Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trials
<p><strong>Background:</strong> Equipoise and role conflict have been previously identified as important factors in professionals’ engagement with trials, inducing behaviours which can impact on recruitment. We explored these phenomena as potential explanations for the low levels o...
| Main Authors: | , , , , |
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| Format: | Journal article |
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BioMed Central
2020
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| _version_ | 1797078558383800320 |
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| author | Hart, R Hallowell, N Harden, J Jesudason, A Lawton, J |
| author_facet | Hart, R Hallowell, N Harden, J Jesudason, A Lawton, J |
| author_sort | Hart, R |
| collection | OXFORD |
| description | <p><strong>Background:</strong> Equipoise and role conflict have been previously identified as important factors in professionals’ engagement with trials, inducing behaviours which can impact on recruitment. We explored these phenomena as potential explanations for the low levels of involvement of teenagers and young adults (TYA) with cancer in clinical trials in oncology.</p> <p><strong>Methods:</strong> We report findings from interviews with 30 purposively sampled direct care professionals, involved in delivering cancer care and/or facilitating clinical trials in Scotland. We undertook qualitative descriptive analysis, focussed on identifying key issues and themes.</p> <p><strong>Results:</strong> Interviewees largely identified as clinician-researchers and portrayed oncology as a specialty in which research was integral to care. They saw their primary responsibility as ensuring patients received the best treatment, but asserted that, in general, trials provided a vehicle for optimal care. Role conflict in its traditional form was little in evidence; however, other tensions were manifest. Professionals found the significant time costs of delivering trials difficult to reconcile with the increasing pressures on clinical services. They felt a responsibility to make prudent choices about which trials to engage with. Guided by utilitarian principles, these choices were oriented towards benefiting the largest number of patients. This favoured trials in high volume diseases; as TYA tend to have rarer forms of cancer, professionals’ support for – and TYA’s access to – relevant trials was by default more limited. </p> <p><strong>Conclusions:</strong> Neither lack of individual equipoise nor experiences of traditional forms of role conflict accounted for low levels of involvement of TYA with cancer in clinical trials. However, prominent tensions around the management of scarce resources provided an alternative explanation for TYA’s limited access to cancer trials. The prevailing approach to decision-making about whether and which trials to support was recognised as contributing to inequalities in access and care. Professionals’ choices, however, were made in the context of scarcity, and structured by incentives and sanctions understood by them as signalling governmental priorities. A franker discussion of the extent and distribution of the costs and benefits of trials work is needed, for change to be achieved.</p> |
| first_indexed | 2024-03-07T00:33:37Z |
| format | Journal article |
| id | oxford-uuid:80a91a68-5543-4eb4-9d16-a99d0d686a87 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T00:33:37Z |
| publishDate | 2020 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:80a91a68-5543-4eb4-9d16-a99d0d686a872022-03-26T21:24:49ZClinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trialsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:80a91a68-5543-4eb4-9d16-a99d0d686a87Symplectic Elements at OxfordBioMed Central2020Hart, RHallowell, NHarden, JJesudason, ALawton, J<p><strong>Background:</strong> Equipoise and role conflict have been previously identified as important factors in professionals’ engagement with trials, inducing behaviours which can impact on recruitment. We explored these phenomena as potential explanations for the low levels of involvement of teenagers and young adults (TYA) with cancer in clinical trials in oncology.</p> <p><strong>Methods:</strong> We report findings from interviews with 30 purposively sampled direct care professionals, involved in delivering cancer care and/or facilitating clinical trials in Scotland. We undertook qualitative descriptive analysis, focussed on identifying key issues and themes.</p> <p><strong>Results:</strong> Interviewees largely identified as clinician-researchers and portrayed oncology as a specialty in which research was integral to care. They saw their primary responsibility as ensuring patients received the best treatment, but asserted that, in general, trials provided a vehicle for optimal care. Role conflict in its traditional form was little in evidence; however, other tensions were manifest. Professionals found the significant time costs of delivering trials difficult to reconcile with the increasing pressures on clinical services. They felt a responsibility to make prudent choices about which trials to engage with. Guided by utilitarian principles, these choices were oriented towards benefiting the largest number of patients. This favoured trials in high volume diseases; as TYA tend to have rarer forms of cancer, professionals’ support for – and TYA’s access to – relevant trials was by default more limited. </p> <p><strong>Conclusions:</strong> Neither lack of individual equipoise nor experiences of traditional forms of role conflict accounted for low levels of involvement of TYA with cancer in clinical trials. However, prominent tensions around the management of scarce resources provided an alternative explanation for TYA’s limited access to cancer trials. The prevailing approach to decision-making about whether and which trials to support was recognised as contributing to inequalities in access and care. Professionals’ choices, however, were made in the context of scarcity, and structured by incentives and sanctions understood by them as signalling governmental priorities. A franker discussion of the extent and distribution of the costs and benefits of trials work is needed, for change to be achieved.</p> |
| spellingShingle | Hart, R Hallowell, N Harden, J Jesudason, A Lawton, J Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trials |
| title | Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trials |
| title_full | Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trials |
| title_fullStr | Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trials |
| title_full_unstemmed | Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trials |
| title_short | Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to teenagers and young adults involvement in cancer trials |
| title_sort | clinician researchers and custodians of scarce resources a qualitative study of health professionals views on barriers to teenagers and young adults involvement in cancer trials |
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