Exploring patient-reported barriers to participating in proton therapy clinical trials

Introduction

Clinical trials lead the progress in healthcare. To ensure reliable research conclusions, it is essential to enroll diverse patient groups. Identifying and understanding patient-reported barriers to clinical trials may help enhance recruitment among diverse patient groups.The clinical potential of proton therapy (PT) to reduce late effects is being investigated in clinical trials worldwide. Thus, for some patients, PT is only accessible by participating in clinical trials.Individuals with smoking-related head and neck cancer (HNC) are sometimes socioeconomically deprived, leading to barriers to trial participation. This study aims to identify barriers to their participation in a randomised controlled trial (RCT) involving PT.

Method

Interviews were conducted with 14 HNC patients declining participation in an RCT involving PT. The interviews were transcribed and systematically analysed using an inductive approach identifying categories and themes.

Results

The identified barriers to RCT-participation are: (1) existential distress, which influenced participants' mental and cognitive capacities, (2) insufficient RCT-related knowledge arising from information overload during clinical consultations, (3) the wish for safety and familiarity during the treatment trajectory, particularly for participants needing accommodation during  radiotherapy, and (4) the motivation for study participation was impacted by uncertainty due to randomisation and clinical equipoise. Existential distress is identified as an overarching theme because it influences and amplifies the other three themes.

Conclusion

Existential distress is a central theme that influences and amplifies other participation barriers in PT RCTs. It affects participants' comprehension of trial information, their preference for familiar environments, and their motivation to participate in clinical trials.

External validation of a prediction model for timely implementation of innovations in radiotherapy

BACKGROUND AND PURPOSE

The aim of this study was to externally validate a model that predicts timely innovation implementation, which can support radiotherapy professionals to be more successful in innovation implementation.

MATERIALS AND METHODS

A multivariate prediction model was built based on the TRIPOD (Transparent Reporting of a multivariate prediction model for Individual Prognosis Or Diagnosis) criteria for a type 4 study (1). The previously built internally validated model had an AUC of 0.82, and was now validated using a completely new multicentre dataset. Innovation projects that took place between 2017-2019 were included in this study. Semi-structured interviews were performed to retrieve the prognostic variables of the previously built model. Projects were categorized according to the size of the project; the success of the project and thepresence of pre-defined success factors were analysed.

RESULTS

Of the 80 included innovation projects (32.5% technological, 35% organisational and 32.5% treatment innovations), 55% were successfully implemented within the planned timeframe. Comparing the outcome predictions with the observed outcomes of all innovations resulted in an AUC of the external validation of the prediction model of 0.72 (0.60-0.84, 95% CI). Factors related to successful implementation included in the model are sufficient and competent employees, desirability and feasibility, clear goals and processes and the complexity of a project.

CONCLUSION

For the first time, a prediction model focusing on the timely implementation of innovations has been successfully built and externally validated. This model can now be widely used to enable more successful innovation in radiotherapy.

Clues to address barriers for access to proton therapy in the Netherlands

BACKGROUND AND PURPOSE

The Netherlands has National Indication Protocols on proton therapy (PT) to select patients who benefit most from PT. However, referrals to proton therapy centres (PTCs) are lagging. The objective of this research is to identify the barriers for access to PT and to design interventions to address these barriers.

MATERIAL AND METHODS

We conducted a nationwide survey among radiation oncologists (ROs), and semi- structured in-depth interviews with ROs and patients. Subsequently, four workshops were held, in which ROs from one PTC and ROs from referring hospitals participated. The workshops were based on design-thinking research, where ideas were co-created on a multidisciplinary basis to encourage joint problem ownership. Kruskal Wallis and X2 tests were used to analyze data.

RESULTS

The most prominent barriers mentioned by ROs were patient selection, poor logistics, and logistical worries about the combination of radiation treatment with chemotherapy. Patients pointed out the inefficient coordination between organisations, poor communication, travel issues and discomfort during treatment. Clues to increase referrals revealed the need for additional tools for patient selection and innovative ways to improve logistics. A case manager was identified as beneficial to the patients' journey as part of a multidisciplinary approach. Such an approach should include the active involvement of medical oncologists, surgeons and pulmonologists.

CONCLUSION

Barriers for access to PT were identified and prioritized in the inter-organisational care- pathway of proton therapy patients in The Netherlands. Innovative solutions were co- designed to solve the barriers.

Goods and Services Tax (GST) Implementation in India: A SAP-LAP-Twitter Analytic Perspective

In a federal structure, India's determination to much-needed fiscal reforms has been widely applauded at its face value when she relinquished her previous complex and inefficient tax regime to embrace the long-awaited Goods and Services Tax (GST). It has been a significant economic move post-independence and requires validation of facts after its introduction. The present study aims to present a general macroeconomic analysis of the extent to which the adoption of GST has improved existing tax administration and resultant general economic well-being of a democratic political economy like India in light of innovation implementation theoretical perspective. Further, the study tried to determine how the stakeholders perceived such big-bang reform even after the three years of its adoption. The study attempted to assess to what extent the adoption of GST has indeed influenced the economy in general and citizens and/or consumers in particular while using a case-based qualitative inquiry. The present research applied the situation-actor-process; learning-action-performance analysis framework for the case analysis. The facts reveal that India has observed a tremendous increase in tax base vis-à-vis revenue collection. Yet, some efforts are desired to improve the low tax to GDP ratio, skewed GST payers base, negative stakeholders' perception of GST (revealed through Twitter sentiment analysis), and the evil of tax evasion. The other merits realized by the economy are presented as benefits to the consumers, MSMEs, improved ease of doing business ranking, and foster make-in-India and AatmanirbharBharat move by the government.

Implementation of MR-linac and proton therapy in two radiotherapy departments in The Netherlands: Recommendations based on lessons learned

Recently, two new treatment techniques, i.e. proton therapy and MR-linac based radiotherapy (RT), have been introduced in Dutch RT centres with major impact on daily practice. The content and context of these techniques are frequently described in scientific literature while little is reported about the implementation phase. This process is complex due to a variety of aspects, such as the involvement of multiple stakeholders, significant unpredictability in the start-up phase, the impact of the learning curve, standard operating procedures under development, new catchment areas, and extensive training programs. Insight about implementation in daily care is utterly important for clinics that are about to introduce these new technologies in order to prevent that every centre needs to reinvent the wheel. This position paper gives an overview of the implementation of proton therapy and MR-linac based RT in two large academic RT centres in the Netherlands, i.e. Maastro and Radboudumc respectively. With this paper we aim to report our lessons learned, in order to facilitate other RT centres that consider introducing these and other new techniques in their departments.

Barriers and facilitators to the uptake of new medicines into clinical practice: a systematic review

BACKGROUND

Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research.

METHOD

A systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them.

RESULTS

A total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored.

CONCLUSION

This systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines.

REGISTRATION

PROSPERO database (CRD42018108536).

Design and baseline results of a coaching intervention for implementation of trans-radial access in percutaneous coronary intervention

Trans-radial artery access (TRA) for cardiac catheterization and percutaneous coronary intervention has many advantages over trans-femoral artery access (TFA), but implementation has been slow. The steep learning curve, logistical issues, and radiation exposure have been documented as barriers to implementation. Although many cardiac catheterization laboratories have overcome these barriers, we lack evidence on effective implementation strategies. Our objective is to test a team-based coaching intervention that targets the learning curve and other barriers to increase use of TRA. We use a stepped-wedge cluster-randomized trial to test a coaching intervention in Department of Veterans Affairs cardiac catheterization laboratories. The coaching intervention comprises team-based didactic instruction with live observation at a TRA-proficient lab, followed by a visit from a cardiologist and catheterization laboratory nurse coaching team. Interview and survey data are collected from participants to test and adapt an implementation science framework known as the Promoting Action on Research Implementation in Health Services (PARIHS) framework. This study is designed to test the effectiveness of the coaching intervention on TRA implementation, inform changes to the coaching intervention itself, and test and adapt the PARIHS framework in practice. While the benefits of TRA, including increased clinical efficiency, patient comfort, and reduced patient complications, are well understood, the underlying drivers of TRA adoption and sustained practice are not. Findings from this trial can inform future research to facilitate change in the cardiac catheterization laboratory.

Towards Post-pandemic Transformative Teaching and Learning: Case Studies of Microlearning Implementations in two Post-secondary Educational Institutions

The recent COVID-19 pandemic has presented challenges to post-secondary education, including that campuses have been closed, removing face-to-face instruction options. Meanwhile, this crisis has also presented unique opportunities to create a "tipping point" or conditions that foster innovative teaching practices. In light of such a "danger-opportunity," the feasibility of introducing microlearning (ML), a technology-mediated teaching and learning (T&L) strategy, has recently been revisited by some institutions. ML offers learning opportunities through small bursts of training materials that learners can comprehend in a short time, according to their preferred schedule and location. Initially considered as "add-on" complementary online learning resources to provide learners with an active and more engaging learning experience through flexible learning modes, the possibility of an institution-wide implementation of ML has been further explored during the COVID-19 lockdown. This paper presents an exploratory case study examining two post-secondary education institutions' ML introductions. Using the SAMR model as the lens, their approaches to adopting ML are examined through analysis of quantitative questionnaires and qualitative teacher reflections. Overall, ML appears to be a promising direction that may not only be able to help institutions survive, but possibly offer an enhanced teaching and learning experience, post-pandemic. However, its current implementations face many challenges, both practical and pedagogical, and their impacts have yet to achieve transformation. With the insights gained, some possible strategies for moving the adoption of ML to the next level are offered.