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Kraft SA, Cho MK, Constantine M, Lee SSJ, Kelley M, Korngiebel D, James C, Kuwana E, Meyer A, Porter K, Diekema D, Capron AM, Alicic R, Wilfond BS, Magnus D. A comparison of institutional review board professionals' and patients' views on consent for research on medical practices. Clin Trials 2016; 13:555-65. [PMID: 27257125 PMCID: PMC5025342 DOI: 10.1177/1740774516648907] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIMS In the context of research on medical practices, which includes comparative effectiveness research and pragmatic clinical trials, empirical studies have begun to raise questions about the extent to which institutional review boards' interpretations and applications of research regulations align with patients' values. To better understand the similarities and differences between these stakeholder groups, we compare and contrast two surveys: one of institutional review board professionals and one of patients, which examine views on consent for research on medical practices. METHODS We conducted online surveys of two target populations between July 2014 and March 2015. We surveyed 601 human subjects research professionals out of 1500 randomly selected from the Public Responsibility in Medicine and Research membership list (40.1% response rate), limiting analysis to 537 respondents who reported having had institutional review board experience. We also surveyed 120 adult patients out of 225 approached at subspecialty clinics in Spokane, Washington (53.3% response rate). Our survey questions probed attitudes about consent in the context of research on medical practices using medical record review and randomization. The patient survey included three embedded animated videos to explain these concepts. RESULTS A majority of institutional review board professionals distinguished between consent preferences for medical record review and randomization, ranked clinicians as the least preferred person to obtain participant consent (54.6%), and viewed written or verbal permission as the minimum acceptable consent approach for research on medical practices using randomization (87.3%). In contrast, most patients had similar consent preferences for research on medical practices using randomization and medical record review, most preferred to have consent conversations with their doctors rather than with researchers for studies using randomization (72.6%) and medical record review (67.0%), and only a few preferred to see research involving randomization (16.8%) or medical record review (13.8%) not take place if obtaining written or verbal permission would make the research too difficult to conduct. Limitations of our post hoc analysis include differences in framing, structure, and language between the two surveys and possible response bias. CONCLUSION Our findings highlight a need to identify appropriate ways to integrate patient preferences into prevailing regulatory interpretations as institutional review boards increasingly apply research regulations in the context of research on medical practices. Dialogue between institutional review boards and research participants will be an important part of this process and should inform future regulatory guidance.
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Affiliation(s)
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford, CA, USA
| | - Melissa Constantine
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | | | - Maureen Kelley
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Diane Korngiebel
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA
| | - Cyan James
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA
| | - Ellen Kuwana
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Adrienne Meyer
- Human Subjects Division, University of Washington, Seattle, WA, USA
| | - Kathryn Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Douglas Diekema
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - Alexander M Capron
- USC Gould School of Law, University of Southern California, Los Angeles, CA, USA
| | - Radica Alicic
- Providence Medical Research Center, Spokane, WA, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - David Magnus
- Stanford Center for Biomedical Ethics, Stanford, CA, USA
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Cho MK, Magnus D, Constantine M, Lee SSJ, Kelley M, Alessi S, Korngiebel D, James C, Kuwana E, Gallagher TH, Diekema D, Capron AM, Joffe S, Wilfond BS. Attitudes Toward Risk and Informed Consent for Research on Medical Practices: A Cross-sectional Survey. Ann Intern Med 2015; 162:690-6. [PMID: 25868119 PMCID: PMC4776759 DOI: 10.7326/m15-0166] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The U.S. Office for Human Research Protections has proposed that end points of randomized trials comparing the effectiveness of standard medical practices are risks of research that would require disclosure and written informed consent, but data are lacking on the views of potential participants. OBJECTIVE To assess attitudes of U.S. adults about risks and preferences for notification and consent for research on medical practices. DESIGN Cross-sectional survey conducted in August 2014. SETTING Web-based questionnaire. PATIENTS 1095 U.S. adults sampled from an online panel (n = 805) and an online convenience river sample (n = 290). MEASUREMENTS Attitudes toward risk, informed consent, and willingness to participate in 3 research scenarios involving medical record review and randomization of usual medical practices. RESULTS 97% of respondents agreed that health systems should evaluate standard treatments. Most wanted to be asked for permission to participate in each of 3 scenarios (range, 75.2% to 80.4%), even if it involved only medical record review, but most would accept nonwritten (oral) permission or general notification if obtaining written permission would make the research too difficult to conduct (range, 70.2% to 82.7%). Most perceived additional risk from each scenario (range, 64.0% to 81.6%). LIMITATION Use of hypothetical scenarios and a nonprobability sample that was not fully representative of the U.S. population. CONCLUSION Most respondents preferred to be asked for permission to participate in observational and randomized research evaluating usual medical practices, but they are willing to accept less elaborate approaches than written consent if research would otherwise be impracticable. These attitudes are not aligned with proposed regulatory guidance. PRIMARY FUNDING SOURCE National Center for Advancing Translational Sciences at the National Institutes of Health.
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Affiliation(s)
- Mildred K. Cho
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Magnus
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa Constantine
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandra Soo-Jin Lee
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen Kelley
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Alessi
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diane Korngiebel
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cyan James
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen Kuwana
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas H. Gallagher
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas Diekema
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander M. Capron
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Joffe
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin S. Wilfond
- From Stanford University, Stanford, California; University of Minnesota, Minneapolis, Minnesota; University of Oxford, Oxford, United Kingdom; University of Washington and Seattle Children's Research Institute, Seattle, Washington; University of Southern California, Los Angeles, California; and University of Pennsylvania, Philadelphia, Pennsylvania
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Curro FA, Thompson VP, Grill A, Vena D, Terracio L, Naftolin F. Practice based research networks impacting periodontal care: PEARL Initiative. J Periodontol 2013; 84:567-71. [PMID: 22702516 PMCID: PMC4264584 DOI: 10.1902/jop.2012.120116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2005, the National Institute of Dental and Craniofacial Research /National Institutes of Health funded the largest initiative to date to affect change in the delivery of oral care. This commentary provides the background for the first study related to periodontics in a Practice Based Research Network (PBRN). It was conducted in the Practitioners Engaged in Applied Research & Learning (PEARL) Network. The PEARL Network is headquartered at New York University College of Dentistry. The basic tenet of the PBRN initiative is to engage clinicians to participate in clinical studies, where they will be more likely to accept the results and to incorporate the findings into their practices. This process may reduce the translational gap that exists between new findings and the time it takes for them to be incorporated into clinical practice. The cornerstone of the PBRN studies is to conduct comparative effectiveness research studies to disseminate findings to the profession and improve care. This is particularly important because the majority of dentists practice independently. Having practitioners generate clinical data allows them to contribute in the process of knowledge development and incorporate the results in their practice to assist in closing the translational gap. With the advent of electronic health systems on the horizon, dentistry may be brought into the mainstream health care paradigm and the PBRN concept can serve as the skeletal framework for advancing the profession provided there is consensus on the terminology used.
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Affiliation(s)
- Frederick A. Curro
- Practitioners Engaged in Applied Research & Learning (PEARL) Network, Department of Oral Pathology, Medicine, and Radiology, College of Dentistry, New York University, New York, NY
| | | | - Ashley Grill
- Department of Dental Hygiene, New York City College of Technology, City University of New York, Brooklyn, NY
- PEARL Network, Department of Dental Hygiene, College of Dentistry, New York University
| | - Don Vena
- PEARL Network, EMMES Corporation, Rockville, MD
| | - Louis Terracio
- PEARL Network, Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University
| | - Frederick Naftolin
- PEARL Network, Department of Obstetrics and Gynecology, School of Medicine, New York University
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The use of patient-reported outcomes (PRO) within comparative effectiveness research: implications for clinical practice and health care policy. Med Care 2013; 50:1060-70. [PMID: 22922434 DOI: 10.1097/mlr.0b013e318268aaff] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of comparative effectiveness research (CER) is to explain the differential benefits and harms of alternate methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. To inform decision making, information from the patient's perspective that reflects outcomes that patients care about are needed and can be collected rigorously using appropriate patient-reported outcomes (PRO). It can be challenging to select the most appropriate PRO measure given the proliferation of such questionnaires over the past 20 years. OBJECTIVE In this paper, we discuss the value of PROs within CER, types of measures that are likely to be useful in the CER context, PRO instrument selection, and key challenges associated with using PROs in CER. METHODS We delineate important considerations for defining the CER context, selecting the appropriate measures, and for the analysis and interpretation of PRO data. Emerging changes that may facilitate CER using PROs as an outcome are also reviewed including implementation of electronic and personal health records, hospital and population-based registries, and the use of PROs in national monitoring initiatives. The potential benefits of linking the information derived from PRO endpoints in CER to decision making is also reviewed. CONCLUSIONS The recommendations presented for incorporating PROs in CER are intended to provide a guide to researchers, clinicians, and policy makers to ensure that information derived from PROs is applicable and interpretable for a given CER context. In turn, CER will provide information that is necessary for clinicians, patients, and families to make informed care decisions.
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