Perspective: The clinical trial barriers: Nature Publishing Group (western medicine/Asian approaches)

"Western medicine depends on science to create and assess drugs at the molecular level. In Asia, there is a commonly held belief that there is an art to healing too, and that both art and science should cooperate to help eradicate illness and relieve suffering."

"For traditional Asian approaches to become integrated into modern medicine, we need to consider alternative inclusion and exclusion criteria for RCTs. We also need to review how outcomes are assessed. These concepts are neither new nor unproven. Both Western-style modern medicine and traditional Asian medicine aim to heal patients in a harmonized way and can be developed together into an integrated form of personalized medicine. Redesigning clinical trials will accelerate the blending of these two styles of healing, for the benefit of humankind."

Hereditary Cancer in Clinical Practice | Full text | Lynch syndrome: barriers to and facilitators of screening and disease management

Conclusions

Individuals with Lynch syndrome often encounter multiple barriers to and facilitators of disease management that go beyond the individual to the provider and health care system levels. The current organization and implementation of health care services are inadequate. A coordinated system of local services capable of providing integrated, efficient health care and follow-up, populated by providers with knowledge of hereditary cancer, is necessary to maintain optimal health.

Table 1. Participant characteristics

"Importantly, Lynch syndrome has significant implications for public health policy [4]. The ultimate plan should be to provide resources that enable individuals in high risk families to develop a strong sense of resilience and maintain a balanced screening schedule. In particular, this cohort requires timely and appropriate health care services, including:

○ A critical mass of genetic counselors to provide timely services to high risk families before, during and following genetic testing.

○ Service providers to coordinate and streamline diverse screening and treatment resources.

○ Health care providers, especially primary care physicians, informed about the risk of cancer within families and reinforcing the importance of maintaining recommended screening and initiating referrals to appropriate specialists.

○ Clinical monitoring tools designed to evaluate the impact of predictive testing and the ongoing psychosocial and behavioral adjustment to living in families with hereditary cancer. 

The current uncoordinated, physician dependent organization of screening for individuals with Lynch syndrome in Canada is inadequate. Given the incidence and prevalence of these hereditary cancers and the clinical benefits of screening, there is a critical need to provide integrated health care and timely follow-up in a manner that facilitates navigation of and access to the health system"

webinar - Wed Jan 11th - 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults

Date:	Wed, Jan 11, 2012
Time:	11:30 AM EST
Duration:	1 hour 30 minutes
Host(s):	Christine Haran

 2011 Commonwealth Fund International Health Policy Survey of Sicker Adults

Please register for this meeting.

Meeting Description:

This webinar will examine the findings of the latest International Health Policy Survey of Sicker Adults in Eleven Countries, conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S.    Published in November, the study compared the experiences of adults with complex care needs on financial barriers to care, access to care, care coordination, preventive care, and support for self-management.    International respondents from England, Switzerland, and the Netherlands will comment on survey findings.

Cancer-advocacy group slams barriers to treatment - The Globe and Mail

Note: includes media commentary regarding financial conflicts of interest, doctors' barriers in advocating for patients....

full free access: Women's Constructions of the 'Right Time' to Consider Decisions about Risk-Reducing Mastectomy and Risk-Reducing Oophorectomy (B.C.)

Methods (abstract): 

In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods. 

pdf file (free access):

A women-centred approach addresses issues beyond traditional
medical interventions, placing health in its broad social context, and also addresses barriers to access and respects women’s diversity [55]. Although risk-reducing surgery decisions are women’s decisions, women should not be saddled with the burden of tackling barriers to accessing health care services.
Health care professionals, health care organizations, and government must work hard to resolve these challenges.

 

A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part(R) Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group

Note: abstract/full free access/study outline/criteria:


Background

"Postoperative adhesions occur when fibrous strands of internal scar tissue bind anatomical structures to one another. The most common cause of intra-abdominal adhesions is previous intra-abdominal surgical intervention. Up to 74% of intestinal obstructions are caused by post surgical adhesions. Although a variety of methods and agents have been investigated to prevent post surgical adhesions, the problem of peritoneal adhesions remains largely unsolved. Materials serving as an adhesion barrier are much needed."

Barriers to participation in cancer prevention clinical trials; Acta Oncologica - 0(0):Pages 1-10 - Informa Healthcare

Abstract

Background. Cancer prevention clinical trials seek to enroll individuals at increased risk for cancer. Little is known about attitudes among physicians and at-risk individuals towards cancer prevention clinical trials. We sought to characterize barriers to prevention trial participation among medical oncologists and first-degree relatives of their patients.
Methods. Physician participants were practicing oncologists in Pennsylvania. Eligible first-degree participants were adult relatives of a cancer patient being treated by one of the study physicians. The influence of perceived psychosocial and practical barriers on level of willingness to participate in cancer prevention clinical trials was investigated.  
Results. Response rate was low among physicians, 137/478 (29%), and modest among eligible first-degree relatives, 82/129 (64%). Lack of access to an eligible population for prevention clinical trials was the most commonly cited barrier to prevention clinical trials among oncologists. Nearly half (45%) of first-degree relatives had not heard of cancer prevention clinical trials, but 68% expressed interest in learning more, and 55% expressed willingness to participate. In the proportional odds model, greater information source seeking/responsiveness (i.e., interest in learning more about clinical prevention trials from more information sources) (p = 0.04), and having fewer psychosocial barriers (p = 0.02) were associated with a greater willingness to participate.  
Conclusions. Many individuals who may be at greater risk for developing cancer because of having a first-degree relative with cancer are unaware of the availability of clinical cancer prevention trials. Nonetheless, many perceive low personal risk associated with these studies, and are interested in learning more.

full free access: Identifying the barriers to conducting outcomes research in integrative health care clinic settings

Conclusions
"..... as IHC clinics are often complex systems, a whole systems approach to research should be used taking into account the multidimensional and complex nature of such treatment systems so that the results are useful and reflect real life."