PATIENT INVOLVEMENT IN CLINICAL RESEARCH
Derek Stewart, OBE Associate Director for Involvement at National Institute for Health Research – Clinical Research Network, England
Public Involvement in clinical research
Improving Research – Involving patients, carers and the public
“Whilst you have your voices, use them and use them to effect.”
I’m not a researcher, a doctor, etc but that shouldn’t stop us getting involved in research. We don’t need to know what they do but we need to sometimes tell them what we see. It is our job to bring the professionals back to earth. Never think you need knowledge, a university degree, particular skills… all of us can get involved in research.
From patient … to advocate, activist, ambassador and associate
- Participation – taking part in a trial
- Engagement – I get a newsletter, find out what’s going on, I’m asked to go to meetings.
- In the middle – Patient Involvement. Where we actually hold hands with each other working together as clinicians, researchers and patients.
Why is it important for SPAEN?
Your Patient and Carer EXPERIENCE is of VALUE
Gold dust to researcher… they can work on it forever more. YOU have knowledge.
Did you know about cancer before you got it?
Your knowledge is fantastic.
You still have questions that are unanswered. How do I get those answers? That’s research.
Our bodies. When they ask us to get involved. It’s our bodies. We should have a say in that. It is our DNA what happens in it, what happens in genetics we should be able to speak about.
It’s our money £££$$$$. The charities are not the funders of research… it’s our money given to them directly or via taxes. Never forget it.
How can we make a difference?
Inform -> Form -> Influence
Inform – your experience can help. Tell them what happened but remember that sometimes researchers live in a little bubble and think that their idea is the best ever. They need the experience to understand… that’s us. We can work with them to learn and influence to improve the system and the policies.
Consultation -> Partnership -> Patient centred culture (bring fresh air to open the doors and windows)
Clinical Research Network in England. Supports the infrastructure in England Funding an integrated Clinical Research Network.
Supports Involvement of Patients, Carers and Public involvement
£3m put into it. 1,200 patients.
It is 70 days from accepting the trial to the first patient involvement.
A Movement for Change
Fight for Sarcoma, GIST and Desmoid. Bang that drum at all times.
- But on the bigger picture. We’re all aiming to create better research. Based on our experience ad patient outcomes as a result.
- We are all wanting to see simpler and more effective systems that get research on to the books.
- We should all be making sure there is clearer access to research studies. (Hospitals claiming they’re a world leader in research but reception didn’t know… no leaflets etc… On the website ‘get involved in research’ it says how to donate body to research.
- Improved recruitment. If we’ve not helped with the leaflets, what time, etc Think about what’s needed to improve the recruitment process.
- Open access for results. We need ALL trial results to be published. They cannot hide the results.
- Speedier application. Good research needs to be applied not sit on a shelf somewhere. The clinician (ALL) should be up to date and giving us the best and up to date information available based on the research. Always ask your consultant – ‘What’s the research on this?’ Is this the latest research?’
- Better patient outcomes. Sometimes research is done for clever researchers but we need to ask what is the outcome and what is the difference that this is going to make.
- Satisfactory experience. Do we ask people what their experience was like when they participated in trials?
Are we making a difference?
- Getting Involved
- Understand the context. No point in going into a meeting with a researcher – are they looking at recruitment, funding or what?
- Be clear about the goal and the purpose. Don’t expect an answer… Goal and Objective Settings. If you ask researchers you often get the answer – I’ve just been told to involve patients. Discuss.
- What happened? What was the impact? If we don’t’ have a goal we won’t know if we’ve achieved it.
- What was the benefit? (Benefit may be negative – feed it back to them..)
Context – purpose – impact and benefit.
When we first got involved the British Medical Journal wrote an article about patients getting involved in research about patients being aliens at the table.
View from the Top
Dame Sally Davies – “No matter how complicated the research, or how brilliant the researcher, patients and the public always offer unique, invaluable insights. Their advice when designing, implementing and evaluating research invariably makes studies more effective, more credible and often more cost efficient as well.”
Signpost people to consent form, finding out information, exploring impact. Learn the language of trials. Do not give up…
When patients are present, we make a difference.
Q – we are trying to involve Europe wide in clinical trials. One more problem is that European Clinical Trials Register is not suitable for giving information to patients as it’s not accurate or complete.
A – It’s why we need to be at the table and keep doing this. Danger in Europe from some drug companies fighting against open access. We mustn’t do solely fight for one cancer against another disease… we keep on.
Q – Inspiring presentation. Positive energy thank you. How do I respond to my Dr that once I have mentioned that I am participating in a patient group, they close all the doors and windows?
A – Only tip I can give you is try to find another Dr in the area, another clinician, another group…. Because when your Dr hears you are talking to them, they often think ‘I should be doing that too’. Often Derek asks ‘what are the problems you’re facing and how can I help?’. Ask them about why they get involved, what their passions are etc… build a rapport.
Q – We have the opportunity to create a patient group in bone sarcomas. Do you have the experience and wish to be involved?
Q – What would you say are the three main points to get involved?
– Knock on the door.. if you can’t get through the door, go through the window.
– Never feel that you haven’t got a right to be there.
– Keep a simple diary, a few notes about what it felt like not knowing. We need to remember what it’s like for someone starting out. “I walked ½ way round the lake but was too tired, so walked all the way back”. As you know as you learn you improve… remember what it’s like at the start.
Markus Wartenberg, SPAEN, Germany
Practical experiences and examples from patient organisations
Patients Involvement in Cancer Clinical Research.
When we look to our experience as patient groups.
- Majority of patients. No or less knowledge about trials or experience. Perhaps about experiments not trials.
- Very often we see we have no transparency about access. Where do we find Clinical trials in rare cancers?
- Access and specifically in rare cancers. Access beyond borders in EU.
- Access in the direction of losing patients who are not being referred to trials because doctors are losing the patients.
- Practical issues – schedule? Distances? Costs for the patients.
- Informed consent. Very often a medical legal wording that is too much to understand for patients.
- Some patients are not aware they are on a clinical trial!
- Is the right trial centre the real experts?
- Sensitive topics like placebo trials in cancer.
Cancer patients 6-12% of cancer patients are participating in clinical trials.
- Public image vs guinea pigs
- Barriers to clinical trial accrual/recruitment
This leads to delay in knowledge/innovations, slower progress etc.
Trials and Endpoints?
- Patients don’t care about ‘endpoints’
- Their personal status/pathway/options -> important whether they ‘hope for/expect a
- Stabilisation of the disease
- Slow progressing disease
- Expert care in rare caners (centres of excellence)
- Multi-model approach
- Drugs – resection – radiation – clinical trials
Often it’s a ‘game’ against time…
Trials and Treatments?
- Critical – how close are trials/trial results to daily practice?
- What drugs can deliver and what we need?
- How to measure an innovation/a breakthrough?
- What is value for money?
- Target therapies – how to define progression?
- Do we need more ‘me to drugs”?
- Targeted therapies – Belittlement of the side effects
- Quality of life is a very individual topic
- Individual and ethical
- Very critical – if treatments are/would be available but are not reimbursed.
Big issue at the moment is we need future options. We need better treatments for the future. But at the moment we also see that we are not able to get the best out the therapy. We need innovations but also need to be involved with the industry and experts to get the best out of the treatments at the moment.
Each patient is unique. There is no THE patient. The obvious differences, gender, age, ethnicity etc but so much more!
Patients who are going into clinical trials. They have an emotional overload as they enter the trials. Fear, shock, hope life death, new territory, confused, depression, anger, need support, options expectations.
Patients have physical aspects: Family commitments, work commitments, side effects, job career, fatigue etc.
Cognitive Aspects; regarding cancer but also for the trials. A new area to learn about.
What’s the role of patient organisations in clinical trials:
- Information, knowledge, education, inclusion criteria.
- Inform about background of clinical trials.
- We can communicate as a patient organisation about available and upcoming trials. Work closely with the medical experts to find out, seek information and work ‘with’.
- Making trial issues more understandable. Our job to interpret.
- Supporting recruitment in specifically rare cancer sub-types.
- Informed consent
- Aspects of quality of life
- Dissemination of the results… positive and negative results.
- Involvement at the design stage. Work together on the issues for the future.
Dialogue with the Customers!
Patients are the customer… previously it was always the doctor… needs are changing
Partnership: Translate From/To The Patient/Customer
Physicians/Researchers <–> Patient Group <–> Researching Industry
Other players in the room – research organisations, regulators, HTA, payers etc.
Patients/Patient advocacy groups have a lot to offer
- A common patient voice
- Patient advocacy groups can argue in a way – experts/pharma can’t
- Motivation to be involved
- Needs overall
- Expert patients
Clinical Trials’ offer some collaborate fields
Information access, design/quality and recruitment.
- The general challenge is not specific enough for rarer cancers
- Current trials system vs practice
- Pharma/ experts often have no experience why and how.
- EU trials directive – legal, confidentiality, regulatory aspects etc.
- Involvement as early as possible. Not as troubleshooters but from the beginning.
- Public media opinion. Collaboration is vital.
- Patient organisations. How to identify patient organisations who are interested, prepared or willing to be involved in trials. Perhaps knowledge.
- Patient organisations as a professional behaviours. Set rules with industry and behave!
- We need to go back from talking more to action. Are there pilot projects to learn from.
- How can we get the best out of our current therapies? Looking at them in practice and work out what to get out of them and improve.
- New mindset: Patient centric research = Collaboration. Not lip service!
- Awareness. Bring the topic to policy, healthcare, regulations and the public. Sometimes we need to seek it out other times people will come to us.
- Working in initiative s for rarer cancers.
- Working through a better approach for the informed consent EORTC.
- Intense discussions with our industry colleagues. Getting feedback following completion of a clinical trial… this surely would improve the next one!
- Training of patient organisations. Understanding cancer clinical research.
- Medical advisory boards – we need to be involved in a collaborative way in each of these boards for the whole process and have the opportunity to talk to the regulators
- Look at pilot projects.
BASICS OF STRATEGIC PLANNING FOR PATIENT GROUPS
Markus Wartenberg, SPAEN, German and Lindsey Bennister, Sarcoma UK
Lecture: The basics of strategic planning and practical experiences from a patient group
Strategic planning is an important part of business skills for patient groups. Idea of session is introduction to the topic…
Questions to consider:
- Is your group thinking/planning strategically
- Are you creating strategies from a share vision
- DO you learn from the past and gather information from and about the external environment
- Do you have immediate measurable goals in place
- Are individuals or the boards (teams) accountable to plan
- Is the organisation creative and flexible
- Does it recognise, reward and institutionalise positive change.
What about shared vision?
Often people have a difference expectation and view of what is needed or required. You need to find a common shared vision.
A lot of areas in modern life are using ‘strategies’
- marketing strategy
- survival strategy
What about patient organisations and non-profit organisations… makes sense to use strategies.
What is a strategy?
- A method of plan chosen to bring about a desired future, such as achievement of a goal or solution to a problem.
- The art and science of planning and marshalling resources for their most efficient and effective use. The team is derived from the Greek word of generalship or leading an army.
Your team! Your goal! Your proceeding? What Questions? How do you do it?
- Setting part goal posts, markers to get there.
- What materials do I need? What resources, tools, people?
- Sharing responsibilities amongst the team members
- Assuming responsibility as a team member.
- What experience does the team have?
- What conditions, environment etc influence your planning?
We have to think about the process and plan. Discuss and build up a strategy and planning process to get there.
What is Strategic Planning?
A systematic process of envisioning a desired future, and translating this vision into roadly defined goals or objectives and a sequence of steps to achieve them.
A systematic approach through which an organisation agrees on the priorities that are essential to its mission and responsive to its environment.
What is strategic planning NOT…
- A prediction for the future
- A smooth, predictable, linear process
- A substitute for judgement of leadership.
Hope is NOT a strategy.
Benefits of Strategic Planning.
- Defines mission, vision and values
- Establishes realistic coals, objectives and strategies
- Ensures effective use of resources
- Provides base to measure progress – need to assess value and feedback
- Develops consensus on future direction
- Builds stronger teams. A lot of people coming together motivated to do things but are they doing things in the right direction and utilising their skills and strengths.
- Solves major problems.
Some thoughts for the process
- Strategic planning involves choosing the highest priority achievements over the period of 3-5 years.
- What is the strategy to achieve goals.
- Strategic planning builds commitment to the vision.
- Important for all levels of the organisation to be involved.
- A strategic planning committee
- Outside consultant/facilitator to facilitate conversations, capture external interviews, move the process along or to maybe draft the final plan.
- In the end, Plan must be owned by the board/staff in order to move it successfully and strategically into the future….
- To assess the current situation and review the relevance of the mission and programs
- Developing a ‘plan for the plan’ ie this means that if this is a big organisation how will you develop and implement the plan.
- What is the outcome of the strategic process?
- What is the time frame?
- Strategic planning committees composition. Full board members, staff involvement and perhaps an external facilitator?
- Thinking, collective experience, external and internal research.
- Summarise the organisational history
- What has been accomplished and what has NOT been accomplished between the plans.
- Collecting data and information to make decision.
The big 5 for strategic planning:
- Why does the organisation exist?
- What is the reason for being?
- How will your community be changed and made better by what you have done?
- What is your organisations vision of excellence
- What core principles should guide your organisation in the present and into the future?
- SMART goals. These are outcome statements
- How are you going to meet the goals?
Remember if strategies get too detailed, you are moving away fro m strategic planning and into annual operational planning.
- Swot – Analysis
What are strengths and weaknesses of organisation. Opportunities, threats etc facing us. This will help with key priorities and process.
Strengths and weaknesses
- How is your organisation positioned?
- What are the internal challenges?
- What are the areas where the organisation shines?
- Organisation reputation and history
- Weaknesses such as capacity, funding, infrastructure etc
Resources or strengths that help us to accomplish our mission or mandate or create value for our members (and their patients).
Internal weaknesses are deficiencies in resources or capabilities that hinder us to accomplish our mission or mandate or create value for our members (and their patients).
Opportunities and threats
These are the external factors to the organisation.
Are there new programme areas where you should be new, new funding, community collaborations, regulations, government, economy dependencies etc.
External opportunities are primarily outside factors or situations that we can take advance of to better fulfil our mission or mandate or create.
External threats or challenges
SWOT and other tools
Identify the current environment and will inform your plan. You need to understand what is going on with your environment otherwise you will l have problems about reaching the goal and implementing the strategy.
Screen external relations. Who are the people the organisation are working with? Medical experts, Industry, payers, regulators etc.
What are the main stakeholders the organisation is dealing with. What are their roles, influences, interests, expectations? Are they target groups/audiences for future actions?
But also collection of available data? Do you know everything, have information on target groups, how do they behave etc. About environment and perhaps legal influencers in anyway. Do you know what the needs and expectation of your patients and carers really are?
To complete ‘your picture’ you can also initiate surveys, interviews focus groups etc.
All required to build your strategy for the future.
Lindsey Bennister, Sarcoma UK
Transforming the landscape for sarcoma
Sarcoma UK’s Goals and Strategy 2014-2020
“If you don’t know what you’re going to do, you can’t know that you’ve made an impact”
Lindsay summarised further the importance of planning and strategising that Markus had referred to in his presentation.