Leukemia Clinical Trial
Official title:
Informed Consent in Pediatric Phase I Cancer Trials
Background:
- Informed consent is the process by which prospective participants in clinical trials
learn about clinical research in order to decide whether they want to enroll in the
study. It consists of meetings and discussions with the health care team.
- Phase I clinical trials are designed to determine what dose of an investigational agent
is safe to administer to patients.
Objectives:
- To study communication, comprehension and decision-making during the informed consent
process.
- To examine ethical, psychological, social, and educational issues regarding informed
consent.
- To help researchers understand how to improve informed consent and education about
clinical research.
Eligibility:
- Parents or guardians of children with cancer who are being considered for participation
in phase I clinical trials
- Prospective patients for pediatric phase I clinical trials who are between 14 and 21
years of age.
- Members of the research team who obtain consent from patients and families for pediatric
phase I clinical trials
Design:
- Research assistants observe and record the informed consent conference held with the
research team and the parents and children.
- After the conference, the research assistant interviews the parents in a private area
about their experience during the conference and their decision-making process. They are
asked about their thoughts and opinions during the informed consent conference,
including the decision-making process, communication and trust in the medical team.
- With their parent's permission, patients are interviewed privately to discuss their
experience during the informed consent conference.
- After parents and patients have made their decision about participation in the study,
they are interviewed again about how they made the decision, aspects of the
communication during the conference, and how they feel about the doctor. This interview
is also recorded.
- Parents may be contacted 6 months to 2 years from the time of their participation to be
part of a parent advisory group about the informed consent process.
Background:
- The clinical course and poor prognosis of children and adolescents eligible for
pediatric phase I trials may increase the vulnerability of patients and their families
and confound informed consent
- Physicians report a tension between presenting reasonable options and a truthful
prognosis while maintaining hope.
- Research on the communication and decisions regarding participation in pediatric phase I
trial is needed.
Objectives:
- The primary objective of this study is to understand communication, comprehension, and
decision-making in Phase I childhood cancer trials (Specific Aim 1) by examining:
- The way that phase I pediatric trials are presented (Aim 1 Hypothesis 1)
- Whether and how alternatives (such as hospice) are introduced (Aim 1 Hypothesis 2)
- What parents and children older than 14 years understand after the consent
discussion (Aim 1 Hypothesis 3)
- How the communication process influences parental comprehension and decision-making
regarding participation of their child in a phase I study (Aim 1 Hypothesis 4)
- How clinician-investigator perspectives may vary from that of the parent of a child
participating in a phase I study (Aim 1 Hypothesis 5)
- Compare Phase I vs. Phase III pediatric cancer informed consent (Specific Aim 2)
regarding:
- Parental understanding of the scientific goals of the trial (Aim 2 Hypothesis 1)
- Trust, decision making preferences, strength of recommendation by investigators
interactivity as measured by number of parental questions, reasons for decisions,
child's involvement, reading consent document, parental understanding of choice and
trial design/purpose, disclosure of prognosis (Aim 2 Hypothesis 1-9)
- Develop suggestions for interventions to improve informed consent in Phase I
pediatric cancer trials through Parent Advisory Group on Informed Consent
(PAGIC).(Specific Aim 3)
Eligibility:
- Parents or guardians of children and adolescents considering enrollment on Phase I
Trials of anti-cancer agents, gene transfer or vaccine studies are eligible if the child
or adolescent is less than 22yrs with diagnosed with a recurrent or refractory malignant
solid tumor or leukemia.
- Participants must speak English or Spanish.
- Parents or guardians of children or adolescents who are newly diagnosed with cancer or
previously participated in informed consent research are excluded.
- In addition, we plan to interview a smaller number of patients who are 14-21 years of
age and who have participated in an informed consent conference for a Phase I cancer
trial.
Design:
- Parents (n=132) of children or adolescents (age less than or equal to 21 years) who are
being offered participation in a Phase I clinical trial for cancer will be sequentially
recruited.
- The methods will include direct observation, digital recording of ICC, and
questionnaires of parent/guardian, patients, and health care team members. Research
Assistants (RAs) will be trained to observe and record all interactions between families
and clinicians that relate to the Phase I clinical trial. Children over 14 years old
will be interviewed using a separate instrument
- Data will be analyzed by quantitative and qualitative analytic methods. To assure 120
cases for analysis, the total accrual is 132 cases at six institutions, up to 100 will
be accrued at the NCI.
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