Grant Number:	5R01CA196131-05 Interpret this number
Primary Investigator:	Ulrich, Connie
Organization:	University Of Pennsylvania
Project Title:	Retention in Cancer Clinical Trials: Modeling Patients' Risk Benefit Assessments
Fiscal Year:	2019

Description: This application responds to PA-11-180: Research on Ethical Issues in Biomedical, Social and Behavioral Research with a focus on seriously ill cancer patients enrolled in cancer clinical trials (CCTs) and the ethics of science. Risk-benefit assessment is an essential component of informed consent and provides information central to patient-participants' research-related decisions in CCTs. Indeed, institutional review boards are charged with discerning whether the "risks are reasonable in relation to anticipated benefits, if any, to subjects." However, patient-participants' risk-benefit assessments may differ in significant ways, especially if they are confronted with a life-limiting illness such as cancer, have no other means to receive cancer care, or simply place their trust in the physician investigator and other study team members. A critical gap exists between the theoretical ideal of informed consent (i.e., all information processed and risks and benefits thoroughly evaluated) and how people, particularly those with serious illnesses, make research participation decisions. When patient-participants do not weigh the risks and benefits of trial participation, it may lead to compromised study outcomes, participant withdrawal, and sub-optimal patient and investigator experiences. Building on the work of a recently completed R21 study, this R01 application will innovatively examine how patient-participant, investigator, clinical characteristics and other external factors (pressure from others) influence risk-benefit assessment and subsequent retention in CCTs. To fully capture the experiences of patient-participants, we uniquely measure both the prevalence (assessed versus not assessed) and the extent/degree (extent of assessment and intensity of perceptions) of participants' risk-benefit assessment. Our specific aims intend to: 1) examine the relationship between patient-participant, clinical, and investigator characteristics and other external influences on patient-participants' risk-benefit assessment; 2) examine the relationship between risk-benefit assessment and retention in CCTs after adjusting for important prognostic factors a priori; and 3) define, name, and profile (through cluster analysis techniques) a typology of patient- participants based on their CCT risk-benefit assessment. Moreover, we will model/map via perceptual mapping (multidimensional scaling) how each patient type conceptualizes the risks and benefits involved in CCTs. We will also explore whether risk-benefit perceptions change during the course of CCT enrollment among the first time cohort of participants we enroll (baseline: 30-59 days since consent; second assessment: 90 days since CCT enrollment) in order to help assess potential differential informational or recall bias. These aims will be met through a mixed methods approach with 432 participants enrolled in CCTs. The complementary qualitative semi-structured interviews will lead to a deeper understanding of risk-benefit assessment as well as examine the factors that influence participant withdrawal. Thus, this project will fundamentally advance our theoretical, empirical, and clinical understanding of risk-benefit assessment in CCTs for those who are seriously ill.




Rhetoric of research: a call for renaming the clinical research partnership.
Authors: Foxwell A.M. , LaRochelle L.M. , Ulrich C.M. .
Source: Bmj Open, 2024-05-20 00:00:00.0; 14(5), p. e080137.
EPub date: 2024-05-20 00:00:00.0.
PMID: 38772594
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Informed Consent among Clinical Trial Participants with Different Cancer Diagnoses.
Authors: Ulrich C.M. , Ratcliffe S.J. , Hochheimer C.J. , Zhou Q. , Huang L. , Gordon T. , Knafl K. , Richmond T. , Schapira M.M. , Miller V. , et al. .
Source: Ajob Empirical Bioethics, 2023-11-03 00:00:00.0; , p. 1-13.
EPub date: 2023-11-03 00:00:00.0.
PMID: 37921867
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Caregiver Perspectives on the Benefits, Burdens, and Moral Distress of Participation in Cancer Clinical Trials.
Authors: Paidipati C.P. , Foxwell A.M. , Mooney-Doyle K. , Tiller D. , Pinto-Martin J. , Ulrich C.M. .
Source: Journal Of Family Nursing, 2023 Feb; 29(1), p. 89-98.
EPub date: 2022-05-25 00:00:00.0.
PMID: 35611586
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Association of Perceived Benefit or Burden of Research Participation With Participants' Withdrawal From Cancer Clinical Trials.
Authors: Ulrich C.M. , Ratcliffe S.J. , Zhou Q. , Huang L. , Hochheimer C. , Gordon T. , Knafl K. , Miller V. , Naylor M.D. , Schapira M.M. , et al. .
Source: Jama Network Open, 2022-11-01 00:00:00.0; 5(11), p. e2244412.
EPub date: 2022-11-01 00:00:00.0.
PMID: 36449287
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Experiences of Patients After Withdrawal From Cancer Clinical Trials.
Authors: Ulrich C.M. , Knafl K. , Foxwell A.M. , Zhou Q. , Paidipati C. , Tiller D. , Ratcliffe S.J. , Wallen G.R. , Richmond T.S. , Naylor M. , et al. .
Source: Jama Network Open, 2021-08-02 00:00:00.0; 4(8), p. e2120052.
EPub date: 2021-08-02 00:00:00.0.
PMID: 34374772
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Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation.
Authors: Starr L.T. , Ulrich C.M. , Perez G.A. , Aryal S. , Junker P. , O'Connor N.R. , Meghani S.H. .
Source: The American Journal Of Hospice & Palliative Care, 2021-07-28 00:00:00.0; , p. 10499091211034383.
EPub date: 2021-07-28 00:00:00.0.
PMID: 34318700
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Alternative Consent Models in Pragmatic Palliative Care Clinical Trials.
Authors: Carpenter J.G. , Ulrich C. , Hodgson N. , Hanson L.C. , Ersek M. .
Source: Journal Of Pain And Symptom Management, 2020-10-29 00:00:00.0; , .
EPub date: 2020-10-29 00:00:00.0.
PMID: 33129936
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Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients.
Authors: Starr L.T. , Ulrich C.M. , Junker P. , Appel S.M. , O'Connor N.R. , Meghani S.H. .
Source: Journal Of Pain And Symptom Management, 2020 Oct; 60(4), p. 801-810.
EPub date: 2020-05-23 00:00:00.0.
PMID: 32454185
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Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis.
Authors: Starr L.T. , Ulrich C.M. , Junker P. , Huang L. , O'Connor N.R. , Meghani S.H. .
Source: The American Journal Of Hospice & Palliative Care, 2020 Oct; 37(10), p. 767-778.
EPub date: 2020-06-30 00:00:00.0.
PMID: 32602349
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Goals-of-Care Consultations Are Associated with Lower Costs and Less Acute Care Use among Propensity-Matched Cohorts of African Americans and Whites with Serious Illness.
Authors: Starr L.T. , Ulrich C.M. , Appel S.M. , Junker P. , O'Connor N.R. , Meghani S.H. .
Source: Journal Of Palliative Medicine, 2020 09; 23(9), p. 1204-1213.
EPub date: 2020-04-27 00:00:00.0.
PMID: 32345109
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COVID-19: Advancing Empirical Bioethics Research.
Authors: Ulrich C.M. , Anderson E.E. , Walter J.K. .
Source: Ajob Empirical Bioethics, 2020 Jul-Sep; 11(3), p. 145-147.
EPub date: 2020-07-13 00:00:00.0.
PMID: 32657635
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Informed consent and ethical reporting of research in clinical trials involving participants with psychotic disorders.
Authors: Weissinger G.M. , Ulrich C.M. .
Source: Contemporary Clinical Trials, 2019 09; 84, p. 105795.
EPub date: 2019-06-24 00:00:00.0.
PMID: 31247285
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Cancer Clinical Trial Patient-Participants' Perceptions about Provider Communication and Dropout Intentions.
Authors: Zhou Q. , Ratcliffe S.J. , Grady C. , Wang T. , Mao J.J. , Ulrich C.M. .
Source: Ajob Empirical Bioethics, 2019 Jul-Sep; 10(3), p. 190-200.
EPub date: 2019-06-10 00:00:00.0.
PMID: 31180295
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Development and Preliminary Testing of the Perceived Benefit and Burden Scales for Cancer Clinical Trial Participation.
Authors: Ulrich C.M. , Zhou Q.P. , Ratcliffe S.J. , Knafl K. , Wallen G.R. , Richmond T.S. , Grady C. .
Source: Journal Of Empirical Research On Human Research Ethics : Jerhre, 2018 Jul; 13(3), p. 230-238.
EPub date: 2018-04-09 00:00:00.0.
PMID: 29631487
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The ethics of sensor technology use in clinical research.
Authors: Ulrich C.M. , Demiris G. , Kennedy R. , Rothwell E. .
Source: Nursing Outlook, 2020 Nov - Dec; 68(6), p. 720-726.
EPub date: 2020-07-02 00:00:00.0.
PMID: 32622646
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