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Luseno WK, Iritani BJ, Hartman S, Odongo FS, Otieno FA, Ongili BO, Rennie S. Assessment of Consent Comprehension Among Kenyan Adolescents, Young Adults, and Parents: Comparison of Enhanced and Standard Consenting Procedures. J Adolesc Health 2024; 74:605-612. [PMID: 38069940 PMCID: PMC10873115 DOI: 10.1016/j.jadohealth.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Youth aged 15-19 years and parents of minors aged 15-17 years in sub-Saharan Africa are under-represented in empirical consent research. Thus, knowledge is limited concerning the adequacy of consent procedures and need for strategies to improve consent comprehension among these groups. We assessed comprehension following standard consent procedures and evaluated an enhanced procedure among Kenyan youth and parents. METHODS Participants were adolescents aged 15-17 years (n = 273), their parents (n = 196), and young adults aged 18-19 years (n = 196). We used a quasi-experimental cohort design to implement standard and enhanced (single condition: extended discussion, test/feedback) consent procedures. Participants completed a 21-item informed consent comprehension assessment instrument. RESULTS After standard consent procedures, mean comprehension scores were 11.36, 13.64, and 13.43 (score range: 0-21) among adolescents, young adults, and parents, respectively. About 6.2% of adolescents, 19.6% of young adults, and 21.4% of parents answered ≥ 80% of the questions correctly. After the enhanced procedures, comprehension scores (15.87 adolescents, 17.81 young adults, and 16.77 parents) and proportions answering ≥ 80% of the questions correctly (44.9% adolescents, 76.8% young adults, and 64.3% parents) increased significantly. Regression analysis indicated statistically significant differences (p < .001) in comprehension scores between the enhanced and standard groups (β = 3.87 adolescents, β = 4.03 young adults, and β = 3.60 parents) after controlling for sociodemographic factors. DISCUSSION Enhancing consent procedures with extended discussions, quizzes, and additional explanation where understanding is inadequate is a promising approach for improving comprehension. However, poorer comprehension among adolescents compared to young adults and parents underscores the need for research to identify additional approaches to improve understanding.
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Affiliation(s)
| | - Bonita J Iritani
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, North Carolina
| | - Shane Hartman
- Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, North Carolina
| | - Fredrick S Odongo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Barrack Otieno Ongili
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Knapp P, Martin-Kerry J, Moe-Byrne T, Sheridan R, Coleman E, Roche J, Young B, Higgins S, Preston J, Bower P, Gamble C, Stones C. The effectiveness and acceptability of multimedia information when recruiting children and young people to trials: the TRECA meta-analysis of SWATs. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-112. [PMID: 38140894 DOI: 10.3310/htpm3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Background The information provided to potential trial participants plays a crucial role in their decision-making. Printed participant information sheets for trials have received recurrent criticism as being too long and technical, unappealing and hard to navigate. An alternative is to provide information through multimedia (text, animations, video, audio, diagrams and photos). However, there is limited evidence on the effects of multimedia participant information on research recruitment rates, particularly in children and young people. Objectives The study objectives were as follows: 1. to develop template multimedia information resources through participatory design, for use when recruiting children and young people to trials 2. to evaluate the multimedia information resources in a series of Studies Within A Trial, to test their effects on recruitment and retention rates, and participant decision-making, by comparing the provision of multimedia information resources instead of printed participant information sheets, and comparing the provision of multimedia information resources in addition to printed participant information sheets. Design Two-phase study: 1. multimedia information resources development including qualitative study; user testing study; readability metrics; enhanced patient and public involvement 2. multimedia information resources' evaluation comprising Studies Within A Trial undertaken within host trials recruiting children and young people. Setting United Kingdom trials involving patients aged under 18. Participants Development phase: n = 120 (children and young people, parents, clinicians, trial personnel). Evaluation phase: n = 1906 (children and young people being asked to take part in trials). Interventions Multimedia information resources (comprising text, audio, 'talking heads' video, trial-specific and trial-generic animations). Printed participant information sheets. Main outcome measures Primary outcome: trial recruitment rate comparing multimedia information resource-only with printed participant information sheet-only provision. Secondary outcomes: trial recruitment rate comparing combined multimedia information resource and printed participant information sheet with printed participant information sheet-only provision; trial retention rate; quality of participant decision-making. Results for each trial were calculated and combined in a two-stage random-effects meta-analysis. Results Phase 1 generated two multimedia information resource templates: (1) for children aged 6-11 years; (2) for children aged 12-18 years and parents. In the Phase 2 Studies Within A Trial the multimedia information resources improved trial recruitment, when compared to printed information alone [odds ratio (OR) = 1.54; 95% confidence interval (CI) 1.05 to 2.28; p = 0.03; I2 = 0%]. When printed participant information sheet-only provision was compared to combined multimedia information resource and printed participant information sheet provision, there was no effect on trial recruitment (OR = 0.89; 95% CI 0.53 to 1.50; I2 = 0%). There were no differences between multimedia information resource and printed participant information sheet on trial retention or participant decision-making quality. In a study within a hypothetical trial setting, multimedia information resource-only provision produced higher ratings of 'information was easy to understand' (Z = 3.03; p = 0.003) and 'I had confidence in decision-making' (Z = 2.00; p = 0.044) than printed participant information sheet-only provision. Limitations It was not possible to include data from three Studies Within A Trial in the meta-analysis due to limited sample size, and questionnaire return rates were low, which reduced the strength of the findings. Conclusions Use of multimedia information increased the rate of recruitment to trials involving children and young people compared to standard patient information sheets. Future work There should be further evaluation of the effects of multimedia information on recruitment to trials involving children and young people. It would be valuable to assess any impacts of multimedia information resources on communication between trial recruiters, children and young people, and parents. Study registration This trial is registered as TRECA ISRCTN 73136092 and Northern Ireland Hub for Trials Methodology Research SWAT Repository (SWAT 97). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 14/21/21) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 24. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Peter Knapp
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Jacqueline Martin-Kerry
- Department of Health Sciences, University of York, York, UK
- School of Allied Health Professions, College of Life Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Jenny Roche
- York Trials Unit, University of York, York, UK
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Jennifer Preston
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Carrol Gamble
- Centre for Medical Statistics and Health Evaluation, University of Liverpool, Liverpool, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, Leeds, UK
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MacDonald KR, Enane LA, McHenry MS, Davis NL, Whipple EC, Ott MA. Ethical Aspects of Involving Adolescents in HIV Research: A Systematic Review of the Empiric Literature. J Pediatr 2023; 262:113589. [PMID: 37399918 PMCID: PMC11119419 DOI: 10.1016/j.jpeds.2023.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the ethics of involving adolescents in HIV research, we conducted a systematic review of the empiric literature. METHODS Electronic databases Ovid Medline, Embase, and CINAHL were systematically searched using controlled vocabulary terms related to ethics, HIV, specified age groups, and empiric research studies. We reviewed titles and abstracts, including studies that collected qualitative or quantitative data, evaluated ethical issues in HIV research, and included adolescents. Studies were appraised for quality, data were extracted, and studies were analyzed using narrative synthesis. RESULTS We included 41 studies: 24 qualitative, 11 quantitative, 6 mixed methods; 22 from high-income countries (HIC), 18 from low- or middle-income countries (LMIC), and 1 from both HIC and LMIC. Adolescent, parent, and community perspectives assert the benefits of involving minors in HIV research. Participants in LMIC expressed mixed views regarding parental consent requirements and confidentiality, given adolescents' both increasing autonomy and continued need for adult support. In studies in HIC, sexual or gender minority youth would not participate in research if parental consent were required or if there were confidentiality concerns. There was variation in the comprehension of research concepts, but adolescents generally demonstrated good comprehension of informed consent. Informed consent processes can be improved to increase comprehension and study accessibility. Vulnerable participants face complex social barriers that should be considered in study design. CONCLUSIONS Data support the inclusion of adolescents in HIV research. Empiric research can inform consent processes and procedural safeguards to ensure appropriate access.
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Affiliation(s)
- Katherine R MacDonald
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Leslie A Enane
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Megan S McHenry
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Neilkant L Davis
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth C Whipple
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - Mary A Ott
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
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Buckley MT, O'Shea MR, Kundu S, Lipitz-Snyderman A, Kuperman G, Shah S, Iasonos A, Houston C, Terzulli SL, Lengfellner JM, Sabbatini P. Digitalizing the Clinical Research Informed Consent Process: Assessing the Participant Experience in Comparison With Traditional Paper-Based Methods. JCO Oncol Pract 2023; 19:e355-e364. [PMID: 36534933 PMCID: PMC10022878 DOI: 10.1200/op.22.00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/14/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Consent processes are critical for clinical care and research and may benefit from incorporating digital strategies. We compared an electronic informed consent (eIC) option to paper consent across four outcomes: (1) technology burden, (2) protocol comprehension, (3) participant agency (ability to self-advocate), and (4) completion of required document fields. METHODS We assessed participant experience with eIC processes compared with traditional paper-based consenting using surveys and compared completeness of required fields, over 3 years (2019-2021). Participants who consented to a clinical trial at a large academic cancer center via paper or eIC were invited to either pre-COVID-19 pandemic survey 1 (technology burden) or intrapandemic survey 2 (comprehension and agency). Consent document completeness was assessed via electronic health records. RESULTS On survey 1, 83% of participants (n = 777) indicated eIC was easy or very easy to use; discomfort with technology overall was not correlated with discomfort using eIC. For survey 2, eIC (n = 262) and paper consenters (n = 193) had similar comprehension scores. All participants responded favorably to at least five of six agency statements; however, eIC generated a higher proportion of positive free-text comments (P < .05), with themes such as thoroughness of the discussion and consenter professionalism. eIC use yielded no completeness errors across 235 consents versus 6.4% for paper (P < .001). CONCLUSION Our findings suggest that eIC when compared with paper (1) did not increase technology burden, (2) supported comparable comprehension, (3) upheld key elements of participant agency, and (4) increased completion of mandatory consent fields. The results support a broader call for organizations to offer eIC for clinical research discussions to enhance the overall participant experience and increase the completeness of the consent process.
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Affiliation(s)
| | | | | | | | | | - Suken Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Paul Sabbatini
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Groff E, Orzechowski M, Schuetz C, Steger F. Ethical Aspects of Personalized Research and Management of Systemic Inflammatory Response Syndrome (SIRS) in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:470. [PMID: 36612792 PMCID: PMC9819223 DOI: 10.3390/ijerph20010470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Systemic inflammatory response syndrome (SIRS) is a life-threatening condition with nonspecific symptoms. Because of that, defining a targeted therapy against SIRS in children and adults remains a challenge. The identification of diagnostic patterns from individualized immuneprofiling can lead to development of a personalized therapy. The aim of this study was to identify and analyze ethical issues associated with personalized research and therapy for SIRS in pediatric populations. We conducted an ethical analysis based on a principled approach according to Beauchamp and Childress' four bioethical principles. Relevant information for the research objectives was extracted from a systematic literature review conducted in the scientific databases PubMed, Embase and Web of Science. We searched for pertinent themes dealing with at least one of the four bioethical principles: "autonomy", "non-maleficence", "beneficence" and "justice". 48 publications that met the research objectives were included in the thorough analysis, structured and discussed in a narrative synthesis. From the analysis of the results, it has emerged that traditional paradigms of patient's autonomy and physician paternalism need to be reexamined in pediatric research. Standard information procedures and models of informed consent should be reconsidered as they do not accommodate the complexities of pediatric omics research.
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Affiliation(s)
- Elisa Groff
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
| | - Catharina Schuetz
- Paediatric Immunology, Medical Faculty “Carl Gustav Carus”, Technic University Dresden, 01307 Dresden, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89073 Ulm, Germany
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Fons‐Martinez J, Ferrer‐Albero C, Diez‐Domingo J. Co-creation of information materials within the assent process: From theory to practice. Health Expect 2022; 26:429-439. [PMID: 36416386 PMCID: PMC9854296 DOI: 10.1111/hex.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 08/29/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The informed consent process is key to safeguarding the autonomy of the participant in medical research. For this process to be valid, the information presented to the potential participant should meet their needs and be understood by them. The i-CONSENT project has developed 'Guidelines for adapting the informed consent process in clinical trials' which aim to improve informed consent so that they are easier to understand and better adapted to the needs and preferences of the target population. The best way to tailor information to the characteristics and preferences of the target population is to involve the community itself. METHODS Following guidelines developed by i-CONSENT, assent materials were co-created for a mock clinical trial of the human papillomavirus vaccine in adolescents. During the process, two design thinking sessions were conducted involving a total of 10 children and 5 parents. The objectives of the sessions were to find out the children's opinion of the informed consent (assent in their case) process in clinical trials, identify the parts that were most difficult to understand and alternatives for their presentation and wording, identify the preferred formats for receiving the information and the main characteristics of these formats, design a video explaining the clinical trial and evaluate a tool for assessing comprehension. RESULTS Assent materials were co-created in three formats: a web-based material following a layered approach; a video in story format; a pdf document with an innovative way of presenting information compared to traditional assent documents. In addition, the Comprehension of Assent Questionnaire was co-designed, based on the Quality of Informed Consent questionnaire. CONCLUSION The design thinking methodology has proven to be an easy and useful tool for involving children in designing information tailored to their needs and preferences. PATIENT OR PUBLIC CONTRIBUTION A sample of the target population participated in the design and piloting of the materials created using design thinking methodology. In addition, patient representatives participated in the design and evaluation of the guidelines developed by the i-CONSENT project that were followed for the development of the materials in this study.
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Affiliation(s)
- Jaime Fons‐Martinez
- Vaccine Research AreaFoundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIOValenciaSpain
| | - Cristina Ferrer‐Albero
- Facultad de Medicina y Ciencias de la SaludUniversidad Católica de Valencia San Vicente MártirValenciaSpain
| | - Javier Diez‐Domingo
- Vaccine Research AreaFoundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIOValenciaSpain,Facultad de Medicina y Ciencias de la SaludUniversidad Católica de Valencia San Vicente MártirValenciaSpain
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Yusof MYPM, Teo CH, Ng CJ. Electronic informed consent criteria for research ethics review: a scoping review. BMC Med Ethics 2022; 23:117. [DOI: 10.1186/s12910-022-00849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The research shows a growing trend in using an electronic platform to supplement or replace traditional paper-based informed consent processes. Instead of the traditionally written informed consent document, electronic informed consent (eConsent) may be used to assess the research subject’s comprehension of the information presented. By doing so, respect for persons as one of the research ethical principles can be upheld. Furthermore, these electronic methods may reduce potential airborne infection exposures, particularly during the pandemic, thereby adhering to the beneficence and nonmaleficence principle. This scoping review aims to identify the ethics related criteria that have been included in electronic informed consent processes and to synthesize and map these criteria to research ethics principles, in order to identify the gaps, if any, in current electronic informed consent processes.
Methods
The search was performed based on internet search and three main databases: PubMed, SCOPUS and EBSCO. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation guideline was used to report this work.
Results
Of 34 studies that met the inclusion criteria, 242 essential original constructs were collated, and 7 concepts were derived. Digital content showed the highest percentage of collated original constructs (27%, n = 65) followed by accessibility (24%, n = 56), comprehension engagement (18%, n = 43), autonomy (14%, n = 34), confidentiality (11%, n = 25), language (5%, n = 13), and parental consent (1%, n = 2). Twenty-five new items were synthesized for eConsent criteria which may provide guidance for ethical review of research involving eConsent.
Conclusion
The current study adds significant value to the corpus of knowledge in research ethics by providing ethical criteria on electronic informed consent based on evidence-based data. The new synthesized items in the criteria can be readily used as an initial guide by the IRB/REC members during a review process on electronic informed consent and useful to the future preparation of a checklist.
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Chen C, Lee PI, Pain KJ, Delgado D, Cole CL, Campion TR. Replacing Paper Informed Consent with Electronic Informed Consent for Research in Academic Medical Centers: A Scoping Review. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2020; 2020:80-88. [PMID: 32477626 PMCID: PMC7233043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although experts have identified benefits to replacing paper with electronic consent (eConsent) for research, a comprehensive understanding of strategies to overcome barriers to adoption is unknown. To address this gap, we performed a scoping review of the literature describing eConsent in academic medical centers. Of 69 studies that met inclusion criteria, 81% (n=56) addressed ethical, legal, and social issues; 67% (n=46) described user interface/user experience considerations; 39% (n=27) compared electronic versus paper approaches; 33% (n=23) discussed approaches to enterprise scalability; and 25% (n=17) described changes to consent elections. Findings indicate a lack of a leading commercial eConsent vendor, as articles described a myriad of homegrown systems and extensions of vendor EHR patient portals. Opportunities appear to exist for researchers and commercial software vendors to develop eConsent approaches that address the five critical areas identified in this review.
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Affiliation(s)
- Cindy Chen
- Information Technologies & Services Department, Weill Cornell Medicine, New York, NY
| | - Pou-I Lee
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Kevin J Pain
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Diana Delgado
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY
| | - Curtis L Cole
- Information Technologies & Services Department, Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Thomas R Campion
- Information Technologies & Services Department, Weill Cornell Medicine, New York, NY
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
- Clinical & Translational Science Center, Weill Cornell Medicine, New York, NY
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Soll D, Guraiib MM, Rollins NC, Reis AA. Improving assent in health research: a rapid systematic review. BMC Med Res Methodol 2020; 20:114. [PMID: 32404063 PMCID: PMC7222594 DOI: 10.1186/s12874-020-01000-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background Enrolment in a research study requires the participant’s informed consent. In the case of minors, informed consent of the respective legal guardian is obtained in conjunction with informed assent of the underage p articipant. Since comprehension of the information provided may be limited, effective interventions to improve understanding should be identified. Thus, it is the objective of this study to review quantitative studies that tested interventions to improve the understanding of information provided during assent processes in health research. The studied population consisted of minors that participated or were willing to participate in research. The primary outcome was the level of comprehension after intervention. Methods A systematic search was conducted in eleven databases including regional databases: PubMed, Web of Science, ERIC, PsycINFO, CINAHL, POPLINE, AIM, LILACS, WPRIM, IMSEAR, and IMEMR and included references from inception of the database until July 2018 except PubMed which spanned the period from May 2013 to July 2018. Search terms focused on Informed Consent/Assent, Minors, and Comprehension. To complement the search, reference lists of retrieved publications were additionally searched. We included all quantitative studies that were conducted in minors, tested an intervention, covered assent processes in health research, and assessed comprehension. One reviewer screened titles, abstracts, and full-texts to determine eligibility and collected data on study design, population, intervention, methods, outcome, and for critical appraisal. Interventions comprised enhanced paper forms, interspersed questions, multimedia format, and others. Results Out of 7089 studies initially identified, 19 studies comprising 2805 participants and conducted in seven countries were included in the review. Fourteen studies (74 %) tested an intervention against control and ten (53 %) were randomized controlled trials. Heterogeneous methodology as well as incomplete outcome and statistical reporting impaired the reliability of the collected data. Positive effects were suggested for use of enhanced paper forms, interspersed questions, use of pie charts, and organizational factors. Conclusions Improving assent in health research is an under-researched area with little reliable evidence. While some interventions are proposed to improve understanding in assent processes, further investigation is necessary to be able to give evidence-based recommendations. Trial registration PROSPERO ID: 106808.
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Affiliation(s)
- Dominik Soll
- Department of Endocrinology and Metabolism, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Nigel Campbell Rollins
- Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Andreas Alois Reis
- Global Health Ethics Team, World Health Organization, Geneva, Switzerland
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Martin-Kerry JM, Knapp P, Atkin K, Bower P, Watt I, Stones C, Higgins S, Sheridan R, Preston J, Horton Taylor D, Baines P, Young B. Supporting children and young people when making decisions about joining clinical trials: qualitative study to inform multimedia website development. BMJ Open 2019; 9:e023984. [PMID: 30782720 PMCID: PMC6340013 DOI: 10.1136/bmjopen-2018-023984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To understand stakeholders' views regarding the content and design of paediatric clinical trial multimedia websites. To describe how this knowledge informed the development of the multimedia websites. DESIGN Qualitative study comprising two rounds of interviews or focus groups, with thematic analysis of interview transcripts. PARTICIPANTS Sixty-two people (21 children and young people with long-term health conditions, 24 parents and 17 professionals). SETTING One UK children's hospital and one UK Young Persons' Advisory Group. RESULTS When asked what was important in deciding whether to join a trial, children, young people and parents prioritised information about what participation would involve, what the trial was testing, potential benefits and risks of participation and knowing they could leave the trial if they later changed their minds. Young people and parents trusted trial teams to follow regulatory and quality requirements and therefore did not think such information was a priority for the websites, although logos of trusted organisations could lend credibility. Professionals largely concurred with these views. Children and young people advised on the importance of designing the multimedia website to ensure its appearance, tone and wording suited the intended audience and on using animated characters to facilitate children's engagement. CONCLUSIONS Our study provides insights into the information that families value when deciding about healthcare trial participation. It provides guidance on the design of information resources to appeal to children and young people, while also being acceptable to parents and professionals who are often gatekeepers of children's access to information. Our findings will be of use to others developing similar multimedia websites. We report specific information needs and new visual preferences that are not usually addressed in printed trial information. Our work illustrates what qualitative research and participatory design practices can contribute to the development of information resources more generally. TRIAL REGISTRATION NUMBER ISRCTN73136092; Pre-results.
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Affiliation(s)
| | - Peter Knapp
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Ian Watt
- Department of Health Sciences & Hull York Medical School, University of York, York, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, Leeds, UK
| | | | | | - Jenny Preston
- University of Liverpool, Liverpool, UK
- Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | - Paul Baines
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Bridget Young
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Abstract
AIM To report an analysis of the concept of pediatric assent. BACKGROUND The concept of assent is poorly defined in current literature which may lead to potentially flawed practices in obtaining pediatric assent. DESIGN The Walker and Avant (2011) method is used to provide clarity to the concept of pediatric assent. DATA SOURCES Data were collected from PubMed, Academic Search Premier, PhilPapers, Wikipedia, and Google. REVIEW METHODS Data were collected from 2014 to 2015. Twenty-three sources published between 2011 and 2015, nine sources published between 2003 and 2009, the Belmont Report (1979), and the American Academy of Pediatrics' report (1995) were included for pertinent contributions to this multidisciplinary concept analysis. RESULTS Elements of assent include a patient's thoughtful review of the proposed treatment and rational decision in choosing the best course of action. There may be social, familial, and cognitive development factors influencing this process. CONCLUSION This framework uses nurses' knowledge of cognitive development and ethics to inform practice. Assent is respectful of minor patients and ensures their rights are protected. Policies and procedures can be developed to incorporate assent, researchers have a stronger conceptual base, and educators can train nurses to help pediatric patients develop medical decision making skills.
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Affiliation(s)
| | - Jennifer A Coddington
- Director of the Pediatric Nurse Practitioner Master's Program, Director of Practice and Outreach, and Medical Director of North Central Nursing Clinics, Purdue University School of Nursing
| | - Karen J Foli
- Associate Professor, Director of PhD Program in Nursing, Purdue University School of Nursing
| | - Melanie L Braswell
- Clinical Nurse Specialist Indiana University Health Arnett, Affiliate Faculty Purdue University School of Nursing
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