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Current landscape of research ethics consultation services: National survey results. J Clin Transl Sci 2023; 6:e148. [PMID: 36756077 PMCID: PMC9879897 DOI: 10.1017/cts.2022.470] [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: 04/20/2022] [Revised: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction The goal of a research ethics consultation service (RECS) is to assist relevant parties in navigating the ethical issues they encounter in conduct of research. The goal of this survey was to describe the current landscape of research ethics consultation and document if and how it has changed over the last decade. Methods The survey instrument was based on the survey previously circulated. We included a number of survey domains from the previous survey with the goal of direct comparison of outcomes. The survey was sent to 57 RECS in the USA and Canada. Results Forty-nine surveys were completed for an overall response rate of 86%. With the passing of 10 years, the volume of consults received by RECS surveyed has increased. The number of consults received by a subset of RECS remains low. RECS continues to receive requests for consults from a wide range of stakeholders. About a quarter of RECS surveyed actively evaluate their services, primarily through satisfaction surveys routinely shared with requestors. The number of RECS evaluating their services has increased. We identified a group of eight key competencies respondents find as key to providing RECS. Conclusions The findings from our survey demonstrate that there have been growth and development of RECS since 2010. Further developing evaluation and competency guidelines will help existing RECS continue to grow and facilitate newly established RECS maturation. Both will allow RECS personnel to better serve their institutions and add value to the research conducted.
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Eder M(M. Aligning clinical research ethics with community-engaged and participatory research in the United States. Front Public Health 2023; 11:1122479. [PMID: 37213625 PMCID: PMC10192870 DOI: 10.3389/fpubh.2023.1122479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
The professional role in ethical review of research in which boards review proposed research involving human beings continues to evolve. The scholarly literature on institutional review boards in academic centers of the United States, at which a majority of the community engaged and participatory research emanates and is reviewed, suggests the need to implement changes in board education, the infrastructure supporting review, and the accountability of review. The recommendations for change advanced in this perspective involve enhancing reviewer knowledge of local community contexts and developing an infrastructure that supports engagement in and dialogue among individuals involved in community-academic research to inform ethical review and the assessment of review outcomes. Additionally, recommendations regarding putting an institutional infrastructure in place are advanced in order to sustain community engaged and participatory research. The infrastructure can also support the collection and review of outcome data as the foundation of accountability. The recommendations outlined intend to improve clinical research ethics reviews of community-engaged and participatory research.
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Taylor HA, Porter KM, Paquette ET, McCormick JB, Tumilty E, Arnold JF, Spector-Bagdady K, Danis M, Brandt D, Shah J, Wilfond BS, Lee LM. Creating a Research Ethics Consultation Service: Issues to Consider. Ethics Hum Res 2021; 43:18-25. [PMID: 34496156 DOI: 10.1002/eahr.500101] [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: 11/09/2022]
Abstract
This article provides pragmatic advice for organizations interested in creating a research ethics consultation service (RECS). A robust RECS has the potential to build capacity among investigators to identify and consider the ethical issues they encounter while conducting their research. Determining whether to establish an RECS should begin with an institutional-needs assessment that includes three key questions: What are the current resources available to research teams to navigate ethical concerns that arise from their research? Is there a demand or perceived need for more resources? Is there institutional support (financial and otherwise) to establish and maintain an RECS? If this results in the decision to establish the consultation service, relevant institutional stakeholders must be identified and consulted, and personnel with the requisite skills recruited. The next step is to establish an RECS and build the infrastructure to process and respond to requests. The RECS's long-term sustainability will depend on a stable source of funding and a mechanism to receive constructive feedback to ensure that the service is meeting the institutional needs it set out to address.
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Affiliation(s)
- Holly A Taylor
- Research bioethicist in the Department of Bioethics at the Clinical Center at the National Institutes of Health
| | - Kathryn M Porter
- Research scientist at the Seattle Children's Hospital and Research Institute
| | - Erin Talati Paquette
- Assistant professor of pediatrics (critical care) at the Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago and an assistant professor of law (by courtesy) at the Northwestern University Pritzker School of Law
| | - Jennifer B McCormick
- Associate professor in the Department of Humanities in the College of Medicine at the Pennsylvania State University
| | - Emma Tumilty
- Bioethicist and lecturer at the School of Medicine in the Faculty of Health at Deakin University Waurn Ponds, Geelong, Australia
| | - Jason F Arnold
- Senior fellow of bioethics and health policy and the assistant director of the CTR fellowship program at the Institute of Human Values in Health Care at the Medical University of South Carolina
| | - Kayte Spector-Bagdady
- Associate director of the Center for Bioethics & Social Sciences in Medicine and an assistant professor of obstetrics and gynecology at the University of Michigan Medical School
| | - Marion Danis
- Head of the section on ethics and health policy in the Department of Bioethics at the Clinical Center of the National Institutes of Health
| | - Debra Brandt
- Research assistant professor in the Department of Obstetrics and Gynecology at the University of Iowa
| | - Jina Shah
- Senior director of patient safety and pharmacovigilance at Kite, a Gilead Sciences company, in Santa Monica, CA
| | - Benjamin S Wilfond
- Professor in the divisions of bioethics and palliative care and pulmonary and sleep medicine in the Department of Pediatrics at the Seattle Children's Hospital and Research Institute at the University of Washington School of Medicine
| | - Lisa M Lee
- Associate vice president for research and innovation, the director of scholarly integrity and research compliance, and a professor of population health sciences at Virginia Tech
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Harris KW, Cunningham TV, Hester DM, Armstrong K, Kim A, Harrell FE, Fanning JB. Comparison Is Not a Zero-Sum Game: Exploring Advanced Measures of Healthcare Ethics Consultation. AJOB Empir Bioeth 2021; 12:123-136. [PMID: 33215975 DOI: 10.1080/23294515.2020.1844820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Studies across the healthcare spectrum consistently show that sharing and comparing data across institutions improves the quality of patient care. Whether comparing data about healthcare ethics consultation (HCEC) would similarly improve quality is unknown due to the lack of research on HCEC data sharing and comparison. Methods: To explore this possibility, we analyzed data from two academic medical centers in the Central-Southern United States that both employ a shared, robust coding system for ethics consultations (N = 703 cases total over 2.5 years) using descriptive and chi-square statistics, correlation coefficients and logistic regressions. Results: Our findings relate to patient age, care location, requestor role, and ethical themes, which together contribute to an improved evidence base for explanatory analyses and quality improvement initiatives. Conclusions: We conclude it is possible to analyze and compare HCEC activities across separate institutions using a standardized approach to data gathering, that this approach is consistent with concurrent narrative case review and assessment, and that cross-institutional comparisons are meaningful. Our results suggest future comparative analyses will require additional standardization of advanced measures for describing and analyzing HCEC activities.
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Affiliation(s)
- Kelly W Harris
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas V Cunningham
- Kaiser Permanente Southern California Bioethics Program, Los Angeles, California, USA
| | - D Micah Hester
- Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kelly Armstrong
- Clinical and Organizational Ethics, Inova Health System, Falls Church, Virginia, USA
| | - Ahra Kim
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Frank E Harrell
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph B Fanning
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Tozzo P, Mazzi A, Aprile A, Rodriguez D, Caenazzo L. Certification ISO 9001 in clinical ethics consultation for improving quality and safety in healthcare. Int J Qual Health Care 2018; 30:486-491. [PMID: 29590373 DOI: 10.1093/intqhc/mzy047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/08/2018] [Indexed: 12/27/2022] Open
Abstract
This paper refers to the quality management process of the Laboratory of Clinical Bioethics (LCB) of the University of Padua (Italy), which has obtained the quality certification to ISO 9001:2008, as a Clinical Ethics Support Service. Its activities consist mainly in clinical ethics consultations and training services, addressed to those who are called to decisions with ethical implications in the clinical setting, proposing a structured approach to identify and analyze the ethical issues that may loom in the relationships between health professionals and patients, and participating in their solution. The expected benefits of the application of ISO 9001 were mainly the following: to formalize the procedure adopted for clinical ethics consultation and training, to obtain a controlled management of documents, information and data, to ensure and demonstrate the quality of the provided activities and to make methods and organization publicly available. The main results which have been achieved with the 'quality management project' are summarized as follows: the enunciation of LCB Mission and Quality Policy; the drafting of the procedure by which clinical ethics consultation is provided; the formalization of members' skills and the adoption of relevant process and outcome indicators. Our experience may be useful in promoting accountability for the quality of ethics consultation services. We consider the certification process as a tool for transparent and reliable management of one of the most critical tasks in the current context of healthcare, motivating similar facilities to undertake similar pathways, with the aim to provide quality control on their activities.
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Affiliation(s)
- Pamela Tozzo
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Anna Mazzi
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Anna Aprile
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Daniele Rodriguez
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Luciana Caenazzo
- Department of Molecular Medicine, University of Padova, Padova, Italy
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Yanagawa H, Katashima R, Sato C, Takechi K, Nokihara H, Kane C, Chuma M, Aoe Y. Research ethics consultation: an attempt and 5-year experience in a Japanese University Hospital. BMC Res Notes 2018; 11:665. [PMID: 30208946 PMCID: PMC6134693 DOI: 10.1186/s13104-018-3772-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/07/2018] [Indexed: 11/21/2022] Open
Abstract
Objective Research ethics consultation is an advisory activity that differs from ethics committees, and its role is not yet widely known in Japan. Research ethics consultations were started in 2012 by members of the Clinical Trial Center of Tokushima University Hospital, a support section for clinical trials. We analyzed the research ethics consultation records from Tokushima University Hospital during the 5-year period of 2012–2016 to examine the Japanese context of research ethics consultation. Results During the study period, 125 research ethics consultations were carried out, 115 (91%) before starting studies. All but one request were from investigators at Tokushima University. The main issue was compatibility with guidance and regulations (n = 74, 67.2%), such as ethical handling of human biological specimens and information utilized in research; only 6 (4.8%) requests involved research ethics issues that investigators face in their research. Therefore, it is necessary to expand the consultation function, with a nationwide system of consultant education and data sharing. Moreover, standardization of consultation should be considered.
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Affiliation(s)
- Hiroaki Yanagawa
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan.
| | - Rumi Katashima
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan
| | - Chiho Sato
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan
| | - Kenshi Takechi
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan
| | - Hiroshi Nokihara
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan
| | - Chikako Kane
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan
| | - Masayuki Chuma
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan
| | - Yuki Aoe
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Kuramoto-cho 2, Tokushima, 770-8503, Japan
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Eckstein L, Otlowski M. Strategies to Guide the Return of Genomic Research Findings: An Australian Perspective. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:403-415. [PMID: 29767375 DOI: 10.1007/s11673-018-9856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 01/17/2018] [Indexed: 06/08/2023]
Abstract
In Australia, along with many other countries, limited guidance or other support strategies are currently available to researchers, institutional research ethics committees, and others responsible for making decisions about whether to return genomic findings with potential value to participants or their blood relatives. This lack of guidance results in onerous decision-making burdens-traversing technical, interpretative, and ethical dimensions-as well as uncertainty and inconsistencies for research participants. This article draws on a recent targeted consultation conducted by the Australian National Health and Medical Research Council to put forward strategies for supporting return of finding decision-making. In particular, we propose a pyramid of decision-making support: decision-making guidelines, technical and interpretative assistance, and ethical assistance for intractable "tough" cases. Each step of the pyramid involves an increasing level of regulatory involvement and applies to a smaller subsection of genomic research findings. Implementation of such strategies would facilitate a growing evidence base for return of finding decisions, thereby easing the financial, time, and moral burdens currently placed on researchers and other relevant decision-makers while also improving the quality of such decisions and, consequently, participant outcomes.
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Affiliation(s)
- Lisa Eckstein
- Faculty of Law, University of Tasmania, Private Bag 89, Hobart, Tasmania, 7001, Australia.
| | - Margaret Otlowski
- Faculty of Law, University of Tasmania, Private Bag 89, Hobart, Tasmania, 7001, Australia
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Nicholls SG. Commentary on "Regulatory Support Improves Subsequent IRB/REC Approval Rates in Studies Initially Deemed Not Ready for Review: A CTSA Institution's Experience". J Empir Res Hum Res Ethics 2018; 13:145-147. [PMID: 29347871 DOI: 10.1177/1556264617752190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In response to researcher concerns a number of initiatives have been developed to support individual researchers seeking ethics review and approval. In this issue, Sonne et al. (2017) outline an example of an intervention to support researchers, which they refer to as a Regulatory Knowledge Support (RKS) service. While the study points to potential benefits, other studies have not had the desired impact on key performance measures. There is a need to develop a community of practice and expand the burgeoning evidence base regarding what interventions work, for whom, and under what circumstances. Advancing the research agenda requires: the development of theoretical models for intervention design and evaluation; developing consensus on key data for collection and measures of effectiveness; conducting evaluations using the strongest possible study designs, and; publishing the findings of evaluations.
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Arnold JF, Boan AD, Lackland DT, Sade RM. Clinical and Translational Research Ethics: Training Consultants and Biomedical Research Personnel. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:57-61. [PMID: 29313773 DOI: 10.1080/15265161.2017.1401172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Paquette ET, Ross L. The Challenges of Incorporating Research Ethics Consultation Into Institutional Human Subjects Protections Programs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:49-51. [PMID: 29313769 PMCID: PMC6214683 DOI: 10.1080/15265161.2017.1401179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - Lainie Ross
- b University of Chicago and MacLean Center for Clinical Medical Ethics
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Porter KM, Danis M, Taylor HA, Cho MK, Wilfond BS. The Emergence of Clinical Research Ethics Consultation: Insights From a National Collaborative. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:39-45. [PMID: 29313771 PMCID: PMC6188703 DOI: 10.1080/15265161.2017.1401156] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards (IRBs), to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation (REC) services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research.
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Cole AM, Baldwin LM, Keppel GA, Kuwana E, Mollis BL, Wilfond BS. Conflicts of Interest and Distribution of Resources to Community Partners: An Organizational Ethics Dilemma. Prog Community Health Partnersh 2017; 11:99-106. [PMID: 28603156 DOI: 10.1353/cpr.2017.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Conflicts of interest can arise when faculty and staff administer programs that distribute research funds, training opportunities, and other resources across academic and community partners. We describe the ethical concerns encountered by a Clinical Translational Science Award (CTSA) program in administering its community-focused pilot grant program and how its Research Bioethics Consultation service helped to address them.Ethical Concerns: CTSA program faculty and staff identified ethical concerns in several areas, including appropriateness of including Regional Research Collaborations (RRC) faculty as principal or co-investigators on applications, determining how much help RRC faculty and staff should provide to prospective applicants, and creating a fair and effective application review process. DISCUSSION The CTSA program identified common goals and values for its community-focused pilot grant program, and resolved the conflicts of interest with the new pilot grant policies. This approach could generalize to conflicts of interest that arise in other academic-community partnerships.
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