patient care perspectives
Clinical Trial Innovation and Accessibility to Patients
Our featured expert notes the importance of ensuring that the patient's voice is being heard throughout the development of clinical trial designs. Additionally, design innovations may reflect recent advancements in imaging accuracy and new modes of treatment.
Neal D. Shore, MD, FACS
Director, CPI, Carolina Urologic Research Center
“We are now seeing the democratization of information in medicine, and advocacy groups for all different cancer types have benefited. Now more than ever, I think that patients need to be involved from the very beginning, including in clinical trial protocol designs and in the ways in which consent forms are written.”
In the past, we had a more paternalistic view of health care, meaning that the physician would instruct the patient, give directives on a medication, state the need for a test, or rule that a clinical trial must be conducted in a certain way. This, stereotypically, was the historical convention.
Things have changed with social media and with our expansion of knowledge through the internet. We are now seeing the democratization of information in medicine, and advocacy groups for all different cancer types have benefited. Now more than ever, I think that patients need to be involved from the very beginning, including in clinical trial protocol designs and in the ways in which consent forms are written. Currently, the verbiage of consent forms often reflects oversight by legal and compliance professionals. Patients should have a voice in how this verbiage is presented because, oftentimes, a simple consent can be daunting for patients to read and understand.
What we, as researchers, scientists, and clinicians, focus on in the protocol design is not always the highest priority for patients. Patients need to be involved in the data safety monitoring committees, publication reviews, and ultimate communication of results. For example, plain language summaries are now being performed by government institutions to make sure that the content is accessible and that patients can understand it. Sometimes these summaries may be even more interpretable to clinicians than an academic article in a journal with a high impact factor.
I am not suggesting that we need to "dummy down" the intellectual gravitas and caliber of our science, but I do think that it is really important to get patients more involved and to give them more access to publications, proceedings, and congresses. Access to this information should not be restricted to the wealthy or to institutions because such barriers do a great disservice to patients who are suffering from the disease.
Innovation is also likely to continue in line with the evolving importance of imaging, advancements in imaging accuracy, and aspects of artificial intelligence. Of course, we continue to improve with staging through enhanced imaging, which enables us to reevaluate how we design trials and appropriately stage localized disease vs advanced disease or low-risk disease vs high-risk disease.
Accessibility to the aforementioned advancements and innovations needs to occur throughout the world and among different communities, otherwise some of our learnings will be encumbered. The combination of enhanced biomarker testing, whether that is genomic profiling, various molecular markers, tumor profiling, and circulating tumor DNA, with enhanced imaging will clearly impact protocol designs as we continue to work to ensure that the patient's voice is being heard throughout the development of trial designs and that findings are accessible to all.
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