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Avinger AM, Sibold HC, Campbell G, Abernethy E, Bourgeois J, McClary T, Blee S, Dixon M, Harvey RD, Pentz RD. Improving oncology first-in-human and Window of opportunity informed consent forms through participant feedback. BMC Med Ethics 2023; 24:12. [PMID: 36803249 PMCID: PMC9938963 DOI: 10.1186/s12910-023-00890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/31/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Although patient advocates have developed templates for standard consent forms, evaluating patient preferences for first in human (FIH) and window of opportunity (Window) trial consent forms is critical due to their unique risks. FIH trials are the initial use of a novel compound in study participants. In contrast, Window trials give an investigational agent over a fixed duration to treatment naïve patients in the time between diagnosis and standard of care (SOC) surgery. Our goal was to determine the patient-preferred presentation of important information in consent forms for these trials. METHODS The study consisted of two phases: (1) analyses of oncology FIH and Window consents; (2) interviews of trial participants. FIH consent forms were analyzed for the location(s) of information stating that the study drug has not been tested in humans (FIH information); Window consents were analyzed for the location(s) of information stating the trial may delay SOC surgery (delay information). Participants were asked about their preferred placement of the information in their own trial's consent form. The location of information in the consent forms was compared to the participants' suggestions for placement. RESULTS 34 [17 FIH; 17 Window] of 42(81%) cancer patients approached participated. 25 consents [20 FIH; 5 Window] were analyzed. 19/20 FIH consent forms included FIH information, and 4/5 Window consent forms included delay information. 19/20(95%) FIH consent forms contained FIH information in the risks section 12/17(71%) patients preferred the same. Fourteen (82%) patients wanted FIH information in the purpose, but only 5(25%) consents mentioned it there. 9/17(53%) Window patients preferred delay information to be located early in the consent, before the "Risks" section. 3/5(60%) consents did this. CONCLUSIONS Designing consents that reflect patient preferences more accurately is essential for ethical informed consent; however, a one-size fits all approach will not accurately capture patient preferences. We found that preferences differed for FIH and Window trial consents, though for both, patients preferred key risk information early in the consent. Next steps include determining if FIH and Window consent templates improve understanding.
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Affiliation(s)
- Anna M Avinger
- Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, USA
| | - Hannah Claire Sibold
- Duke University School of Medicine, 40 Duke Medicine Cir., Durham, NC, 27710, USA
| | - Gavin Campbell
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Eli Abernethy
- Duke University School of Medicine, 40 Duke Medicine Cir., Durham, NC, 27710, USA
| | - John Bourgeois
- Winship Cancer Institute of Emory University, 1365 E Clifton Rd, Atlanta, GA, 30322, USA
| | - Tekiah McClary
- South University Orlando Campus, 5900 Lake Ellenor Dr., Orlando, FL, 32809, USA
| | - Shannon Blee
- Creighton University Medical School, 2621 Burt Street, Omaha, NE, 68178, USA
| | - Margie Dixon
- Winship Cancer Institute of Emory University, 1365 E Clifton Rd, Atlanta, GA, 30322, USA
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
| | - R Donald Harvey
- Winship Cancer Institute of Emory University, 1365 E Clifton Rd, Atlanta, GA, 30322, USA
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
| | - Rebecca D Pentz
- Winship Cancer Institute of Emory University, 1365 E Clifton Rd, Atlanta, GA, 30322, USA.
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA.
- Winship Cancer Institute, 2004 Ridgewood Dr., Office 301, Atlanta, GA, 30322, USA.
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Kraft SA, Rothwell E, Shah SK, Duenas DM, Lewis H, Muessig K, Opel DJ, Goddard KAB, Wilfond BS. Demonstrating 'respect for persons' in clinical research: findings from qualitative interviews with diverse genomics research participants. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106440. [PMID: 33023975 PMCID: PMC8021602 DOI: 10.1136/medethics-2020-106440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 05/11/2023]
Abstract
The ethical principle of 'respect for persons' in clinical research has traditionally focused on protecting individuals' autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals' rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English (n=30) or Spanish (n=10) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female (93%), identified as Hispanic/Latino(a) (43%) or non-Hispanic white (38%), reported annual household income under US$60 000 (70%) and did not have a Bachelor's degree (65%); 30% had limited health literacy. We identified four key domains for demonstrating respect: (1) personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; (2) study communication processes, including following up and sharing results with participants; (3) inclusion, particularly ensuring materials are understandable and procedures are accessible; and (4) consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin Rothwell
- Obstetrics and Gynecology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Seema K Shah
- Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Hannah Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kristin Muessig
- Translational and Applied Genomics, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Katrina A B Goddard
- Translational and Applied Genomics, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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Dickert NW, Bernard AM, Brabson JM, Hunter RJ, McLemore R, Mitchell AR, Palmer S, Reed B, Riedford M, Simpson RT, Speight CD, Steadman T, D Pentz R. Partnering With Patients to Bridge Gaps in Consent for Acute Care Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:7-17. [PMID: 32364468 DOI: 10.1080/15265161.2020.1745931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes should be sensitive to the context in which trials are conducted and to needs of patients and surrogate decision-makers. This manuscript describes a collaborative effort between ethicists, researchers, patients, and surrogates to develop patient-driven, patient-centered approaches to consent for clinical trials in acute myocardial infarction and stroke.Our group identified important ways in which existing consent processes and forms for clinical trials fail to meet patients' and surrogates' needs in the acute context. We collaborated to create model forms and consent processes that are substantially shorter and, hopefully, better-matched to patients' and surrogates' needs and expectations from the perspective of content, structure, and tone. These changes, however, challenge some common conventions regarding consent.
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