1
|
Kyriakos N, Papaefthymiou A, Giakoumis M, Iatropoulos G, Mantzaris G, Liatsos C. Informed consent in inflammatory bowel disease: a necessity in real-world clinical practice. Ann Gastroenterol 2021; 34:466-475. [PMID: 34276184 PMCID: PMC8276362 DOI: 10.20524/aog.2021.0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/08/2021] [Indexed: 11/11/2022] Open
Abstract
In modern medicine, any medical intervention has to be supported by a patient's informed consent. Challenges to this process include the specificity and complexity of medical information being provided, the patient's ability to comprehend the information, the medical uncertainty of the outcomes, and the physician's legal concerns. Important elements of the consent process are respect for the patient's autonomy and self-determination, appropriate disclosure and verification of their understanding, and voluntariness. In inflammatory bowel disease (IBD), pharmaceutical treatment carries significant risks, making discussion and illustration of the treatment critical for decision making. This review aims to emphasize the importance of the informed consent process in routine IBD clinical practice, and suggests an appropriate way of informing patients about the medical treatment on offer. The information that has to be comprehensively presented before consent includes: i) treatment goal; ii) basic characteristics of treatment (route and timetable of drug administration, drug efficacy, adverse events); and iii) consequences of staying untreated. The IBD physician's main concerns must include ensuring not only that the information being provided is detailed and objective, but also that the decision-making process is shared with the patient. Ultimately, the process of obtaining informed consent in real-world clinical practice is undoubtedly of great importance, for both upholding the principles of medical ethics and avoiding legal conflicts.
Collapse
Affiliation(s)
- Nikolaos Kyriakos
- Gastroenterology Department, 401 General Army Hospital of Athens, Greece (Nikolaos Kyriakos, Apostolis Papaefthymiou, Marios Giakoumis, Christos Liatsos)
| | - Apostolis Papaefthymiou
- Gastroenterology Department, 401 General Army Hospital of Athens, Greece (Nikolaos Kyriakos, Apostolis Papaefthymiou, Marios Giakoumis, Christos Liatsos)
| | - Marios Giakoumis
- Gastroenterology Department, 401 General Army Hospital of Athens, Greece (Nikolaos Kyriakos, Apostolis Papaefthymiou, Marios Giakoumis, Christos Liatsos)
| | - George Iatropoulos
- Medical Oncology Department, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, Australia (George Iatropoulos)
| | - Gerasimos Mantzaris
- Gastroenterology Department, General Hospital of Athens “Evangelismos-Ophtalmiatreion Athinon-Polykliniki”, Athens, Greece (Gerasimos Mantzaris)
| | - Christos Liatsos
- Gastroenterology Department, 401 General Army Hospital of Athens, Greece (Nikolaos Kyriakos, Apostolis Papaefthymiou, Marios Giakoumis, Christos Liatsos)
| |
Collapse
|
2
|
Pugliese D, Papi C, Privitera G, Aratari A, Festa S, Armuzzi A. The management of inflammatory bowel diseases in the era of COVID-19 pandemic: When "non-urgent" does not mean "deferrable". Dig Liver Dis 2020; 52:1238-1240. [PMID: 32601025 PMCID: PMC7301120 DOI: 10.1016/j.dld.2020.05.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Daniela Pugliese
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Claudio Papi
- IBD UNIT, Ospedale San Filippo Neri, Largo Gemelli, 8, Rome, Italy
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annalisa Aratari
- IBD UNIT, Ospedale San Filippo Neri, Largo Gemelli, 8, Rome, Italy
| | - Stefano Festa
- IBD UNIT, Ospedale San Filippo Neri, Largo Gemelli, 8, Rome, Italy
| | - Alessandro Armuzzi
- CEMAD - IBD UNIT - Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| |
Collapse
|
3
|
Hug K. Understanding voluntariness of consent in first-in-human cell therapy trials. Regen Med 2020; 15:1647-1660. [PMID: 32609059 DOI: 10.2217/rme-2019-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Consensus about contents of voluntariness in informed consent is lacking. Core criteria for voluntary consent are needed to ensure voluntariness. This article outlines the multidimensionality of voluntariness and identifies what could reduce voluntariness, especially in first-in-human clinical trials involving cell therapies. In such trials, truly voluntary consent is especially important because: such trials may involve risk of serious harm, while in case of some diseases, eligible patients often have potentially effective therapeutic alternatives; patients considering participation in high-risk first-in-human trials may feel more desperate and some may be dependent on their caregivers, including those in the family; implanted cells cannot be taken out of the patient's body if the patient wants to withdraw.
Collapse
Affiliation(s)
- Kristina Hug
- Medical Ethics, Department of Clinical Sciences, Faculty of Medicine, Lund University, BMC I12, 22184 Lund, Sweden
| |
Collapse
|
4
|
Noor NM, Hart AL, Irving PM, Ghosh S, Parkes M, Raine T. Clinical Trials [and Tribulations]: The Immediate Effects of COVID-19 on IBD Clinical Research Activity in the UK. J Crohns Colitis 2020; 14:1769-1776. [PMID: 32598438 PMCID: PMC7337665 DOI: 10.1093/ecco-jcc/jjaa137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
There have been immediate and profound impacts of SARS-CoV-2 and COVID-19 on health care services worldwide, with major consequences for non COVID-19 related health care. Alongside efforts to reconfigure services and enable continued delivery of safe clinical care for patients with IBD, consideration must also be given to management of IBD research activity. In many centres there has been an effective shutdown of IBD clinical trial activity as research sites have switched focus to either COVID-19 related research or clinical care only. As a result, the early termination of trial programmes, and loss of potentially effective therapeutic options for IBD, has become a real and worrying prospect. Moreover, in many countries research activity has become embedded into clinical care-with clinical trials often providing access to new therapies or strategies-which would otherwise not have been available in standard clinical pathways. This pandemic has significant implications for the design, conduct, analysis, and reporting of clinical trials in IBD. In this Viewpoint, we share our experiences from a clinical and academic perspective in the UK, highlighting the early challenges encountered, and consider implications for patients and staff at research sites, sponsors, research ethics committees, funders, and regulators. We also offer potential solutions both for now and for when we enter a recovery phase from the pandemic.
Collapse
Affiliation(s)
- Nurulamin M Noor
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK,Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ailsa L Hart
- St Mark’s Hospital, IBD Unit, Harrow, London, UK
| | - Peter M Irving
- IBD Centre, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK,School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Subrata Ghosh
- Institute of Translational Medicine, NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Miles Parkes
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Tim Raine
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK,Corresponding author: Dr Tim Raine, MB BChir PhD, Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge CB2 OQQ, UK. Tel.: +441223 245151;
| |
Collapse
|
5
|
Sharp D, Ringer S, Park KT, Tole S, Rubin DT, Regueiro M. Listening to the Patient: Improving the Design and Conduct of Clinical Trials in Inflammatory Bowel Diseases. CROHN'S & COLITIS 360 2020; 2:otaa011. [PMID: 36777962 PMCID: PMC9802181 DOI: 10.1093/crocol/otaa011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Lay Summary
There is an urgent need for new treatments for inflammatory bowel diseases, but it’s hard to enroll the large number of patients needed for clinical trials. Making trials more patient-friendly by giving patients a voice would help solve this problem.
Collapse
Affiliation(s)
- Dan Sharp
- IBD patient advocate, DanSharpIBD.org
| | - Sara Ringer
- IBD patient advocate, InflamedAndUntamed.org
| | - K T Park
- Genentech, Inc, South San Francisco, California, USA
| | - Swati Tole
- Genentech, Inc, South San Francisco, California, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA,Address correspondence to: Miguel Regueiro, MD, Department of Gastroenterology, Hepatology & Nutrition, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 ()
| |
Collapse
|