 1996 to study the natural history of women seeking HIV care. This analysis describes the characteristics of women in the cohort who participated in HIV clinical trials between 1999 and 2008. Methods A total of 736 Women’s Cohort participants were in active follow-up and 665 participants from the Women’s Cohort were included in univariable and multivariable analyses to determine socioeconomic and sociodemographic factors associated with women’s participation in HIV clinical trials at our site. Results Of the complete cohort, 23% participated in a clinical trial between January 1999 and July 2008. Odds of participation decreased for women who were younger than 35 years old, currently employed, had an HIV-positive sexual partner, and/or who reported a lifetime history of illicit drug use. Alternatively, the odds of participation increased for women who had more than 8 years of formal education, were living independently, and/or were married or cohabitating. Conclusion The rate of participation in HIV clinical trials by women in the IPEC-Fiocruz Cohort was similar to other published cohorts, but identification of local risk factors and barriers to participation remains important. Our analysis offers a novel description of the factors associated with participation in HIV clinical trials among women in care at IPEC-FIOCRUZ in Rio de Janeiro, Brazil.
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Affiliation(s)
- Jordan E Lake
- Division of Infectious Diseases, University of California at Los Angeles, Los Angeles, CA, USA
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Gollin LX, Harrigan RC, Calderón JL, Perez J, Easa D. Improving Hawaiian and Filipino involvement in clinical research opportunities: qualitative findings from Hawai'i. Ethn Dis 2005; 15:S5-111-9. [PMID: 16312944 PMCID: PMC1473039] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE Investigate the barriers to participation in medical research that involves Asian and Pacific Islander (API) populations in Hawai'i. PARTICIPANTS Fifty people (27 Filipinos, 23 Hawaiian/Pacific Islanders) in five different communities on Oahu. DESIGN Nine focus groups with an ethnically matched moderator were held to explore people's feelings, problems, and recommendations regarding medical research. Sessions were audiotaped, transcribed, and qualitatively analyzed with the constant comparison method. RESULTS Only 12% of study participants said that they absolutely would not participate in a clinical study. Most agreed that research is vital. Filipino participants were more optimistic about the safety and value of joining in medical research. Hawaiian groups were more hesitant and fearful. Reasons for nonparticipation included negative feelings about the purpose and intent of clinical trials and language and cultural barriers. Suggestions on how to encourage API populations to participate in research investigations included improving peoples' understanding of the benefits to family and community. Hawaiian and Filipino groups differed only slightly in their assessments of the type of research needed in their communities. CONCLUSIONS Recruitment campaigns must improve people's awareness of the process of informed consent, research safeguards, and benefits to family and community. Attention should focus on K-12 health education to use members of the younger generations to access and educate elders, involving persons with medical research experience as a recruitment resource, returning results to study participants, and increasing the number of healthcare professionals and researchers that are culturally and linguistically matched to the community.
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Affiliation(s)
- Lisa X Gollin
- John A Burns School of Medicine, University of Hawai'i, USA
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