title: Firefighter willingness to participate in a stem cell clinical trial for burns: A mixed methods study.
abstract: Adult stem cells represent a potentially renewable and autologous source of cells to regenerate skin and improve wound healing. Firefighters are at risk of sustaining a burn and potentially benefiting from a split thickness skin graft (STSG). This mixed methods study examined firefighter willingness to participate in a future stem cell clinical trial, outcome priorities and factors associated with this decision.
  
  
  METHODS
  A sequential explanatory mixed methods design was used. The quantitative phase (online questionnaire) was followed by the qualitative phase (semi-structured interviews). A sample of 149 firefighters completed the online survey, and a purposeful sample of 15 firefighters was interviewed.
  
  
  RESULTS
  A majority (74%) reported they would participate in a future stem cell clinical trial if they experienced burn benefiting from STSG. Hypothetical concerns related to receiving a STSG were pain, itch, scarring/redness and skin durability. Participants indicated willingness to undergo stem cell therapy if the risk of no improvement was 43% or less. Risk tolerance was predicted by perceived social support and having children. Interviews revealed four main themes: a desire to help others, improving clinical outcomes, trusting relationships, and a belief in scientific investigation. Many participants admitted lacking sufficient knowledge to make an informed decision regarding stem cell therapies.
  
  
  CONCLUSIONS
  Firefighters indicated they were largely willing to participate in a stem cell clinical trial but also indicated a lack of knowledge upon which to make a decision. Public education of the role of stem cells in STSG will be increasingly important as clinical trials are developed.
authors.affiliation: Department of Allied Health, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada. Electronic address: jhorch@ucalgary.ca.
authors.forename: Jenny D
authors.initials: JD
authors.lastname: Horch
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eloise C J
authors.initials: EC
authors.lastname: Carr
authors.affiliation: Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Harasym
authors.affiliation: Calgary Firefighters Burn Treatment Centre, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Burnett
authors.affiliation: Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, Department of Surgery, Faculty of Medicine, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Biernaskie
authors.affiliation: Division of Physical Medicine and Rehabilitation, Departments of Clinical Neurosciences, Pediatrics and Surgery, Faculty of Medicine, Alberta Children's Hospital Research Institute, McCaig Institute for Bone and Joint Research, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gabriel
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002056:Burns / Q000628:therapy*; D002986:Clinical Trials as Topic; D005191:Family Characteristics; D005260:Female; D061388:Firefighters / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D035842:Research Subjects / Q000523:psychology*; D012309:Risk-Taking; D016038:Skin Transplantation; D012919:Social Behavior; D012944:Social Support; D033581:Stem Cell Transplantation; D011795:Surveys and Questionnaires; D035502:Trust; D055815:Young Adult
keywords: Burn; Firefighter; Mixed methods; Risk; Split thickness skin graft; Stem cell