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Ibrahim MA, Alshogran OY, Khabour OF, Alzoubi KH. The quality of consent form structure in biomedical research: a study from Jordan and Sudan. J Multidiscip Healthc 2019; 12:727-731. [PMID: 31564889 PMCID: PMC6731522 DOI: 10.2147/jmdh.s219316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background Informed consent is one of the primary standards of ethical clinical research. This study assessed the quality of the informed consent forms (ICF) utilized in medical research conducted in Sudan and Jordan. Subjects and methods A total of 435 studies that were performed at health sciences schools in Jordan and Sudan were initially screened for the presence of ICF. Of these, 189 studies were reviewed for the major components of ICF using a standard checklist. Results The majority of the reviewed ICFs did not achieve the full standards of the universal guidelines for the informed consent structure. The following elements were described in >50% of consent forms reviewed from both countries: study title, objectives, research investigators, description of study procedure, and confidentiality. Other essential elements such as duration of the subject's participation, risks/benefits, compensation, voluntary participation, and contact information were poorly described. Conclusion The major elements of ICFs were not adequately described in medical research studies from Jordan and Sudan. Improved understanding of major elements of ICF among researchers in the examined countries is necessary. Clear and informative consent template can be very valuable in this perspective.
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Affiliation(s)
- Mariam Abbas Ibrahim
- Department of Clinical Chemistry, Sudan University of Science and Technology, Khartoum, Sudan
| | - Osama Y Alshogran
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
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Gungor B, Aylin M, Asena A, Somuncuoglu EI, Bozkurt NB, Ucku SR, Gelal A. Evaluation of Legal Legislation Compliance and Readability of Clinical Trial Informed Consent Forms. Ther Innov Regul Sci 2019. [DOI: 10.1177/2168479019849520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Buket Gungor
- Department of Pharmaceutical and Medical Devices Services, Republic of Turkey Ministry of Health, Antalya Provincial Directorate, Antalya, Turkey
| | - Mualla Aylin
- Department of Pharmacology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Ayse Asena
- Department of Clinical Trials, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Elif Inci Somuncuoglu
- Department of Clinical Trials, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Nihan Burul Bozkurt
- Department of Clinical Trials, Turkish Medicines and Medical Devices Agency, Ankara, Turkey
| | - Serife Reyhan Ucku
- Department of Pharmacology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Ayse Gelal
- Department of Pharmacology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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Nathe JM, Krakow EF. The Challenges of Informed Consent in High-Stakes, Randomized Oncology Trials: A Systematic Review. MDM Policy Pract 2019; 4:2381468319840322. [PMID: 30944886 PMCID: PMC6440043 DOI: 10.1177/2381468319840322] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/05/2018] [Indexed: 02/05/2023] Open
Abstract
Importance. Oncology trials often entail high-stakes interventions where potential for morbidity and fatal side effects, and for life-prolongation or cure, intensify bioethical issues surrounding informed consent. These challenges are compounded in multistage randomized trials, which are prevalent in oncology. Objective. We sought to elucidate the major barriers to informed consent in high-stakes oncology trials in general and the best consent practices for multistage randomized trials. Evidence Review. We queried PubMed for original studies published from January 1, 1990, to April 5, 2018, that focused on readability, quality, complexity or length of consent documents, motivation and sickness level of participants, or interventions and enhancements that influence informed consent for high-stakes oncologic interventions. Exclusion criteria included articles focused on populations outside industrialized countries, minors or other vulnerable populations, physician preferences, cancer screening and prevention, or recruitment strategies. Additional articles were identified through comprehensive bibliographic review. Findings. Twenty-seven articles were retained; 19 enrolled participants and 8 examined samples of consent documents. Methodologic quality was variable. This body of literature identified certain challenges that can be readily remedied. For example, the average length of the consent forms has increased 10-fold from 1987 to 2010, and patient understanding was shown to be inversely proportional to page count; shortening forms, or providing a concise summary as mandated by the revised Common Rule, might help. However, barriers to understanding that stem from deeply ingrained and flawed sociocultural perceptions of medical research seem more difficult to surmount. Although no studies specifically addressed problems posed by multiple sequential randomizations (such as change in risk-benefit ratio due to time-varying treatment responses or organ toxicities), the findings are likely applicable and especially relevant in that context. Concrete suggestions for improvement are proposed.
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Munley B, Buser AT, Gaudreau S, Breault JL, Bazzano LA. An Analysis of Informed Consent Form Readability of Oncology Research Protocols. J Empir Res Hum Res Ethics 2018; 13:363-367. [PMID: 30124102 DOI: 10.1177/1556264618795057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-two percent of adults in the United States have only basic health literacy skills. We used a multiple linear regression model to identify associations between readability of informed consent documents with study sponsor, study phase, and approval year using a sample of 143 oncology studies at Ochsner Medical Center. The M ± SD Flesh-Kincaid Reading Grade Level (RGL) was 10.33 ± 0.85 and Flesh Reading Ease (FRE) was 52.89 ± 5.49. National Cancer Institute studies had a significantly lower mean RGL and FRE as compared with other sponsors (RGL 9.85 ± 0.66 vs. 10.72 ± 0.79; p value < .0001). Mean RGL did not differ by study phase. Future research should include assessment and improvement of the readability of informed consent documents.
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Burro R, Savardi U, Annunziata MA, De Paoli P, Bianchi I. The effects of presenting oncologic information in terms of opposites in a medical context. Patient Prefer Adherence 2018; 12:443-459. [PMID: 29628757 PMCID: PMC5877498 DOI: 10.2147/ppa.s147091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An extensive body of literature has demonstrated that many patients who have been asked to participate in clinical trials do not fully understand the informed consent forms. A parallel independent study has demonstrated that opposites have a special status in human cognitive organization: they are common to all-natural languages and are intuitively and naturally understood and learnt. PURPOSE The study investigates whether, and how, the use of opposites impacts on doctor-patient communication: does using the terms "small-large" to describe a nodule (ie, bipolar communication) rather than speaking in terms of centimeters (ie, unipolar communication) affect a patient's understanding of the situation? And is it better to speak of "common-rare" side effects (ie, bipolar communication) instead of the number of people who have suffered from particular side effects (ie, unipolar communication)? METHODS Two questionnaires were created and used, one presenting the information in terms of opposites (ie, bipolar communication) and another using unipolar communication. RESULTS The participants' perception of their situation (in terms of feeling healthy-ill, being at high-low risk, and their treatment requiring high-low commitment) varied in the two conditions. Moreover, self-reported levels of understanding and satisfaction with how the information was communicated were higher when opposites were used. LIMITATIONS Since this is the first study that addresses the merits of using bipolar structures versus unipolar structures in doctor-patient communication, further work is needed to consolidate and expand on the results, involving not only simulated but also real diagnostic contexts. CONCLUSION The encouraging results imply that further testing of the use of opposites in informed consent forms and in doctor-patient communication is strongly advisable.
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Affiliation(s)
- Roberto Burro
- Department of Human Sciences, University of Verona, Verona, Italy
- Correspondence: Roberto Burro, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 27, 37129 Verona, Italy, Email
| | - Ugo Savardi
- Department of Human Sciences, University of Verona, Verona, Italy
| | | | - Paolo De Paoli
- National Cancer Institute IRCCS ‘Centro di Riferimento Oncologico’ (CRO), Aviano, Italy
| | - Ivana Bianchi
- Department of Humanities (Section Philosophy and Human Sciences), University of Macerata, Macerata, Italy
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Affiliation(s)
- Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Danny Young-Afat
- Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Behfar Ehdaie
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott YH Kim
- National Institutes of Health, Bethesda, MD, USA
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Wen G, Liu X, Huang L, Shu J, Xu N, Chen R, Huang Z, Yang G, Wang X, Xiang Y, Lu Y, Yuan H. Readability and Content Assessment of Informed Consent Forms for Phase II-IV Clinical Trials in China. PLoS One 2016; 11:e0164251. [PMID: 27701471 PMCID: PMC5049790 DOI: 10.1371/journal.pone.0164251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/20/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose To explore the readability and content integrity of informed consent forms (ICFs) used in China and to compare the quality of Chinese local ICFs with that of international ICFs. Methods The length, readability and content of 155 consent documents from phase II-IV drug clinical trials from the Third Xiangya Hospital Ethics Committee from November 2009 to January 2015 were evaluated. Reading difficulty was tested using a readability formula adapted for the Chinese language. An ICF checklist containing 27 required elements was successfully constructed to evaluate content integrity. The description of alternatives to participation was assessed. The quality of ICFs from different sponsorships were also compared. Results Among the 155 evaluable trials, the ICFs had a median length of 5286 words, corresponding to 7 pages. The median readability score was 4.31 (4.02–4.41), with 63.9% at the 2nd level and 36.1% at the 3rd level. Five of the 27 elements were frequently neglected. The average score for the description of alternatives to participation was 1.06, and 27.7% of the ICFs did not mention any alternatives. Compared with Chinese local ICFs, international ICFs were longer, more readable and contained more of the required elements (P < 0.05). Conclusion The ICFs used in China were difficult to read for most participants. These forms had poor description of alternatives to participation, and failed to provide a high degree of information disclosure, including an explanation of informed consent, follow-up processing of the data/sample, inclusion/exclusion criteria, double blinding, and unpredictable risks. International ICFs had better readability and content integrity than Chinese local ICFs. More efforts should thus be made to improve the quality of consent documents in China.
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Affiliation(s)
- Gaiyan Wen
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xinchun Liu
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lihua Huang
- Center for Medical Experiments, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingxian Shu
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Nana Xu
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ruifang Chen
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhijun Huang
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Guoping Yang
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaomin Wang
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuxia Xiang
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yao Lu
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- * E-mail: (HY); (YL)
| | - Hong Yuan
- The Ethics Committee, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Pharmacology Center, the 3rd Xiangya Hospital of Central South University, Changsha, Hunan, China
- * E-mail: (HY); (YL)
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Foe G, Larson EL. Reading Level and Comprehension of Research Consent Forms. J Empir Res Hum Res Ethics 2016; 11:31-46. [DOI: 10.1177/1556264616637483] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Consent forms continue to be at a higher reading level than the recommended sixth to eighth grade, making it difficult for participants to comprehend information before enrolling in research. To assess and address the extent of the problem regarding the level of literacy of consent forms and update previously published reports, we conducted an integrative literature review of English language research published between January 1, 2000, and December 31, 2013; 35 descriptive and eight intervention studies met inclusion criteria. Results confirmed that developing forms at eighth-grade level was attainable though not practiced. It was found that risks of participation was the section most poorly understood. There was also a lack of consensus regarding the most effective method to increase comprehension. Further research using standardized tools is needed to determine the best approach for improving consent forms and processes.
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Kim EJ, Kim SH. Simplification improves understanding of informed consent information in clinical trials regardless of health literacy level. Clin Trials 2015; 12:232-6. [PMID: 25701156 DOI: 10.1177/1740774515571139] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study evaluated the effect of a simplified informed consent form for clinical trials on the understanding and efficacy of informed consent information across health literacy levels. METHODS A total of 150 participants were randomly assigned to one of two groups and provided with either standard or simplified consent forms for a cancer clinical trial. The features of the simplified informed consent form included plain language, short sentences, diagrams, pictures, and bullet points. RESULTS Levels of objective and subjective understanding were significantly higher in participants provided with simplified informed consent forms relative to those provided with standard informed consent forms. The interaction effects between type of consent form and health literacy level on objective and subjective understanding were nonsignificant. CONCLUSION Simplified informed consent was effective in enhancing participant's subjective and objective understanding regardless of health literacy.
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Affiliation(s)
- Eun Jin Kim
- College of Nursing, Kyungpook National University, Daegu, Korea
| | - Su Hyun Kim
- College of Nursing, Kyungpook National University, Daegu, Korea
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Dal-Ré R, Morell F, Tejedor J, Gracia D. Therapeutic misconception in clinical trials: Fighting against it and living with it. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Dal-Ré R, Morell F, Tejedor J, Gracia D. El equívoco terapéutico en los ensayos clínicos: combatirlo y convivir con él. Rev Clin Esp 2014; 214:470-4. [DOI: 10.1016/j.rce.2014.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
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Langford AT, Resnicow K, Dimond EP, Denicoff AM, Germain DS, McCaskill-Stevens W, Enos RA, Carrigan A, Wilkinson K, Go RS. Racial/ethnic differences in clinical trial enrollment, refusal rates, ineligibility, and reasons for decline among patients at sites in the National Cancer Institute's Community Cancer Centers Program. Cancer 2014; 120:877-84. [PMID: 24327389 PMCID: PMC3947654 DOI: 10.1002/cncr.28483] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/20/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study examined racial/ethnic differences among patients in clinical trial (CT) enrollment, refusal rates, ineligibility, and desire to participate in research within the National Cancer Institute's Community Cancer Centers Program (NCCCP) Clinical Trial Screening and Accrual Log. METHODS Data from 4509 log entries were evaluated in this study. Four logistic regression models were run using physical/medical conditions, enrollment into a CT, patient eligible but declined a CT, and no desire to participate in research as dependent variables. RESULTS Age ≥ 65 years (OR = 1.51, 95% CI = 1.28-1.79), males (OR = 2.28, 95% CI = 1.92-2.71), and non-Hispanic black race (OR = 1.53, 95% CI = 1.2-1.96) were significantly associated with more physical/medical conditions. Age ≥ 65 years was significantly associated with lower CT enrollment (OR = 0.83, 95% CI = 0.7-0.98). Males (OR = 0.78, 95% CI = 0.65-0.94) and a higher grade level score for consent form readability (OR = 0.9, 95% CI = 0.83-0.97) were significantly associated with lower refusal rates. Consent page length ≥ 20 was significantly associated with lower odds of "no desire to participate in research" among CT decliners (OR = 0.75, 95% CI = 0.58-0.98). CONCLUSIONS There were no racial/ethnic differences in CT enrollment, refusal rates, or "no desire to participate in research" as the reason given for CT refusal. Higher odds of physical/medical conditions were associated with older age, males, and non-Hispanic blacks. Better management of physical/medical conditions before and during treatment may increase the pool of eligible patients for CTs. Future work should examine the role of comorbidities, sex, age, and consent form characteristics on CT participation.
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Affiliation(s)
- Aisha T. Langford
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan 48109
| | - Ken Resnicow
- University of Michigan, School of Public Health,
| | | | | | | | | | | | - Angela Carrigan
- Clinical Research Directorate/CMRP, SAIC-Frederick, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
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Reinert C, Kremmler L, Burock S, Bogdahn U, Wick W, Gleiter CH, Koller M, Hau P. Quantitative and qualitative analysis of study-related patient information sheets in randomised neuro-oncology phase III-trials. Eur J Cancer 2013; 50:150-8. [PMID: 24103146 DOI: 10.1016/j.ejca.2013.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/07/2013] [Accepted: 09/08/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In randomised controlled trials (RCTs), patient informed consent documents are an essential cornerstone of the study flow. However, these documents are often oversized in format and content. Clinical experience suggests that study information sheets are often not used as an aid to decision-making due to their complexity. MATERIAL AND METHODS We analysed nine patient informed consent documents from clinical neuro-oncological phase III-studies running at a German Brain Tumour Centre with the objective to investigate the quality of these documents. Text length, formal layout, readability, application of ethical and legal requirements, scientific evidence and social aspects were used as rating categories. Results were assessed quantitatively by two independents investigators and were depicted using net diagrams. RESULTS All patient informed consent documents were of insufficient quality in all categories except that ethical and legal requirements were fulfilled. Notably, graduate levels were required to read and understand five of nine consent documents. DISCUSSION Quality deficits were consistent between the individual study information texts. Irrespective of formal aspects, a document that is intended to inform and motivate patients to participate in a study needs to be well-structured and understandable. We therefore strongly mandate to re-design patient informed consent documents in a patient-friendly way. Specifically, standardised components with a scientific foundation should be provided that could be retrieved at various times, adapted to the mode of treatment and the patient's knowledge, and could weigh information dependent of the stage of treatment decision.
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Affiliation(s)
- Christiane Reinert
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Lukas Kremmler
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Susen Burock
- EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Wolfgang Wick
- Division of Neuro Oncology, University of Heidelberg and National Center for Tumor Diseases, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Christoph H Gleiter
- CenTrial GmbH, University Hospital Tübingen, Paul-Ehrlich-Str. 5, 72076 Tübingen, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany.
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van der Biessen DAJ, Cranendonk MA, Schiavon G, van der Holt B, Wiemer EAC, Eskens FALM, Verweij J, de Jonge MJA, Mathijssen RHJ. Evaluation of patient enrollment in oncology phase I clinical trials. Oncologist 2013; 18:323-9. [PMID: 23429738 DOI: 10.1634/theoncologist.2012-0334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For anticancer drug development, it is crucial that patients participate in early-phase clinical trials. The main aim of this study was to gain insight into the motivations and other variables influencing patients in their decision to participate in phase I oncology trials. MATERIALS AND METHODS Over a period of 25 months, all patients who were informed about (specific) phase I trials in our cancer center were retrospectively included in this study. Data on providing informed consent and final phase I enrollment were collected. RESULTS In total, 365 patients, with a median age of 59 years and a median World Health Organization performance status score of 1, were evaluated. The majority of patients (71%) were pretreated with systemic therapy, with a median of two lines. After specific study information had been given, 145 patients (40%) declined informed consent, 54% of them mainly because of low expectations regarding treatment benefits and concerns about potential side effects. Patients who had received previous systemic therapy consented more frequently than others. After initial consent, 61 patients (17%) still did not receive study treatment, mostly because of secondary withdrawal of consent or rapid clinical deterioration prior to first dosing. DISCUSSION After specific referral to our hospital for participation in early clinical trials, only 44% of all patients who were informed about a specific phase I trial eventually participated. Reasons for both participation and nonparticipation were diverse. Patient participation rates could be improved by forming an experienced and dedicated study team.
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Affiliation(s)
- Diane A J van der Biessen
- Department of Medical Oncology, Erasmus University Medical Center – Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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15
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Smith DL. Patient Nonadherence in Clinical Trials: Could There Be a Link to Postmarketing Patient Safety? ACTA ACUST UNITED AC 2012. [DOI: 10.1177/0092861511428300] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gordon EJ, Bergeron A, McNatt G, Friedewald J, Abecassis MM, Wolf MS. Are informed consent forms for organ transplantation and donation too difficult to read? Clin Transplant 2011; 26:275-83. [PMID: 21585548 DOI: 10.1111/j.1399-0012.2011.01480.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Informed consent for organ transplantation and donation is an ethical obligation, legally required, and considered as part of the Patient's Rights Condition of Medicare Participation for hospitals. National policy-makers recommend that informed consent forms and patient education materials be written at a low reading level (5th-8th grade level) to facilitate patient comprehension. We assessed reading levels of informed consent forms (CFs) for adult organ transplant recipients and living organ donors across US transplant centers. CFs were analyzed using three measures of reading level: Lexile Measure, Flesch-Kincaid Grade Level, and the Gunning Fog Index. Of active transplant centers contacted (N=209), 75 (36%) sent a total of 332 CFs. CFs were written, on average, at the college level, which is a considerably higher reading level than the standards set by policy-makers. CF reading levels were negatively correlated with transplant center volume (r=-0.119; p<0.03). CFs for intestine transplantation and for evaluation/listing were the easiest to read, while consent forms for liver transplantation/donation and pre-transplant agreements were the most difficult to read. Reducing CFs' reading level may help to increase patient comprehension for adequate informed consent.
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery, Comprehensive Transplant Center, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3152, USA.
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Ménoni V, Lucas N, Leforestier JF, Doz F, Chatellier G, Jacqz-Aigain E, Giraud C, Tréluyer JM, Chappuy H. Readability of the written study information in pediatric research in France. PLoS One 2011; 6:e18484. [PMID: 21494689 PMCID: PMC3071832 DOI: 10.1371/journal.pone.0018484] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/09/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim was to evaluate the readability of research information leaflets (RIL) for minors asked to participate in biomedical research studies and to assess the factors influencing this readability. METHODS AND FINDINGS All the pediatric protocols from three French pediatric clinical research units were included (N = 104). Three criteria were used to evaluate readability: length of the text, Flesch's readability score and presence of illustrations. We compared the readability of RIL to texts specifically written for children (school textbooks, school exams or extracts from literary works). We assessed the effect of protocol characteristics on readability. The RIL had a median length of 608 words [350 words, 25(th) percentile; 1005 words, 75(th) percentile], corresponding to two pages. The readability of the RIL, with a median Flesch score of 40 [30; 47], was much poorer than that of pediatric reference texts, with a Flesch score of 67 [60; 73]. A small proportion of RIL (13/91; 14%) were illustrated. The RIL were longer (p<0.001), more readable (p<0.001) and more likely to be illustrated (p<0.009) for industrial than for institutional sponsors. CONCLUSION Researchers should routinely compute the reading ease of study information sheets and make greater efforts to improve the readability of written documents for potential participants.
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Affiliation(s)
- Véronique Ménoni
- Unité de Recherche Clinique Paris Centre, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Laboratoire d'Ethique Médicale, Université Paris Descartes, Paris, France
- CIC P0901 Mère Enfant, Inserm, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Noël Lucas
- CIC E4 Inserm, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Jean-François Leforestier
- CIC E4 Inserm, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - François Doz
- Service de pédiatrie, Institut Curie, Université Paris Descartes, Paris, France
| | - Gilles Chatellier
- CIC E4 Inserm, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Evelyne Jacqz-Aigain
- Centre d'Investigation Clinique Inserm 9202, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Carole Giraud
- Unité de Recherche Clinique Paris Centre, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- CIC P0901 Mère Enfant, Inserm, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
- EA3620, Université Paris Descartes, Paris, France
| | - Jean-Marc Tréluyer
- Unité de Recherche Clinique Paris Centre, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- CIC P0901 Mère Enfant, Inserm, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, Paris, France
- Pharmacologie, Groupe Hospitalier Broca Cochin Hôtel Dieu, Assistance Publique Hôpitaux de Paris, Paris, France
- EA3620, Université Paris Descartes, Paris, France
| | - Hélène Chappuy
- Unité de Recherche Clinique Paris Centre, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Laboratoire d'Ethique Médicale, Université Paris Descartes, Paris, France
- EA3620, Université Paris Descartes, Paris, France
- Service d'Urgences Pédiatriques, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
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