Barriers and Facilitators to Initiating and Completing Time-Limited Trials in Critical Care*

Bruce, Courtenay R.; Liang, Cecilia; Blumenthal‐Barby, Jennifer; Zimmerman, Janice L.; Downey, Andrea; Pham, Linda; Theriot, Lisette; Delgado, Estevan D.; White, Douglas B.

doi:10.1097/ccm.0000000000001307

Cited by 36 publications

(28 citation statements)

References 14 publications

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“…Each issue acted as a barrier or facilitator to clinical trial recruitment. Bruce et al 1 outlined how navigating rapidly changing clinical courses and communication breakdown adversely affected recruitment 1. That these factors did not emerge in this synthesis may reflect different healthcare systems, funding and the larger number of hospitals.…”

Section: Discussionmentioning

confidence: 92%

“…Approaches to improve recruitment included simple incentive schemes to reward clinical staff, broadening the range of clinicians who could take consent. The latter is particularly pertinent to CTIMPs where time-limited recruitment was more relevant 1 2. Previous work has suggested lack of equipoise as a barrier to enrolment 17 18.…”

Section: Discussionmentioning

confidence: 99%

“…Previous work has suggested lack of equipoise as a barrier to enrolment 17 18. An area for further exploration relates to consent waivers, already explored in some recent research,1 17 19 20 although with less known of patient and family perspectives. ‘Overburdening’ has been described previously21 as concern regarding making initial approaches to families during particularly sensitive times19–23 but again the patient/family voice in these studies is largely absent 19–21.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical trials in critical care are integral to improving patient care, although unique practical and ethical challenges exist including the time-sensitive nature of treatment and enrolling patients who lack capacity 1. Data exploring barriers to conducting clinical trials in this setting are scarce, but include managing changing clinical courses, communication breakdowns and requests for more time for consent 2.…”

Section: Introductionmentioning

confidence: 99%

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Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure

et al. 2019

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Conducting clinical trials in critical care is integral to improving patient care. Unique practical and ethical considerations exist in this patient population that make patient recruitment challenging, including narrow recruitment timeframes and obtaining patient consent often in time-critical situations. Units currently vary significantly in their ability to recruit according to infrastructure and level of research activity.AimTo identify variability in the research infrastructure of UK intensive care units and their ability to conduct research and recruit patients into clinical trials.DesignWe evaluated factors related to intensive care patient enrolment into clinical trials in the UK. This consisted of a qualitative synthesis carried out with two datasets of in-depth interviews (distinct participants across the two datasets) conducted with 27 intensive care consultants (n=9), research nurses (n=17) and trial coordinators (n=1) from 27 units across the UK. Primary and secondary analyses of two datasets (one dataset had been analysed previously) were undertaken in the thematic analysis.FindingsThe synthesis yielded an overarching core theme of normalising research, characterised by motivations for promoting research and fostering research-active cultures within resource constraints, with six themes under this to explain the factors influencing critical care research capacity: organisational, human, study, practical resources, clinician and patient/family factors. There was a strong sense of integrating research in routine clinical practice, and recommendations are outlined.ConclusionsThe central and transferable tenet of normalising research advocates the importance of developing a culture where research is inclusive alongside clinical practice in routine patient care and is a requisite for all healthcare individuals from organisational to direct patient contact level.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure

et al. 2019

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“…When deterioration occurs, TLT treatment is withdrawn and palliative care becomes the main goal of care. 38–40 …”

Section: Discussionmentioning

confidence: 99%

The Exercise of Autonomy by Older Cancer Patients in Palliative Care: The Biotechnoscientific and Biopolitical Paradigms and the Bioethics of Protection

Niemeyer-Guimarães

Schramm

2017

Palliat�Care

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Toward the end of life, older cancer patients with terminal illness often prefer palliative over life-extending care and also prefer to die at home. However, care planning is not always consistent with patients’ preferences. In this article, discussions will be centered on patients’ autonomy of exercising control over their bodies within the current biotechnoscientific paradigm and in the context of population aging. More specifically, the biopolitical strategy of medicine in the context of hospital-centered health care control and of the frail condition of cancer patients in the intensive care unit will be considered in terms of the bioethics of protection. This ethical principle may provide support to these patients by ensuring that they receive appropriate treatment of pain and other physical, psychosocial, and spiritual problems in an attempt to focus attention on the values of the ill person rather than limiting it to the illness.

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Time-Limited Trials of Intensive Care Unit Care

2023

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Barriers and Facilitators to Initiating and Completing Time-Limited Trials in Critical Care*

Cited by 36 publications

References 14 publications

Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure

Synthesis of qualitative research studies regarding the factors surrounding UK critical care trial infrastructure

The Exercise of Autonomy by Older Cancer Patients in Palliative Care: The Biotechnoscientific and Biopolitical Paradigms and the Bioethics of Protection

Time-Limited Trials of Intensive Care Unit Care

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