1st Supervisor: Professor Maxine Robertson
2nd Supervisor: Dr Manuela Perrotta
The role of (dis)trusting in clinical trials: A practice-based approach.
The research shall examine theoretical concept of trust in clinical trials, taking a practice-based approach. A majority of the literature which looks at trust in healthcare has focused on the patient-provider relationship (Calnan and Rowe, 2004) as it has been argued to be essential in the running of an effective health service (Rhodes and Strain, 2000). It is said to be critical because people have to trust the healthcare system (and those who work in it) with their personal information, when performing tests, and that the procedures and drugs given to them are of benefit (Calnan and Rowe, 2006, Meyer et al, 2008).
Looking specifically at clinical trials, trust is often cited as a ‘factor’ which is crucial for patient participation (Daugherty, et al, 1995, Newington and Metcalfe, 2014, Zvonareva et al, 2015. Moorecraft, et al, 2016). In addition, reviews of the barriers to participation in trials have found distrust of hospitals and clinicians as a reason for patients not taking part in trials (Harth and Thong, 1990, Ross et al, 1999, Taber et al, 2014). Trust in trials themselves, and those who undertake them have an impact on patient recruitment, and therefore it is important to understand the practices that support the development of trust or may lead to their demise. However, many previous studies have generally conceptualised trust as a variable, something which if present, will increase likelihood of participation (and vice versa). They have lacked detail or analysis of the practices involved in building (or destroying) trust within clinical trials. The processes that lead to the development of trusting relationships, how it is formed, broken and reproduced are not yet understood in the context of clinical trials. A better appreciation of the development of trust may lead to a greater understanding of how to run successful clinical trials, so that outcomes might produce a tangible health benefit to patient populations. The focus in this study will be on trust development, reproduction, and repair in a selection of live clinical trials concerned with cardiovascular disease in London. It is hoped that the findings may inform more generalizable strategies in other geographic/ health contexts. In order to do this, this study will carry out ethnographic observation and semi-structured interviews at a clinical trial centre which focuses on the treatment of cardiovascular disease in London.