EVALUATION OF PATIENTS’ WILLINGNESS TO PARTICIPATE IN MEDICAL RESEARCH IN UBTH AND CENTRAL HOSPITAL; A COMPARATIVE STUDY
ABSTRACT
INTRODUCTION
Research is very important in finding solution to contemporary problems. The importance of research cannot be overemphasized as very many discoveries have been made via research and through this same important tool, many more breakthrough will be made in all human endeavor, the health system inclusive as there are still many diseases that defy cure currently and are at best, managed. But the participation of patients in the above exercise is no less important. The aim of this study was evaluation of patients’ willingness to participate in research in both the University of Benin Teaching Hospital (UBTH) and Central Hospital, Benin City (CHB). It also to compare factors that encouraged and discouraged patients’ participation in medical research.
SAMPLING METHODOLOGY
The study design was a descriptive cross-sectional study where data was obtained via interviewer administered questionnaires. A total of 855 questionnaires were analysed using statistical package for scientific solutions (SPSS 20.0). Appropriate measures of statistical significance were utilized were p-value was set at p= 0.05.
RESULTS
A total of 855(65%) had heard about medical research.47.1% of respondents who have heard about medical research had participated.91.7% of the respondents were willing to consent to clinical research. Among the 65% of respondents who knew about medical research, 188 (33.9%) were influenced by trust in the researcher,158(28.4%) by aim and objective of research,125(22.5%),when given by doctor,159(24.6%),when there are no adverse effect and 146(26.3%) for other reasons. Also among the 65% of respondents who knew about research,273 (50.1%) were discouraged when it involved serious adverse effect,251(45.1%) when it is time consuming,127(22.9%) by mistrust of the researcher and 146(26.3%) by other reasons.
CONCLUSION
Majority of the respondents were willing to consent to research in both UBTH and Central Hospital, Benin City. The factors that influenced patient willingness to participate in medical research were the aims and objective of the research, less time requirement, absence of adverse effects, researchers trust, when it is given by doctor and transportation fare. The discouraging factors were mistrust of researchers, time consuming research, adverse effect, uninteresting research topic and absence of monetary reward.
TABLE OF CONTENTS
TITLE PAGE……………………………………………………………………………...i
DEDICATION………………………………………………………………………...........ii
DECLARATION……………………………………………………………………..........iii
CERTIFICATION….............................................................................................................iv
ACKNOWLEDGEMENT………………………………………………………….............v
TABLE OF CONTENTS…………………………………………………………………..vi
LIST OF TABLES………………………………………………………………………...ix
LIST OF FIGURES…………………………………………………………………...........x
ABSTRACT…………………………………………………………………………........xiii
CHAPTER ONE: INTRODUCTION………………………………………………………...1
1.1 BACKGROUND OF STUDY
1.2.PROBLEM STATEMENT
1.3 JUSTIFICATION
1.4. AIM AND OBJECTIVES
CHAPTER TWO: LITERATURE REVIEW………………………………………………7
2.1Medical research
2.1.1 Historical perspective.
2.1.2Patient Medical research
2.1.3Patients exposure in medical research.
2.2 Reasons why patient partakes in research.
2.2.1Trust.
2.2.2Serious illness.
2.2.3 Research ethics.
2.2.4Request
2.2.5Absence of side effects.
2.2.6 Aim of research
2. 3.0 Determinants of patients’ participation in research.
2. 3.1 Positive determinants of patients’ participation in research.
2.3.2 Level of education/ patient enlightenment.
2.4.0Negative determinants of patients’ participation in research.
2.4.2 Greater risk.
2.4.3 Side effects and fear of the unknown.
2.4.4 Time-consuming research program.
2.4.5 Race and patients’ participation in research.
2.4.6 Preference for a form/ type of treatment.
2.4.7 Hospital site.
2.4.8 Physician involvement.
2.4.9 Other determinants influencing patients’ participation in research.
2.5 Human involvement n cloning.
CHAPTER THREE: MATERIALS AND METHODS…………………………………...17
3.1 STUDY AREA
3.2STUDY DESIGN: A comparative descriptive cross-sectional study design was used for
3.3STUDY DURATION: The study was carried out within one year, between
3.4 STUDY POPULATION: This comprised of medical, surgical, and obstetrics and
3.5SELECTION CRITERIA:
3.51 INCLUSION CRITERIA: Both Medical, Surgical,Psychiatric and Obstetric and
3.52 EXCLUSSION CRITERIA: Those patients who were too ill to fill the questionnaires.
3.6 SAMPLE SIZE DETERMINATION: In calculation of the sample size, a prevalence rate
3.7 SAMPLING METHOD: A stratified sampling method was used and the categories of
3.8 DATAMANAGEMENT:
3.81 TOOL FOR DATA COLLECTION
3.82 MEHOD OF DATA ANALYSIS
3.83 DATA PRESENTATION
3.9 ETHICAL CONSIDERATION
CHAPTER FOUR: RESULTS……………………………………………………….........23
CHAPTER FIVE: DISCUSSION, CONCLUSION, RECOMMENDATIONS…………..43
REFERENCES……………………………………………………………………….........50
APPENDIX…………………………………………………………………………..........57
CHAPTER ONE
INTRODUCTIO
1.1 BACKGROUND OF STUDY
Research is discovery of new facts, enunciation of new principles, or fresh interpretation of the facts or principles. It is a systematic Investigation to develop or contribute to generalizable knowledge1. Research it is systemic and organized wayof finding better answers to questions. It is a step in searching for truth and the basic function of research is to answer why and how of a phenomenon. It also involve searching answers to what, when, how much, etc. All thesequestions have relevance to any discipline but Medicine seems tohave special appetite for such enquiries. The goal of medical researchis to improve health, and the purpose is to learn how systems in human body work, why we get sick, and how to get back to health and stay fit.It is a systematic process to better determine ethology, patho-physiology, diagnosis, therapy and prognosis. Research is the very foundation of improved medical care1.
The Nazi physicians conducted harmful research on unwilling human subjects during World War II and were unprecedented in their scope and the degree of harm and Suffering to which human beings were subjected “Medical experiments” were performed on thousands of concentration camp prisoners and included deadly studies andtortures such as injecting people with Gasoline and live viruses, immersing people in ice water, and forcing people to ingestpoisons2.
The rights of the subjects were violated by physicians. The actions were condemned as crimes against humanity. Permissible Medical Experiments were to be carried out and this becameknown as theNuremberg Codeand was the first international code of researchethics. The code stated the basic principles that must be observed in order to satisfy moral, ethical, and legal concepts in the conduct of human subject research2.
The approach of patient participation in medical decision- making has been discussed openly in Germany. However, the first publications in German3only discussed the approach conceptually. Clinical trials fortheevaluation of patient participation in medical Decision making were primarily initiated through the research program of theFederal Ministry of Health4.
In 1999, theConference of German Health Ministers adopted the document‘‘Patient rights in Germany today’’. It is explicitly laid down that patients have the right to clear, expert and satisfactory education and counselling in order to explain the usage and risks of diagnostics, and advantages and risks of the treatment or non-treatment options. Physicians must be sure that patients have understood the information. It is pre-assigned that patients must be informed about the type and Possibility of different risks and their relation to recovery chances3.
Randomized controlled clinical trials are the most rigorous way to determine treatment efficacy.Recruitment into clinical trials, however, is notoriously difficult in general5, and surgical trials in particular face further obstacles to recruitment 6. Low recruitment leads to poor statistical power to detect meaningful differences, subjecting participants to potentially risky interventions with no guarantee that their participation will lead to results of scientific value7. Investigators planning a Randomized controlled clinical trial mustensure that recruitment of subjects intothetrialwill be sufficient to achieve the study aims.
In addressing issues of trial recruitment, investigators have tried to Identify barriers to clinician andpatient participation8, to modify trialsto make them more palatable to clinicians and patients 9and to assess differences between those patients who agree to participate in trialsand those who refuse10.
Demographic factors, such as gender, race, age and education level, have been associated in some studies with willingness to participate5.
1.2.PROBLEM STATEMENT
Research withhuman subjects can occasionally result in a dilemma for investigators. When the goals of the research are designed to make major contributions to a field, such asimprovingthe understanding of a disease process or determining the efficacy of an intervention, investigators may perceive the outcomes of their studies to be more important than providing protections for individual participants in the research2.
Although it is understandable to focus on goals, our society values the rights and welfare of individuals. It is not considered ethical behaviour to use individuals solely as means to an end. The importance of demonstrating respect for research participants is reflected in the principles used to define ethical research and the regulations, policies, and guidance that describe the implementation of thoseprinciples2.us
It is becoming increasingly recognised that patients can make Valuable contributions to their health care safety11. However, while these interventions are well intentioned, a key issue is the lack of evidence on patients’ preferences to adhere to the advice and recommendations, namely how willing patients really are to take on such an active role12. Patients were more willing to ask factual (eg, ‘How long will I be in hospital for?’)as opposed to challenging questions(eghave you washed your hands?’) particularly when interacting with a doctor .The research also highlighted the potential facilitating role of doctors: patients reported they would be more willing to ask challenging questions if they were instructed to by a doctor.In addition, previous research solely examined the potential effect that doctors could have on increasing patients’ willingness to participate. However, given patient involvement in safety is largely a function of patients’ interactions with different health care professionals12.
1.3 JUSTIFICATION
Available studies have showed that patients value safety, convenience, oversight and open communication in research. However they were put off by some aspects that are valued by health care professionals. Educating the public about research may improve participation.
This study was conducted in order to evaluate factors that will improve Patients’ willingness to participate in research and to assess patients’ awareness of medical research. Also to educate and encourage patients that they are essential to the conduct of research intended to improve human health in UBTH. As such,the relationship between investigators and human subjects is critical and should be based on honesty, trust andrespect.
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