Patients' perspectives on participation in clinical trials and subsequent ethical challenges in a hospital setting in Jordan.

Background The number of global clinical trials is increasing. Recruitment rate in clinical trials is a challenging task that affects sample size, power of the study, and adequate representation of the targeted population. An understanding of the worries and reasons why patients may refrain from participation in trials may lead to improved enrollment rates. Objectives To assess the rate of patients who are willing to participate in clinical trials, and aspects that might have an impact on the patients' willingness to participate. Setting Government tertiary hospital in Jordan. Methods This is a cross-sectional study. Patients were interviewed by pharmacists in different clinics in a tertiary hospital and information was collected using a data collection sheet. Main outcome measure Factors that might predict the inclination of a patient to participate in clinical trials, and the rate of willingness to participation in randomized controlled trials in cancer patients compared to non-cancer patients. Results A total of 1193 participants were enrolled in the study, one hundred and thirty-five participants (11.3%) had cancer and 80% of the participants had at least one chronic medical condition. Majority of patients (n = 882, 73.9%) believed that trials were safe and 1106 (92.7%) patients thought they were important. Age, education level, income, having cancer or any chronic medical condition, and degree of control of chronic diseases were statistically significant predictors of the willingness of patients to participate in trials. Patients with cancer had a higher rate of acceptance to participation in randomized controlled trials compared to non-cancer patients, 80.0% versus 62.4%, p value < 0.001. Conclusion In general, almost two-thirds of patients were willing to participate in clinical trials, with a higher rate in cancer patients. Factors such as education level, income, and extent of control of medical conditions that might refrain patients from enrollment in trials will lower recruitment rate and must be addressed and taken into consideration before launching clinical trials.

Evaluation of venous thromboembolism prophylaxis in a major hospital in a developing country.

Background Venous thromboembolism is the most common preventable cause of hospital death. Despite that, there is still a large gap between what we know about venous thromboembolism prophylaxis and what is happening in current practice. Objective To evaluate VTE prophylaxis in Al-Basheer hospital and assess the extent of agreement of physicians' practice with the guidelines. Setting Al-Basheer governmental hospital in Jordan between January 2016 and June 2016. Method In this cross-sectional observational study, patients were randomly selected from medical and surgical wards. The need for venous thromboembolism prophylaxis was assessed according to the American College of Chest Physicians guideline (9th edition) for men and non-pregnant women, and the Royal College of Obstetricians and Gynecologists guidelines for pregnant women. MAIN OUTCOME MEASURE: rate of agreement of venous thromboembolism prophylaxis with the guidelines. Results The total number of patients was 1030, Patients in the medical wards constituted most of the participants. The rate of concordance with the guidelines was 718/1030 (69.7%) in the total number of patients When the patients were divided into groups: those that required venous thromboembolism prophylaxis and those that did not, the rate of agreement with guidelines in the subgroup that needed prophylaxis 160/456 (35.1%) was lower than the rate in the subgroup that did not need prophylaxis 558/574 (97.2%), p value <0.001. Conclusion venous thromboembolism prophylaxis in Al-Basheer hospital is not appropriate and underused, this might be attributed to the absence of an institutional guideline.