How the new European data protection regulation affects clinical research and recommendations?

Opportunities and barriers for prehospital emergency medical services research in the Netherlands; results of a mixed-methods consensus study

INTRODUCTION

Quality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands.

METHODS

This mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement.

RESULTS

Forty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data.

CONCLUSION

Barriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations.

Design a Clinical Research Protocol: Influence of Real-World Setting

The design of a clinical research protocol to evaluate new therapies, devices, patient quality of life, and medical practices from scratch is probably one of the greatest challenges for the majority of novice researchers. This is especially true since a high-quality methodology is required to achieve success and effectiveness in academic and hospital research centers. This review discusses the concrete steps and necessary guidelines needed to create and structure a research protocol. Along with the methodology, some administrative challenges (ethics, regulatory and people-management barriers) and possible time-saving recommendations (standardized procedures, collaborative training, and centralization) are discussed.

Patients' and Members of the Public's Wishes Regarding Transparency in the Context of Secondary Use of Health Data: Scoping Review

BACKGROUND

Secondary use of health data has reached unequaled potential to improve health systems governance, knowledge, and clinical care. Transparency regarding this secondary use is frequently cited as necessary to address deficits in trust and conditional support and to increase patient awareness.

OBJECTIVE

We aimed to review the current published literature to identify different stakeholders' perspectives and recommendations on what information patients and members of the public want to learn about the secondary use of health data for research purposes and how and in which situations.

METHODS

Using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review using Medline, CINAHL, PsycINFO, Scopus, Cochrane Library, and PubMed databases to locate a broad range of studies published in English or French until November 2022. We included articles reporting a stakeholder's perspective or recommendations of what information patients and members of the public want to learn about the secondary use of health data for research purposes and how or in which situations. Data were collected and analyzed with an iterative thematic approach using NVivo.

RESULTS

Overall, 178 articles were included in this scoping review. The type of information can be divided into generic and specific content. Generic content includes information on governance and regulatory frameworks, technical aspects, and scientific aims. Specific content includes updates on the use of one's data, return of results from individual tests, information on global results, information on data sharing, and how to access one's data. Recommendations on how to communicate the information focused on frequency, use of various supports, formats, and wording. Methods for communication generally favored broad approaches such as nationwide publicity campaigns, mainstream and social media for generic content, and mixed approaches for specific content including websites, patient portals, and face-to-face encounters. Content should be tailored to the individual as much as possible with regard to length, avoidance of technical terms, cultural competence, and level of detail. Finally, the review outlined 4 major situations where communication was deemed necessary: before a new use of data, when new test results became available, when global research results were released, and in the advent of a breach in confidentiality.

CONCLUSIONS

This review highlights how different types of information and approaches to communication efforts may serve as the basis for achieving greater transparency. Governing bodies could use the results: to elaborate or evaluate strategies to educate on the potential benefits; to provide some knowledge and control over data use as a form of reciprocity; and as a condition to engage citizens and build and maintain trust. Future work is needed to assess which strategies achieve the greatest outreach while striking a balance between meeting information needs and use of resources.

Challenges related to data protection in clinical research before and during the COVID-19 pandemic: An exploratory study

Background

The COVID-19 pandemic brought global disruption to health, society and economy, including to the conduct of clinical research. In the European Union (EU), the legal and ethical framework for research is complex and divergent. Many challenges exist in relation to the interplay of the various applicable rules, particularly with respect to compliance with the General Data Protection Regulation (GDPR). This study aimed to gain insights into the experience of key clinical research stakeholders [investigators, ethics committees (ECs), and data protection officers (DPOs)/legal experts working with clinical research sponsors] across the EU and the UK on the main challenges related to data protection in clinical research before and during the pandemic.

Materials and methods

The study consisted of an online survey and follow-up semi-structured interviews. Data collection occurred between April and December 2021. Survey data was analyzed descriptively, and the interviews underwent a framework analysis.

Results and conclusion

In total, 191 respondents filled in the survey, of whom fourteen participated in the follow-up interviews. Out of the targeted 28 countries (EU and UK), 25 were represented in the survey. The majority of stakeholders were based in Western Europe. This study empirically elucidated numerous key legal and ethical issues related to GDPR compliance in the context of (cross-border) clinical research. It showed that the lack of legal harmonization remains the biggest challenge in the field, and that it is present not only at the level of the interplay of key EU legislative acts and national implementation of the GDPR, but also when it comes to interpretation at local, regional and institutional levels. Moreover, the role of ECs in data protection was further explored and possible ways forward for its normative delineation were discussed. According to the participants, the pandemic did not bring additional legal challenges. Although practical challenges (for instance, mainly related to the provision of information to patients) were high due to the globally enacted crisis measures, the key problematic issues on (cross-border) health research, interpretations of the legal texts and compliance strategies remained largely the same.

Current recommendations/practices for anonymising data from clinical trials in order to make it available for sharing: A scoping review

Background/Aims

There are increasing pressures for anonymised datasets from clinical trials to be shared across the scientific community, and differing recommendations exist on how to perform anonymisation prior to sharing. We aimed to systematically identify, describe and synthesise existing recommendations for anonymising clinical trial datasets to prepare for data sharing.

Methods

We systematically searched MEDLINE^®, EMBASE and Web of Science from inception to 8 February 2021. We also searched other resources to ensure the comprehensiveness of our search. Any publication reporting recommendations on anonymisation to enable data sharing from clinical trials was included. Two reviewers independently screened titles, abstracts and full text for eligibility. One reviewer extracted data from included papers using thematic synthesis, which then was sense-checked by a second reviewer. Results were summarised by narrative analysis.

Results

Fifty-nine articles (from 43 studies) were eligible for inclusion. Three distinct themes are emerging: anonymisation, de-identification and pseudonymisation. The most commonly used anonymisation techniques are: removal of direct patient identifiers; and careful evaluation and modification of indirect identifiers to minimise the risk of identification. Anonymised datasets joined with controlled access was the preferred method for data sharing.

Conclusions

There is no single standardised set of recommendations on how to anonymise clinical trial datasets for sharing. However, this systematic review shows a developing consensus on techniques used to achieve anonymisation. Researchers in clinical trials still consider that anonymisation techniques by themselves are insufficient to protect patient privacy, and they need to be paired with controlled access.

Medical journal requirements for clinical trial data sharing: Ripe for improvement

Florian Naudet and co-authors discuss strengthening requirements for sharing clinical trial data.

Network Theory and Switching Behaviors: A User Guide for Analyzing Electronic Records Databases

As part of studies that employ health electronic records databases, this paper advocates the employment of graph theory for investigating drug-switching behaviors. Unlike the shared approach in this field (comparing groups that have switched with control groups), network theory can provide information about actual switching behavior patterns. After a brief and simple introduction to fundamental concepts of network theory, here we present (i) a Python script to obtain an adjacency matrix from a records database and (ii) an illustrative example of the application of network theory basic concepts to investigate drug-switching behaviors. Further potentialities of network theory (weighted matrices and the use of clustering algorithms), along with the generalization of these methods to other kinds of switching behaviors beyond drug switching, are discussed.

Overview of clinical trials vigilance units in French institutional sponsors - A study from the REVISE working group

PURPOSE

To follow the European Directive 2001/20/EC, institutional sponsors created or reinforced their vigilance units. Since 2007, the working group "REflexion sur la VIgilance et la Sécurité des Essais" (REVISE) rallies French institutional vigilance units (IVUs) to share their experience. The group decided to elaborate a collective work to provide a real-life descriptive picture of French IVUs activities and resources over the 2011-2016 period.

METHOD

A questionnaire was sent to the 60 IVUs of the group. It included questions on staff and activities, such as the number of received and analyzed serious adverse events (SAEs). All results and proposals were discussed and consensus was achieved in general meeting.

RESULTS/CONCLUSION

The results highlight the commitment of IVU staffs at many steps of CTs, but also the frailty of some units, leading to 6 proposals intended to institutional sponsors and competent authorities for ensuring (1) IVU visibility to all actors; (2) sustainable IVU staff; (3) IVU resources adapted to sponsor's ambitions; (4) valorization of IVUs in publications; (5) recognition of IVU's value in clinical research quality; (6) involvement of IVUs in regulatory changes and their procedures of implementation.

[Data sharing policies of clinical trials funders in France]

AIMS

The aims of this survey were to evaluate the percentage of French clinical trial funders with a data sharing policy, to describe their data sharing policies and, more generally, the transparency of the research they fund.

METHODS

The different funders of clinical trials in France have been identified from 3 lists of tenders for clinical research projects: the internal list of the University Hospital Center (CHU) of Rennes, the list of the Interregional Group for Clinical Research and Innovation (GIRCI EST), the list of the portal for calls for projects in health research. Funders were contacted, first by email and then by phone (at least two email and/or phone reminders) to respond to an online survey via Google form. The questionnaire aimed to assess the existence of a sharing policy or not, as well as the way in which it was set up.

RESULTS

Out of 190 funders contacted, 94 did not respond. Sixty-five of the respondents were excluded because they did not fund clinical trials. Of the 31 funders included (including Direction générale de l'offre de soins [DGOS], Institut national contre le cancer [INCa], Groupement Interrégional de Recherche Clinique et d'Innovation [GIRCIs]), only 9 (29%) had implemented a data sharing policy. Among these nine funders, only one had a mandatory sharing policy and eight a policy supporting but not enforcing data sharing. Five allowed the use of budget lines dedicated to data sharing. Three reported granting data sharing incentives. Three had dedicated guidelines indicating a specific mode of sharing data (sharing on request and/or on a specialized platform) and specifying the type of data (individual patient data and/or protocol and amendments). For all three, there were restrictions on sharing data to researchers only. Data sharing policies concerned 19% of the total financial volume (850,032,000 euros) of the 26 funders who reported this information.

CONCLUSION

Despite international interest in clinical trial data sharing practices, clinical trials funders with a strong data-sharing policy remain an exception in France.

Pragmatic considerations for fostering reproducible research in artificial intelligence

Artificial intelligence and deep learning methods hold great promise in the medical sciences in areas such as enhanced tumor identification from radiographic images, and natural language processing to extract complex information from electronic health records. Scientific review of AI algorithms has involved reproducibility, in which investigators share protocols, raw data, and programming codes. Within the realm of medicine, reproducibility introduces important challenges, including risk to patient privacy, challenges in reproducing results, and questions regarding ownership and financial value of large medical datasets. Scientific review, however, mandates some form of resolution of these inherent conflicts. We propose several approaches to permit scientific review while maintaining patient privacy and data confidentiality.