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McCausland D, Haigh M, McCallion P, McCarron M. IRB challenges in multisite studies: A case report and commentary from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). HRB Open Res 2024; 7:3. [PMID: 38784966 PMCID: PMC11109535 DOI: 10.12688/hrbopenres.13854.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 05/25/2024] Open
Abstract
A shift from single to multi-site health studies enabled a range of research benefits including faster recruitment of larger and more diverse samples; increased statistical power, greater rigour, generalisability, and external reliability; and increased likelihood of impacting policy and clinical practice. However, ethical review of multi-site studies by Institutional Review Boards (IRBs) raises specific challenges compared with single site studies, with requirements to apply to multiple local IRBs increasing the burden on research, possibly endangering the integrity of the research process or inhibiting development of multi-site studies. The option of a single centralised IRB may offer a clearer, more consistent and efficient review process. This study presents a case report and commentary from 15 years engaging with IRBs in multiple sites in Ireland by the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). It examines the ethics review process for IDS-TILDA through its first four waves. While the majority of 48 IRBs granted ethical approval within 13 weeks, six IRBs took 21-47 weeks to approve, leading to delays in data collection of up to 11 months. Despite additional review time, no changes were required to the study protocol. Therefore, a critical impact of the process was the delay in starting data collection within a small number of organisations, and reduced involvement in the study for one organisation. The ethical review process with multiple IRBs increased the degree of complexity of the process, with added bureaucracy and far greater communication required across 48 IRBs, substantially adding to the resource commitment for the review process. The relatively quick approval from the majority of IRBs was partially a result of the longitudinal study building relationships with organisations throughout multiple waves. That other health studies may not accrue this benefit supports calls for a single IRB system for multi-site health studies.
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Affiliation(s)
- Darren McCausland
- Trinity Centre for Ageing and Intellectual Disability, The University of Dublin Trinity College, Dublin, Leinster, Ireland
| | - Margaret Haigh
- Trinity Centre for Ageing and Intellectual Disability, The University of Dublin Trinity College, Dublin, Leinster, Ireland
| | | | - Mary McCarron
- Trinity Centre for Ageing and Intellectual Disability, The University of Dublin Trinity College, Dublin, Leinster, Ireland
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2
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Samir N, Amarasena L, Sealy L, Hodgins M, Gelaw Y, Lingam R, Zwi K. Ethics and governance for a multi-site study in Australia: Navigating the snakes and ladders. J Paediatr Child Health 2022; 58:16-23. [PMID: 34529302 DOI: 10.1111/jpc.15747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/26/2021] [Accepted: 09/05/2021] [Indexed: 11/28/2022]
Abstract
Multi-site research studies are essential if we are to conduct national research across all Australian jurisdictions. There is widespread agreement among clinicians and researchers that obtaining essential approvals to conduct multi-site research studies in Australia can be complex, bureaucratic and time consuming. Although there is inherent value in the review process, resources and months of valuable research time are often expended long before the study has begun. Using our recent experience for a multi-site, longitudinal paediatric cohort study of children and adolescents who were detained in offshore immigration detention on Nauru, we describe the process of navigating the ethics and governance approval systems. We identify tips for researchers and clinicians conducting multi-site studies, including early consultation with ethics and governance committees, using their recommended templates, anticipating time delays, and commencing time consuming processes as early as permissible. Our recommendations at the systemic level include streamlined and integrated ethics and governance review processes for all Australian jurisdictions, with co-ordinated requests for further information, a standardised approach across all Research Governance Offices, a rapid system for addressing amendments and individualised study support and consultations. Above all, a nationally agreed framework whereby ethics and governance committees across jurisdictions communicate with each other, use the same electronic platform and present a unified process whilst protecting the welfare, rights, dignity and safety of research participants is required. The complexity of the current ethics and governance processes may inadvertently and unintentionally be a barrier to conducting ethical research.
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Affiliation(s)
- Nora Samir
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Sealy
- Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Michael Hodgins
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yalemzewod Gelaw
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Tsan MF, Ling B, Feske U, Zickmund S, Stone R, Sonel A, Arnold RM, Fine M, Hall DE. Assessing the Quality and Performance of Institutional Review Boards: Levels of Initial Reviews. J Empir Res Hum Res Ethics 2020; 15:407-414. [PMID: 32917103 DOI: 10.1177/1556264620956795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
How well institutional review boards (IRBs) follow Common Rule criteria for levels of initial protocol review has not been systematically evaluated. We compared levels of review as determined using the Office for Human Research Protections (OHRP) human subject regulations decision charts of 313 protocols that had been approved by IRBs. There was a 97.8% agreement between 140 protocols that were reviewed by full board and the levels of review according to OHRP criteria. Likewise, there was a 93.8% agreement between 113 protocols that were reviewed using an expedited review procedure and OHRP criteria. However, there was only 75% agreement for exempt protocols. Specifically, 10 (16.7%) of the 60 exempt protocols were found to require IRB review, that is, six protocols requiring expedited review and four protocols requiring full board review. Conducting non-exempt research without prior IRB approval constitutes serious noncompliance. Our data suggest that exempt protocols need more scrutiny.
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Affiliation(s)
- Min-Fu Tsan
- McGuire Research Institute, Richmond, VA, USA
| | - Bruce Ling
- VA Pittsburgh Healthcare System, PA, USA.,University of Pittsburgh, PA, USA.,Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Susan Zickmund
- VA Pittsburgh Healthcare System, PA, USA.,VA Salt Lake City Healthcare System, UT, USA.,University of Utah, Salt Lake City, USA
| | | | - Ali Sonel
- VA Pittsburgh Healthcare System, PA, USA.,University of Pittsburgh, PA, USA
| | | | - Michael Fine
- VA Pittsburgh Healthcare System, PA, USA.,University of Pittsburgh, PA, USA
| | - Daniel E Hall
- VA Pittsburgh Healthcare System, PA, USA.,University of Pittsburgh, PA, USA
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4
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Duplancic C, Crough T, Bell SC. Multi-centre ethics and research governance review can impede non-interventional clinical research. Intern Med J 2018; 49:722-728. [PMID: 30417974 DOI: 10.1111/imj.14158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND The inter-jurisdictional National Mutual Acceptance (NMA) scheme for Human Research Ethics Committee (HREC) approvals of human research is designed to reduce the reported delays and costs of ethical review. Introduction of the NMA set forth an uncoupling of the ethics and governance review processes, permitting a single ethical review for multiple sites, while continuing separate governance review for each centre covering financial and operational aspects of the research project. AIM To compare the time required to gain ethics and governance approvals in Australia for a non-interventional investigator-led study from December 2015 to approval times for an earlier pre-NMA study utilising a similar study design and study sites and evaluate the effect that the NMA has had on total approval time for non-interventional multi-centre projects. METHODS We recorded the time taken to obtain ethics and governance approval at 16 sites for our nationwide low-risk non-interventional study looking at the prevalence and aetiology of non-tuberculous mycobacterial infection in people with cystic fibrosis in Australia. RESULTS Applications were submitted to three hospitals and one university HREC to conduct our study at 16 hospital sites, HREC approval took from 16 to 79 days (median 28). Subsequent site-specific governance approval at 15 hospital sites took 23-225 days (median 83). The entire process of gaining ethical and governance approval to conduct the study at 16 sites took 24 months at an estimated cost of AU$56000 (US$ 42 000). CONCLUSION Lengthy governance approval processes negate benefits gained from centralised ethics review under the NMA.
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Affiliation(s)
- Christine Duplancic
- Lung Bacteria, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tania Crough
- Office of Research, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Scott C Bell
- Lung Bacteria, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Office of Research, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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5
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Ferguson A, Master Z. Multisite Research Ethics Review: Problems and Potential Solutions. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044265ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Large scale, multisite clinical research trials have been increasing in frequency. As it stands currently, a research project performed at multiple institutions requires ethics review at each institution. While local (institutional) review may be necessary in some instances, repetitive reviews may require unnecessary changes and not serve to further protect participants. Multiple ethics reviews of a single study have been shown to delay research and require, in some cases, significant resources in order to fulfill the requests of individual ethics boards. This literature review discusses the conceptual issues and outlines empirical research surrounding multisite ethics review from different jurisdictions, as well as alternative methods to streamline the ethics review process including reciprocal review, centralized review, and a proposed modification to the centralized review process.
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Affiliation(s)
- Aidan Ferguson
- Virginia Commonwealth University’s School of Social Work, Virginia, USA
| | - Zubin Master
- Alden March Bioethics Institute, Albany Medical College, New York, USA
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6
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Pratt B, Paul A, Hyder AA, Ali J. Ethics of health policy and systems research: a scoping review of the literature. Health Policy Plan 2017; 32:890-910. [DOI: 10.1093/heapol/czx003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/12/2022] Open
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Barnett AG, Campbell MJ, Shield C, Farrington A, Hall L, Page K, Gardner A, Mitchell BG, Graves N. The high costs of getting ethical and site-specific approvals for multi-centre research. Res Integr Peer Rev 2016; 1:16. [PMID: 29451546 PMCID: PMC5803625 DOI: 10.1186/s41073-016-0023-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/25/2016] [Indexed: 11/24/2022] Open
Abstract
Background Multi-centre studies generally cost more than single-centre studies because of larger sample sizes and the need for multiple ethical approvals. Multi-centre studies include clinical trials, clinical quality registries, observational studies and implementation studies. We examined the costs of two large Australian multi-centre studies in obtaining ethical and site-specific approvals. Methods We collected data on staff time spent on approvals and expressed the overall cost as a percent of the total budget. Results The total costs of gaining approval were 38 % of the budget for a study of 50 centres (mean cost AUD $6960 per site) and 2 % for a study of 11 centres (mean cost AUD $2300 per site). Seventy-five and 90 % of time was spent on repeated tasks, respectively, and many time-consuming tasks, such as reformatting documents, did nothing to improve the study design or participant safety. Conclusions Improvements have been made to the ethical approval application system, but more gains could be made without increasing risks of harm to research participants. We propose that ethical review bodies and individual sites publish statistics on how long they take to process approvals which could then be nationally benchmarked.
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Affiliation(s)
- Adrian G Barnett
- 1Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, Queensland 4059 Australia
| | - Megan J Campbell
- 1Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, Queensland 4059 Australia
| | - Carla Shield
- 1Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, Queensland 4059 Australia
| | - Alison Farrington
- 1Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, Queensland 4059 Australia
| | - Lisa Hall
- 1Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, Queensland 4059 Australia
| | - Katie Page
- 1Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, Queensland 4059 Australia
| | - Anne Gardner
- 2School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, Canberra, Australia
| | - Brett G Mitchell
- 3Faculty of Arts, Nursing and Theology, Avondale College for Higher Education, Wahroonga, New South Wales Australia
| | - Nicholas Graves
- 1Institute of Health and Biomedical Innovation & School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, Queensland 4059 Australia
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8
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White VM, Bibby H, Green M, Anazodo A, Nicholls W, Pinkerton R, Phillips M, Harrup R, Osborn M, Orme LM, Conyers R, Thompson K, Coory M. Inconsistencies and time delays in site-specific research approvals hinder collaborative clinical research in Australia. Intern Med J 2016; 46:1023-9. [DOI: 10.1111/imj.13191] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- V. M. White
- Cancer Council Victoria; Melbourne Victoria Australia
| | - H. Bibby
- Cancer Council Victoria; Melbourne Victoria Australia
| | - M. Green
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
| | - A. Anazodo
- Sydney Children's Hospital; Sydney New South Wales Australia
- Prince of Wales Hospital; Sydney New South Wales Australia
| | - W. Nicholls
- Children's Health Queensland; Brisbane Queensland Australia
| | - R. Pinkerton
- Children's Health Queensland; Brisbane Queensland Australia
| | - M. Phillips
- Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - R. Harrup
- Royal Hobart Hospital; Hobart Tasmania Australia
| | - M. Osborn
- Royal Adelaide Hospital; Adelaide South Australia Australia
| | - L. M. Orme
- Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - R. Conyers
- Royal Children's Hospital; Melbourne Victoria Australia
| | - K. Thompson
- Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - M. Coory
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
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Abstract
BACKGROUND Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers. AIM This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits. RESEARCH DESIGN The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal communication and the experiences of childbearing women, midwives and supporters. Participants and research context: Six women, 11 midwives and 11 childbirth supporters were filmed during the women's labours in hospital birth units and interviewed 6 weeks later. Ethical considerations: The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation. FINDINGS The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process. DISCUSSION The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies. CONCLUSION Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-based results.
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Affiliation(s)
| | | | | | - Nicky Leap
- University of Technology, Sydney, Australia
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10
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Varley PR, Feske U, Gao S, Stone RA, Zhang S, Monte R, Arnold RM, Hall DE. Time required to review research protocols at 10 Veterans Affairs Institutional Review Boards. J Surg Res 2016; 204:481-489. [PMID: 27565086 PMCID: PMC7224356 DOI: 10.1016/j.jss.2016.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/05/2016] [Accepted: 06/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite perceptions that institutional review boards (IRBs) delay research, little is known about how long it takes to secure IRB approval. We retrospectively quantified IRB review times at 10 large Veterans Affairs (VA) IRBs. METHODS We collected IRB records pertaining to a stratified random sample of research protocols drawn from 10 of the 26 largest VA IRBs. Two independent analysts abstracted dates from the IRB records, from which we calculated overall and incremental review times. We used multivariable linear regression to assess variation in total and incremental review times by IRB and review level (i.e., exempt, expedited, or full board) and to identify potential targets for efforts to improve the efficiency and uniformity of the IRB review process. RESULTS In a sample of 277 protocols, the mean review time was 112 d (95% confidence interval [CI]: 105-120). Compared with full-board reviews at IRB 1, average review times at IRBs 3, 8, 9, and 10 were 27 (95% CI: 6-48), 37 (95% CI: 11-63), 45 (95% CI: 20-69), and 24 (95% CI: 2-45) d shorter, and at IRB 6, times were 56 (95% CI: 28-84) d longer. Across all IRBs, expedited reviews were 44 (95% CI: 30-58) d shorter on average than were full-board reviews, with no significant difference between exempt and full-board reviews. However, after subtracting the time required for Research and Development Committee review, exempt reviews were 21 (95% CI: 1-41) d shorter on average than were full-board reviews. CONCLUSIONS IRB review times differ significantly by IRB and review level. Few VA IRBs approach a consensus panel goal of 60 d for IRB review. The unexpectedly longer review times for exempt protocols in the VA can be attributed to time required for Research and Development Committee review. Prospective, routine collection of key time points in the IRB review process could inform IRB-specific initiatives for reducing VA IRB review times.
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Affiliation(s)
- Patrick R Varley
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ulrike Feske
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Shasha Gao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Roslyn A Stone
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Sijian Zhang
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Robert Monte
- Veterans Engineering Resource Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Robert M Arnold
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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11
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Hall DE, Feske U, Hanusa BH, Ling BS, Stone RA, Gao S, Switzer GE, Dobalian A, Fine MJ, Arnold RM. Prioritizing Initiatives for Institutional Review Board (IRB) Quality Improvement. AJOB Empir Bioeth 2016; 7:265-274. [PMID: 32775502 DOI: 10.1080/23294515.2016.1186757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background Institutional Review Boards (IRBs) have been criticized for inconsistency, delay, and bias, suggesting an opportunity for quality improvement. To aid such quality improvement, this study aimed at determining IRB members' and investigators' priorities regarding IRB review at 10 Veterans Affairs (VA) IRBs. Methods 680 anonymous internet surveys were sent to 252 IRB members and staff, and 428 principal investigators and project coordinators at 9 VA Medical Centers and the VA Central IRB. Surveys included 27 statements adapted from Koocher and Kieth-Spiegel's IRB-RAT describing IRB activities or functions (e.g., "An IRB that is open to reversing its earlier decisions"). Respondents indicated how each statement described both their "ideal" and "actual" IRBs. The difference between the ratings of the actual and ideal IRBs was calculated for each item along with estimated 95% confidence intervals. Ratings outside those intervals indicated activities or functions with relatively good or poor performance compared to the ideal IRB. Results 390 (57.4%) responses from 165 IRB members and staff (65.5%) and 225 investigators and project coordinators (52.6%) demonstrated that these IRBs were closest to the ideal when protecting human subjects, treating investigators with respect, and taking appropriate action for alleged scientific misconduct. The IRBs were furthest from the ideal regarding duplicative forms, timeliness of review, and provision of complete rationales for decisions. Although IRB members reported near-ideal willingness to reverse earlier decisions, investigators rated this capacity far from ideal. Investigators rated IRB members' knowledge about procedures and policy as nearly ideal, but IRB members themselves rated this aspect far from ideal. Noteworthy site-level differences in the ratings of IRB functions and activities were also identified. Conclusions Although these VA IRBs perform well in some areas, these data support the need for ongoing quality improvement. The described method of administering and analyzing the IRB-RAT may help identify and monitor site- and activity- specific initiatives for quality improvement.
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Affiliation(s)
- Daniel E Hall
- VA Pittsburgh Healthcare System.,University of Pittsburgh
| | | | | | - Bruce S Ling
- VA Pittsburgh Healthcare System.,University of Pittsburgh
| | - Roslyn A Stone
- VA Pittsburgh Healthcare System.,University of Pittsburgh
| | | | | | | | - Michael J Fine
- VA Pittsburgh Healthcare System.,University of Pittsburgh
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Nicholls SG, Hayes TP, Brehaut JC, McDonald M, Weijer C, Saginur R, Fergusson D. A Scoping Review of Empirical Research Relating to Quality and Effectiveness of Research Ethics Review. PLoS One 2015. [PMID: 26225553 PMCID: PMC4520456 DOI: 10.1371/journal.pone.0133639] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background To date there is no established consensus of assessment criteria for evaluating research ethics review. Methods We conducted a scoping review of empirical research assessing ethics review processes in order to identify common elements assessed, research foci, and research gaps to aid in the development of assessment criteria. Electronic searches of Ovid Medline, PsychInfo, and the Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED, were conducted. After de-duplication, 4234 titles and abstracts were reviewed. Altogether 4036 articles were excluded following screening of titles, abstracts and full text. A total of 198 articles included for final data extraction. Results Few studies originated from outside North America and Europe. No study reported using an underlying theory or framework of quality/effectiveness to guide study design or analyses. We did not identify any studies that had involved a controlled trial - randomised or otherwise – of ethics review procedures or processes. Studies varied substantially with respect to outcomes assessed, although tended to focus on structure and timeliness of ethics review. Discussion Our findings indicate a lack of consensus on appropriate assessment criteria, exemplified by the varied study outcomes identified, but also a fragmented body of research. To date research has been largely quantitative, with little attention given to stakeholder experiences, and is largely cross sectional. A lack of longitudinal research to date precludes analyses of change or assessment of quality improvement in ethics review.
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Affiliation(s)
- Stuart G. Nicholls
- School of Epidemiology, Public health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| | - Tavis P. Hayes
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Jamie C. Brehaut
- School of Epidemiology, Public health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Michael McDonald
- The W. Maurice Young Centre for Applied Ethics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles Weijer
- Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Raphael Saginur
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Dean Fergusson
- School of Epidemiology, Public health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
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13
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Hall DE, Hanusa BH, Stone RA, Ling BS, Arnold RM. Time required for institutional review board review at one Veterans Affairs medical center. JAMA Surg 2015; 150:103-9. [PMID: 25494359 PMCID: PMC4527305 DOI: 10.1001/jamasurg.2014.956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite growing concern that institutional review boards (IRBs) impose burdensome delays on research, little is known about the time required for IRB review across different types of research. OBJECTIVE To measure the overall and incremental process times for IRB review as a process of quality improvement. DESIGN, SETTING, AND PARTICIPANTS After developing a detailed process flowchart of the IRB review process, 2 analysts abstracted temporal data from the records pertaining to all 103 protocols newly submitted to the IRB at a large urban Veterans Affairs medical center from June 1, 2009, through May 31, 2011. Disagreements were reviewed with the principal investigator to reach consensus. We then compared the review times across review types using analysis of variance and post hoc Scheffé tests after achieving normally distributed data through logarithmic transformation. MAIN OUTCOMES AND MEASURES Calendar days from initial submission to final approval of research protocols. RESULTS Initial IRB review took 2 to 4 months, with expedited and exempt reviews requiring less time (median [range], 85 [23-631] and 82 [16-437] days, respectively) than full board reviews (median [range], 131 [64-296] days; P = .008). The median time required for credentialing of investigators was 1 day (range, 0-74 days), and review by the research and development committee took a median of 15 days (range, 0-184 days). There were no significant differences in credentialing or research and development times across review types (exempt, expedited, or full board). Of the extreme delays in IRB review, 80.0% were due to investigators' slow responses to requested changes. There were no systematic delays attributable to the information security officer, privacy officer, or IRB chair. CONCLUSIONS AND RELEVANCE Measuring and analyzing review times is a critical first step in establishing a culture and process of continuous quality improvement among IRBs that govern research programs. The review times observed at this IRB are substantially longer than the 60-day target recommended by expert panels. The method described here could be applied to other IRBs to begin identifying and improving inefficiencies.
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Affiliation(s)
- Daniel E Hall
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania2Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Barbara H Hanusa
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Roslyn A Stone
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania3Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce S Ling
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania4Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M Arnold
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Driscoll A, Tonkin A, Stewart A, Worrall-Carter L, Thompson DR, Riegel B, Hare DL, Davidson PM, Mulvany C, Stewart S. Complexity of management and health outcomes in a prospective cohort study of 573 heart failure patients in Australia: does more equal less? J Clin Nurs 2013; 22:1629-38. [PMID: 23387324 DOI: 10.1111/jocn.12073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To compare the efficacy of chronic heart failure management programmes (CHF-MPs) according to a scoring algorithm used to quantify the level of applied interventions-the Heart Failure Intervention Score (HF-IS). BACKGROUND The overall efficacy of heart failure programmes has been proven in several meta-analyses. However, the debate continues as to which components are essential in a heart failure programme to improve patient outcomes. DESIGN Prospective cohort study of patients participating in heart failure programmes. METHOD Forty-eight of 62 (77%) programmes in Australia participating in a national register of CHF-MPs were evaluated using the HF-IS: derived from a summed and weighted score of each intervention applied by the CHF-MP (27 interventions overall). The CHF-MPs were prospectively categorised as relatively low (HF-IS < 190 - n = 39 programmes & 407 patients) or high (HF-IS ≥ 190 - n = 9 programmes & 166 patients) in complexity. Six-month morbidity and mortality rates in 573 consecutively recruited patients with systolic dysfunction and in New York Heart Association Class II-IV were prospectively examined. RESULTS Patients exposed to CHF-MPs with a high HF-IS had a lower rate of unplanned, all-cause hospitalisation (n = 24, 14% vs. n = 102, 25%) compared with CHF-MPs with a low HF-IS within six months. On an adjusted basis, CHF-MPs with a high HF-IS were associated with a reduced risk of unplanned hospitalisation and/or death within six months and remained event-free longer. CONCLUSION High complexity CHF-MPs applying more evidence-based interventions are associated with a higher event-free survival over six months. RELEVANCE TO CLINICAL PRACTICE The HF-IS is an easy-to-use evidence-based tool to assist programme coordinators to improve the quality of their heart failure programme which may also improve patient outcomes.
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Affiliation(s)
- Andrea Driscoll
- Faculty of Health, School of Nursing and Midwifery, Deakin University & Austin Health, Melbourne, Vic., Australia.
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Maskell J, Newcombe P, Martin G, Kimble R. Conducting a paediatric multi-centre RCT with an industry partner: challenges and lessons learned. J Paediatr Child Health 2012; 48:974-7. [PMID: 22892018 DOI: 10.1111/j.1440-1754.2012.02510.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are many benefits of multi-centred research including large sample sizes, statistical power, timely recruitment and generalisability of results. However, there are numerous considerations when planning and implementing a multi-centred study. This article reviews the challenges and successes of planning and implementing a multi-centred prospective randomised control trial involving an industry partner. The research investigated the impact on psychosocial functioning of a cosmetic camouflage product for children and adolescents with burn scarring. Multi-centred studies commonly have many stakeholders. Within this study, six Australian and New Zealand paediatric burn units as well as an industry partner were involved. The inclusion of an industry partner added complexities as they brought different priorities and expectations to the research. Further, multifaceted ethical and institutional approval processes needed to be negotiated. The challenges, successes, lessons learned and recommendations from this study regarding Australian and New Zealand ethics and research governance approval processes, collaboration with industry partners and the management of differing expectations will be outlined. Recommendations for future multi-centred research with industry partners include provision of regular written reports for the industry partner; continual monitoring and prompt resolution of concerns; basic research practices education for industry partners; minimisation of industry partner contact with participants; clear roles and responsibilities of all stakeholders and utilisation of single ethical review if available.
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Affiliation(s)
- Jessica Maskell
- Department of Paediatrics and Child Health, The University of Queensland, Brisbane, Australia.
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Halkoaho A, Pietilä AM, Vesalainen M, Vähäkangas K. Ethical aspects in tissue research: thematic analysis of ethical statements to the research ethics committee. BMC Med Ethics 2012; 13:20. [PMID: 22873761 PMCID: PMC3472195 DOI: 10.1186/1472-6939-13-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 07/30/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies have been published about ethics committees and the clarifications requested about the submitted applications. In Finland, ethics committees require a separate statement on ethical aspects of the research in applications to the ethics committee. However, little is known about how researchers consider the ethical aspects of their own studies. METHODS The data were collected from all the applications received by the official regional ethics committee in the Hospital District of Northern Savo during 2004-2009 (n = 688). These included a total of 56 studies involving research on tissue other than blood. The statements by the researchers about the ethics about their own research in these applications were analyzed by thematic content analysis under the following themes: recruitment, informed consent, risks and benefits, confidentiality and societal meaning. RESULTS The researchers tended to describe recruitment and informed consent process very briefly. Usually these descriptions simply stated who the recruiter was and that written consent would be required. There was little information provided on the recruitment situation and on how the study recruiters would be informed. Although most of the studies were clinical, the possibility was hardly ever discussed that patients could fail to distinguish between care and research. CONCLUSION The written guidelines, available on the webpages of the ethics committee, do not seem to be enough to help researchers achieve this goal. In addition to detailed guidelines for researchers, investigators need to be taught to appreciate the ethical aspects in their own studies.
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Affiliation(s)
- Arja Halkoaho
- Faculty of Health Sciences, University of Eastern Finland, Research Unit/Research Ethics Committee, University Hospital of Kuopio, PO Box 1777, 70210 , Kuopio, Finland.
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Lutz K, Wilton K, Zytaruk N, Julien L, Hall R, Harvey J, Skrobik Y, Vlahakis N, Meade L, Matte A, Meade M, Burns K, Albert M, Cash BB, Vallance S, Klinger J, Heels-Ansdell D, Cook D. Research ethics board approval for an international thromboprophylaxis trial. J Crit Care 2012; 27:225-31. [PMID: 22305662 DOI: 10.1016/j.jcrc.2011.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 08/16/2011] [Accepted: 12/10/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research ethics board (REB) review of scientific protocols is essential, ensuring participants' dignity, safety, and rights. The objectives of this study were to examine the time from submission to approval, to analyze predictors of approval time, and to describe the scope of conditions from REBs evaluating an international thromboprophylaxis trial. METHODS We generated survey items through literature review and investigators' discussions, creating 4 domains: respondent and institutional demographics, the REB application process, and alternate consent models. We conducted a document analysis that involved duplicate assessment of themes from REB critique of the protocol and informed consent forms (ICF). RESULTS Approval was granted from 65 REB institutions, requiring 58 unique applications. We analyzed 44 (75.9%) of 58 documents and surveys. Survey respondents completing the applications had 8 (5-12) years of experience; 77% completed 4 or more REB applications in previous 5 years. Critical care personnel were represented on 54% of REBs. The time to approval was a median (interquartile range) of 75 (42, 150) days, taking longer for sites with national research consortium membership (89.1 vs 31.0 days, P = .03). Document analysis of the application process and ICF yielded 5 themes: methodology, data management, consent procedures, cataloguing, and miscellaneous. Protocol-specific themes focused on trial implementation, external critiques, and budget. The only theme specific to the ICF was risks and benefits. The most frequent comments on the protocol and ICF were about methodology and miscellaneous issues; ICF comments also addressed study risks and benefits. CONCLUSIONS More studies on methods to enhance efficiency and consistency of the REB approval processes for clinical trials are needed while still maintaining high ethical standards.
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Affiliation(s)
- Kristina Lutz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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18
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Driscoll A, Tonkin A, Stewart A, Thompson DR, Worrall-Carter L, Riegel B, Hare DL, Davidson PM, Stewart S. Development of an evidence-based scoring system (HF-IS) to assess the quality of heart failure programmes for patients postdischarge from hospital. J Clin Nurs 2011; 20:3011-9. [DOI: 10.1111/j.1365-2702.2010.03687.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bucknall TK, Jones D, Barrett J, Bellomo R, Botti M, Considine J, Currey J, Dunning TL, Green D, Levinson M, Livingston PM, O'Connell B, Ruseckaite R, Staples M. Point prevalence of patients fulfilling MET criteria in ten MET equipped hospitals. The methodology of the RESCUE study. Resuscitation 2011; 82:529-34. [PMID: 21345573 DOI: 10.1016/j.resuscitation.2011.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/21/2010] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. DESIGN AND SETTING A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. PATIENTS All inpatients were eligible except intensive care and psychiatric patients. MEASUREMENT AND MAIN RESULTS On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. CONCLUSION In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.
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Palmour N, Affleck W, Bell E, Deslauriers C, Pike B, Doyon J, Racine E. Informed consent for MRI and fMRI research: analysis of a sample of Canadian consent documents. BMC Med Ethics 2011; 12:1. [PMID: 21235768 PMCID: PMC3033859 DOI: 10.1186/1472-6939-12-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 01/14/2011] [Indexed: 11/18/2022] Open
Abstract
Background Research ethics and the measures deployed to ensure ethical oversight of research (e.g., informed consent forms, ethics review) are vested with extremely important ethical and practical goals. Accordingly, these measures need to function effectively in real-world research and to follow high level standards. Methods We examined approved consent forms for Magnetic Resonance Imaging (MRI) and functional Magnetic Resonance Imaging (fMRI) studies approved by Canadian research ethics boards (REBs). Results We found evidence of variability in consent forms in matters of physical and psychological risk reporting. Approaches used to tackle the emerging issue of incidental findings exposed extensive variability between and within research sites. Conclusion The causes of variability in approved consent forms and studies need to be better understood. However, mounting evidence of administrative and practical hurdles within current ethics governance systems combined with potential sub-optimal provision of information to and protection of research subjects support other calls for more scrutiny of research ethics practices and applicable revisions.
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Affiliation(s)
- Nicole Palmour
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Canada
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Kidd TJ, Marks GB, Bye PTP, Wainwright CE, Robinson PJ, Rose BR, Harbour C, Bell SC. Multi-centre research in Australia: analysis of a recent National Health and Medical Research Council-funded project. Respirology 2009; 14:1051-5. [PMID: 19740265 DOI: 10.1111/j.1440-1843.2009.01595.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Human research ethics committees provide essential review of research projects to ensure the ethical conduct of human research. Several recent reports have highlighted a complex process for successful application for human research ethics committee approval, particularly for multi-centre studies. Limited resources are available for the execution of human clinical research in Australia and around the world. METHODS This report overviews the process of ethics approval for a National Health and Medical Research Council-funded multi-centre study in Australia, focussing on the time and resource implications of such applications in 2007 and 2008. RESULTS Applications were submitted to 16 hospital and two university human research ethics committees. The total time to gain final approval from each committee ranged between 13 and 77 days (median = 46 days); the entire process took 16 months to complete and the research officer's time was estimated to cost $A34 143. CONCLUSIONS Obstacles to timely human research ethics committee approval are reviewed, including recent, planned and potential initiatives that could improve the ethics approval of multi-centre research.
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Affiliation(s)
- Timothy J Kidd
- School of Medicine, University of Queensland, Brisbane, QLD, Australia.
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