1
|
Zheng R, Wang J, Wang Y, Zhu P, Wang L, Zhang Z, Dong F. "Let them be": Family members' perspectives on the participation of advanced cancer patients in nursing research: A qualitative descriptive study. Int J Nurs Stud 2024; 155:104772. [PMID: 38676991 DOI: 10.1016/j.ijnurstu.2024.104772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Recruiting advanced cancer patients is crucial for nursing research in cancer care. However, nurse researchers often face various socio-cultural challenges, particularly in mainland China, where cultural taboos around death pose significant obstacles. An unexplored constraint in this context is the pivotal role Chinese family members play in patients' healthcare decision-making. This research gap underscores the need for a deeper understanding of Chinese family members' perspectives on the engagement of advanced cancer patients in nursing research. OBJECTIVE To explore the perceptions and concerns of family members regarding the recruitment and participation of advanced cancer patients in nursing research. DESIGN A qualitative descriptive study was conducted. SETTINGS Three cancer hospitals in mainland China. PARTICIPANTS A purposive sample of 18 family members, consisting of children or spouses of advanced cancer patients, was recruited as participants. METHODS Semi-structured interviews were conducted to collect data between September 2022 and January 2023. The thematic analysis method was used to analyze the data. RESULTS Three themes were identified: The absence of prior participation, Family members' reluctance to facilitate patient involvement, and Strategies to encourage patients' future participation. Family members were hesitant to allow their relatives with advanced cancer to engage in nursing research, primarily due to concerns about distressing patients, the use of potential sensitive language, stigma, and the risks involved in participation. To address these concerns, they emphasized the importance of gaining family approval prior to patient enrolment. They highlighted the need of family involvement on behalf of sick relatives in research, advocating for the inclusion of a wide range of patients rather than targeting specific subgroups. They also reiterated the significance of choosing the right time for participation and avoiding using sensitive terms such as 'cancer', 'dying', and 'death' when engaging with patients. Moreover, they proposed the recruitment of patients by trusted professionals, shortening the duration of research activities and simplifying research procedures. CONCLUSIONS This study provides fresh insights into the perspectives of family members concerning the recruitment and engagement of advanced cancer patients in nursing research. It emphasizes the importance of addressing their concerns and recommendations, aiding nurse researchers in developing culturally sensitive recruitment strategies and fostering the inclusive participation of advanced cancer patients in nursing research within the context of family-centered care and cultural taboos surrounding death.
Collapse
Affiliation(s)
- Ruishuang Zheng
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
| | - Jun Wang
- Center for Human Geography and Urban Development, Guangzhou University, Guangzhou, Guangdong, China
| | - Yanhui Wang
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Zhu
- Department of Nursing, Jiangsu Province Cancer Hospital, Nanjing, China
| | - Li Wang
- Department of VIP Medical Services, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenling Zhang
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Fengqi Dong
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| |
Collapse
|
2
|
Mogili AR, Mukisa D, Campbell P, Giibwa A, Binoga M, Emoru A, Kalumuna AT, Damoi JO, Melendez C, Waye J, Marin ML, Zhang LP. Do patients actually understand? An evaluation of the informed consent process for endoscopic procedures in rural Uganda. Surg Endosc 2024; 38:4024-4030. [PMID: 38877318 DOI: 10.1007/s00464-024-10971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Improving surgical access in low- and middle-income countries is vital for the 5 billion people who lack safe surgical care. Tailoring a culturally sensitive approach to consent is essential for patient comprehension and comfort, thereby alleviating the effects of resource constraints and advancing equitable care. This study examines the consenting process for endoscopy at Kyabirwa Surgical Center in Kyabirwa, Jinja, Uganda, to assess patients' knowledge and attitudes as a potential barrier to participating in endoscopic procedures. METHODS All adult upper endoscopy (EGD) and colonoscopy patients were recruited to participate in a survey of their demographics, knowledge, and attitudes toward their procedure. All patients received a standard consultation explaining the procedure and its risks and benefits. RESULTS 75 patients were included; median age was 54 years and 56% (n = 42) were women. 92% (n = 69) of patients had never had an endoscopy before and 73% (n = 55) of patients were scheduled for an EGD while the remaining 27% (n = 20) were scheduled for a colonoscopy. Most patients 80% (n = 60) had a basic understanding of what an endoscopy is and 87% (n = 65) its diagnostic purpose. Few patients 15% (n = 11) knew of the most common side effects or if they would have a surgical scar 27% (n = 20). Overall, 46.7% (n = 35) of patients were moderately or severely fearful of getting an endoscopy. Additionally, 45.3% (n = 34) of patients were moderately or severely fearful of receiving anesthesia during their endoscopic procedure. Despite this fear, most patients 85.3% (n = 64) stated that they understood the benefits of the procedure either very well or extremely well. CONCLUSIONS Most patients understood the role that an endoscopic procedure plays in their care and its potential benefits. Despite this, many patients continued to have high levels of fear associated with both the endoscopic procedure and with receiving anesthesia during their procedure. Future patient education should focus on addressing patients' fears and the risks of undergoing an endoscopy, which may improve the utilization of surgical services.
Collapse
Affiliation(s)
- Abhishek R Mogili
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Daniel Mukisa
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Peter Campbell
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Angellica Giibwa
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Moses Binoga
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Arthur Emoru
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Anna T Kalumuna
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Joseph O Damoi
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Chelsia Melendez
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Jerome Waye
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Michael L Marin
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Linda P Zhang
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA.
- Department of Surgery, Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA.
| |
Collapse
|
3
|
Pillay N, Ncube N, Moopelo K, Mothoagae G, Welte O, Shogole M, Gwiji N, Scott L, Moshani N, Tiffin N, Boulle A, Griffiths F, Fairlie L, Mehta U, LeFevre A, Scott K. Translating the consent form is the tip of the iceberg: using cognitive interviews to assess the barriers to informed consent in South African health facilities. Sex Reprod Health Matters 2023; 31:2302553. [PMID: 38277196 PMCID: PMC10823893 DOI: 10.1080/26410397.2024.2302553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
The increasing digitisation of personal health data has led to an increase in the demand for onward health data. This study sought to develop local language scripts for use in public sector maternity clinics to capture informed consent for onward health data use. The script considered five possible health data uses: 1. Sending of general health information content via mobile phones; 2. Delivery of personalised health information via mobile phones; 3. Use of women's anonymised health data; 4. Use of child's anonymised health data; and 5. Use of data for recontact. Qualitative interviews (n = 54) were conducted among women attending maternity services in three public health facilities in Gauteng and Western Cape, South Africa. Using cognitive interviewing techniques, interviews sought to:(1) explore understanding of the consent script in five South African languages, (2) assess women's understanding of what they were consenting to, and (3) improve the consent script. Multiple rounds of interviews were conducted, each followed by revisions to the consent script, until saturation was reached, and no additional cognitive failures identified. Cognitive failures were a result of: (1) words and phrases that did not translate easily in some languages, (2) cognitive mismatches that arose as a result of different world views and contexts, (3) linguistic gaps, and (4) asymmetrical power relations that influence how consent is understood and interpreted. Study activities resulted in the development of an informed consent script for onward health data use in five South African languages for use in maternity clinics.
Collapse
Affiliation(s)
- Nirvana Pillay
- Senior Lecturer, Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa; Director, Sarraounia Public Health Trust, 20 4th Avenue, Parktown North, Johannesburg, 2193, South Africa. Correspondence:
| | - Nobukhosi Ncube
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Kearabetswe Moopelo
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Gaolatlhe Mothoagae
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Olivia Welte
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Manape Shogole
- Social Scientist, Sarraounia Public Health Trust, Johannesburg, South Africa
| | - Nasiphi Gwiji
- Social Scientist, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lesley Scott
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Noma Moshani
- Social Scientist, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nicki Tiffin
- Professor, Life Sciences Building, South African Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Andrew Boulle
- Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Frances Griffiths
- Professor, Warwick Medical School, UK; Professor, Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Director of Maternal and Child Health, Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ushma Mehta
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Amnesty LeFevre
- Associate Professor, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Kerry Scott
- Independent research consultant, Toronto, Canada; Associate Faculty, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
4
|
Nguyen YHT, Dang TT, Lam NBH, Le PT, Nguyen PH, Bull S, Kestelyn E, Van Nuil JI. Fragmented understanding: exploring the practice and meaning of informed consent in clinical trials in Ho Chi Minh City, Vietnam. BMC Med Ethics 2023; 24:3. [PMID: 36647039 PMCID: PMC9843952 DOI: 10.1186/s12910-023-00884-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The informed consent process in clinical trials has been extensively studied to inform the development processes which protect research participants and encourage their autonomy. However, ensuring a meaningful informed consent process is still of great concern in many research settings due to its complexity in practice and interwined socio-cultural factors. OBJECTIVES This study explored the practices and meaning of the informed consent process in two clinial trials conducted by Oxford University Clinical Research Unit in collaboration with the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. METHODS We used multiple data collection methods including direct observervations, in-depth interviews with study physicians and trial participants, review of informed consent documents from 2009 to 2018, and participant observation with patients' family members. We recruited seven physicians and twenty-five trial participants into the study, of whom five physicians and thirteen trial participants completed in-depth interviews, and we held twenty-two direct observation sessions. RESULTS We use the concept "fragmented understanding" to describe the nuances of understanding about the consent process and unpack underlying reasons for differing understandings. CONCLUSIONS Our findings show how practices of informed consent and different understanding of the trial information are shaped by trial participants' characteristics and the socio-cultural context in which the trials take place.
Collapse
Affiliation(s)
- Yen Hong Thi Nguyen
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Thuan Trong Dang
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Ngoc Bao Hong Lam
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam
| | - Phuong Thanh Le
- grid.414273.70000 0004 0469 2382Hospital of Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phu Hoan Nguyen
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam ,grid.444808.40000 0001 2037 434XSchool of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
| | - Susan Bull
- grid.4991.50000 0004 1936 8948The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK ,grid.9654.e0000 0004 0372 3343Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Evelyne Kestelyn
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jennifer Ilo Van Nuil
- grid.412433.30000 0004 0429 6814Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, Vietnam ,grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Bellomo T, Fokas J, Tsao N, Anderson C, Becker C, Gioscia-Ryan R, Meurer W. Ethical Considerations during the Informed Consent Process for Acute Ischemic Stroke in International Clinical Trials. Ethics Hum Res 2022; 44:14-25. [PMID: 35802793 DOI: 10.1002/eahr.500133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We sought to investigate the experiences of researchers in existing active-control trials in acute ischemic stroke comparing investigational therapy to tissue plasminogen activator (tPA) in order to identify the approaches and challenges in obtaining informed consent. Out of 401 articles evaluated, 14 trials met inclusion criteria. Trial representatives were contacted to complete a survey concerning the consent process. None of the 14 trials published materials related to the informed consent process. Trials with 75% to 100% of patients directly consented had shorter door-to-treatment (DTT) times than trials that directly consented less than 50% of patients. Trials that had translators available (for recruiting participants who were not native speakers in the local language) and translated consent documents had longer DTT times. The study findings suggest that differences in the standards of informed consent internationally may allow more patients with moderate strokes to provide direct consent without delaying DTT time. Future trials should emphasize transparency to the public and scientific community in the informed consent process.
Collapse
Affiliation(s)
- Tiffany Bellomo
- Vascular surgery resident at the Massachusetts General Hospital
| | - Jennifer Fokas
- Neurology resident at McGaw Medical Center of Northwestern University
| | - Noah Tsao
- Medical student at the University of Rochester
| | | | | | | | - William Meurer
- Associate professor of emergency medicine at the University of Michigan
| |
Collapse
|
6
|
Martin A, Andrews T, Goldbart J, Landers M. Reconciling communication repertoires: navigating interactions involving persons with severe/profound intellectual disability, a classic grounded theory study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:332-352. [PMID: 35194869 PMCID: PMC9305890 DOI: 10.1111/jir.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND A rights-based agenda, informed by the UNCRPD, that advocates person-centredness, inclusion, empowerment and self-determination is shaping service provision to people with intellectual disability (ID). Listening to their perspectives is fundamental to meeting these goals. However, communication with people with severe/profound ID is challenging and difficult. Therefore, this study aims to generate a theory that explains how people communicate with and understand each other in these interactions. METHODS Classic grounded theory (CGT) methodology was used as it recognises that knowledge can be captured rather than interpreted. According to CGT, capturing rather than interpreting experiences strengthens findings, particularly in relation to participants with severe/profound ID. Concurrent theoretical sampling, data collection and analysis were undertaken. Twenty-two individuals participated in the study: 3 people with severe/profound ID and 19 people with whom they interact. Data were collected over a 9-month period and involved video recordings, field notes, individual and group interviews. Data were analysed using CGT methods of coding, constant comparison and memoing. RESULTS The Theory of Reconciling Communication Repertoires was generated. Nurturing a sense of belonging emerged as the main concern and core category that is resolved by reconciling communication repertoires. A communication repertoire refers to the cache of communication skills a person has available to them. To reconcile repertoires is to harmonise or make them compatible with each other in order to communicate. Interactions are navigated through five stages: motivation to interact, connection establishment, reciprocally engaging, navigating understanding and confusion resolution. CONCLUSIONS The Theory of Reconciling Communication Repertoires explains how interactions involving people with severe/profound ID are navigated. While this is a substantive rather than formal theory, it has the potential to inform practice, policy, management, education and research as it outlines how communication with people with severe/profound ID can take place to design, inform and plan person-centred care.
Collapse
Affiliation(s)
- A.‐M. Martin
- School of Nursing and MidwiferyUniversity College CorkCorkIreland
| | - T. Andrews
- School of Nursing and MidwiferyUniversity College CorkCorkIreland
| | - J. Goldbart
- Department of PsychologyManchester Metropolitan UniversityManchesterUK
| | - M. Landers
- School of Nursing and MidwiferyUniversity College CorkCorkIreland
| |
Collapse
|
7
|
Doetsch JN, Dias V, Indredavik MS, Reittu J, Devold RK, Teixeira R, Kajantie E, Barros H. Record linkage of population-based cohort data from minors with national register data: a scoping review and comparative legal analysis of four European countries. OPEN RESEARCH EUROPE 2021; 1:58. [PMID: 37645179 PMCID: PMC10445839 DOI: 10.12688/openreseurope.13689.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 08/31/2023]
Abstract
Background: The GDPR was implemented to build an overarching framework for personal data protection across the EU/EEA. Linkage of data directly collected from cohort participants, potentially serving as a prominent tool for health research, must respect data protection rules and privacy rights. Our objective was to investigate law possibilities of linking cohort data of minors with routinely collected education and health data comparing EU/EEA member states. Methods: A legal comparative analysis and scoping review was conducted of openly accessible published laws and regulations in EUR-Lex and national law databases on GDPR's implementation in Portugal, Finland, Norway, and the Netherlands and its connected national regulations purposing record linkage for health research that have been implemented up until April 30, 2021. Results: The GDPR does not ensure total uniformity in data protection legislation across member states offering flexibility for national legislation. Exceptions to process personal data, e.g., public interest and scientific research, must be laid down in EU/EEA or national law. Differences in national interpretation caused obstacles in cross-national research and record linkage: Portugal requires written consent and ethical approval; Finland allows linkage mostly without consent through the national Social and Health Data Permit Authority; Norway when based on regional ethics committee's approval and adequate information technology safeguarding confidentiality; the Netherlands mainly bases linkage on the opt-out system and Data Protection Impact Assessment. Conclusions: Though the GDPR is the most important legal framework, national legislation execution matters most when linking cohort data with routinely collected health and education data. As national interpretation varies, legal intervention balancing individual right to informational self-determination and public good is gravely needed for health research. More harmonization across EU/EEA could be helpful but should not be detrimental in those member states which already opened a leeway for registries and research for the public good without explicit consent.
Collapse
Affiliation(s)
- Julia Nadine Doetsch
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Vasco Dias
- INESC TEC -Institute for Systems and Computer Engineering, Technology and Science, Campus da Faculdade de Engenharia da Universidade do Porto, Porto, 4050-091, Portugal
| | - Marit S. Indredavik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Jarkko Reittu
- Finnish Institute for Health and Welfare, Legal Services, Helsinki, Finland
- University of Helsinki, Faculty of Law, Helsinki, Finland
| | - Randi Kallar Devold
- Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Raquel Teixeira
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU – Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
- Finnish Institute for Health and Welfare, Population Health Unit, Helsinki and Oulu, Finland
- PEDEGO Research Unit, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henrique Barros
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, 4050-600, Portugal
- EPIUnit, Instituto de Saúde Pública da, Universidade do Porto (ISPUP), Porto, 4050-600, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| |
Collapse
|
8
|
Appiah R. Gurus and Griots: Revisiting the research informed consent process in rural African contexts. BMC Med Ethics 2021; 22:98. [PMID: 34301252 PMCID: PMC8299170 DOI: 10.1186/s12910-021-00659-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Researchers conducting community-based participatory action research (CBPAR) in highly collectivistic and socioeconomically disadvantaged community settings in sub-Saharan Africa are confronted with the distinctive challenge of balancing universal ethical standards with local standards, where traditional customs or beliefs may conflict with regulatory requirements and ethical guidelines underlying the informed consent (IC) process. The unique ethnic, socioeconomic, and cultural diversities in these settings have important implications for the IC process, such as individual decisional autonomy, beneficence, confidentiality, and signing the IC document. MAIN TEXT Drawing on insights and field observations from conducting CBPARs across several rural, highly communal, low literate, and low-income communities in Ghana, we discuss some theoretical, ethico-cultural, and methodological challenges associated with applying the universal, Western individualistic cultural value-laden IC process in sub-Saharan Africa. By citing field situations, we discuss how local cultural customs and the socioeconomic adversities prevalent in these settings can influence (and disrupt) the information disclosure process, individual decisional authority for consent, and voluntariness. We review the theoretical assumptions of the Declaration of Helsinki's statement on IC and discuss its limitations as an ultimate guide for the conduct of social science research in the highly communal African context. We argue that the IC process in these settings should include strategies directed at preventing deception and coercion, in addition to ensuring respect for individual autonomy. We urge Universities, research institutions, and institutional review boards in Africa to design and promote the use of context-appropriate ethical IC guidelines that take into consideration both the local customs and traditional practices of the people as well as the scientific principles underpinning the universal IC standards. CONCLUSION We recommend that, rather than adopt a universal one-size-fits-all IC approach, researchers working in the rural, highly collectivistic, low literate, socioeconomically disadvantaged settings of sub-Saharan Africa should deeply consider the roles and influence of cultural values and traditional practices on the IC and the research process. We encourage researchers to collaborate with target communities and stakeholders in the design and implementation of context-appropriate IC to prevent ethics dumping and safeguard the integrity of the research process.
Collapse
Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Korle-Bu, P. O. Box KB 143, Accra, Ghana.
| |
Collapse
|
9
|
Orzechowski M, Woniak K, Timmermann C, Steger F. Normative framework of informed consent in clinical research in Germany, Poland, and Russia. BMC Med Ethics 2021; 22:53. [PMID: 33933040 PMCID: PMC8088727 DOI: 10.1186/s12910-021-00622-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/26/2021] [Indexed: 02/01/2023] Open
Abstract
Background Biomedical research nowadays is increasingly carried out in multinational and multicenter settings. Due to disparate national regulations on various ethical aspects, such as informed consent, there is the risk of ethical compromises when involving human subjects in research. Although the Declaration of Helsinki is the point of reference for ethical conduct of research on humans, national normative requirements may diverge from its provisions. The aim of this research is to examine requirements on informed consent in biomedical research in Germany, Poland, and Russia to determine how each national regulatory framework relates to the provisions of the Declaration of Helsinki. Methods For this analysis, we conducted a search of the legal databases “Gesetze im Internet” for Germany, “Internetowy System Aktow Prawnych” for Poland, and “ГAPAHT – Garant” for Russia. The search was complemented by a review of secondary literature contained in the databases Google Scholar, PubMed, Polish National Library, and eLibrary.ru. We have identified 21 normative regulations containing provisions on informed consent in clinical research in all three countries. The content of these documents was systematically categorized and analyzed. Results The normative framework in all three countries shows a strong commitment towards the core ethical principles of research envisaged in the Declaration of Helsinki. Nevertheless, provisions on informed consent vary between these three countries. The differences range from the method and language in which information should be provided, through the amount of information required to be disclosed, to the form of documenting consent or withdrawal. In the case of research on vulnerable groups, these differences are particularly visible. Conclusions The identified differences can negatively impact the ethical conduct of international clinical studies. Attention needs to be paid that flexibilities within national regulations are not misused to undermine the protection of research subjects. Achieving global or regional legislative harmonization might prove impossible. Such lack of legal consensus reinforces the significance of the international ethical agreements. Trial registration: Not applicable.
Collapse
Affiliation(s)
- Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany.
| | - Katarzyna Woniak
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
| | - Cristian Timmermann
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
| |
Collapse
|
10
|
Deem MJ, Stokes F. Culture and Consent in Clinical Care: A Critical Review of Nursing and Nursing Ethics Literature. ANNUAL REVIEW OF NURSING RESEARCH 2019; 37:223-259. [PMID: 30692159 DOI: 10.1891/0739-6686.37.1.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Hanson AL, Crosby RD, Basson MD. Patient Preferences for Surgery or Antibiotics for the Treatment of Acute Appendicitis. JAMA Surg 2019; 153:471-478. [PMID: 29322168 DOI: 10.1001/jamasurg.2017.5310] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Studies have compared surgical with nonsurgical therapy for acute uncomplicated appendicitis, but none of these studies have a patient-centered perspective. Objectives To evaluate how patients might choose between surgical and nonsurgical therapy for acute uncomplicated appendicitis and to identify targets to make antibiotic treatment more appealing. Design, Setting, and Participants This study comprised an online survey and an in-person sensitivity analysis survey. For the web survey, a convenience sample of 1728 respondents were asked to imagine that they or their child had acute uncomplicated appendicitis, provided information about laparoscopic and open appendectomy and antibiotic treatment alone, and asked which treatment they might choose. The web survey was open from April 17, 2016, through June 16, 2016, and was disseminated via email link, a poster with a Quick Response code, and social media. For the sensitivity analysis, 220 respondents were given the same scenario and options. Those who chose surgery were asked whether certain factors influenced their decision; each factor was incrementally improved during questioning about whether respondents would consider switching to antibiotics. These participants were recruited at public venues from June 3, 2016, to July 31, 2016. Web survey data were analyzed from June 17, 2016, to September 21, 2017. Sensitivity analysis data were analyzed from August 1, 2016, to September 21, 2017. Main Outcomes and Measures Treatment preferences. Results Among the 1728 web survey respondents, 1225 (70.9%) were female and 500 (28.9%) were male (3 [0.2%] either did not answer or responded as "gender fluid" within the comments section of the survey), and most self-reported being between 50 and 59 years of age (391 [22.6%]) and being non-Hispanic white (1563 [90.5%]). For themselves, 1482 respondents (85.8%) chose laparoscopic appendectomy, 84 (4.9%) chose open appendectomy, and 162 (9.4%) chose antibiotics alone. For their child, 1372 respondents (79.4%) chose laparoscopic appendectomy, 106 (6.1%) open appendectomy, and 250 (14.5%) antibiotics alone. Respondents were somewhat more likely to choose antibiotics for themselves if they had education beyond college (105 [12.6%]; P < .001), identified as other than non-Hispanic white (24 [14.9%]; P < .001), or did not know anyone who had previously been hospitalized (12 [15.8%]; P = .02), but they were less likely to choose antibiotics if they were surgeons (11 [5.4%]; P = .008). Of the 220 participants interviewed for the sensitivity analysis, 120 (54.5%) were female and 100 (45.5%) were male, and most self-reported being between 18 and 24 years of age (53 [24.1%]) and being non-Hispanic white (204 [92.7%]). Their responses suggested that improvements in the short- and long-term failure rate of antibiotic treatment-rather than reductions in the duration of hospitalization or antibiotic treatment-were more likely to increase the desirability of choosing antibiotics. Conclusions and Relevance Most patients may choose surgical intervention over antibiotics alone in treatment of acute uncomplicated appendicitis, but a meaningful number may choose nonoperative management. Therefore, from a patient-centered perspective, this option should be discussed with patients, and future research could be directed at reducing the failure and recurrence rates of antibiotic treatment for appendicitis.
Collapse
Affiliation(s)
- Alexis L Hanson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks
| | - Ross D Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks.,Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Marc D Basson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks
| |
Collapse
|
12
|
Chen SY, Chang SCS, Lin CC, Lou Q, Anderson RM. Psychometric evaluation of the Informed Consent Process Scale in Chinese. Nurs Ethics 2019; 26:2456-2466. [PMID: 30614395 DOI: 10.1177/0969733018819126] [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: 11/16/2022]
Abstract
BACKGROUND Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. RESEARCH OBJECTIVES This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. RESEARCH DESIGN Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after which an exploratory factor analysis was conducted. PARTICIPANTS We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. ETHICAL CONSIDERATIONS This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. FINDINGS The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 - 'Understanding of the research', Factor 2 - 'Trust and confidence' and Factor 3 - 'Doubt and uncertainty'. The three factors accounted for is 52.954 of the total variance with Cronbach's α of .917. DISCUSSION AND CONCLUSION The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application.
Collapse
Affiliation(s)
- Shu Yu Chen
- Changhua Christian Hospital; School of Nursing, Dayeh University
| | | | - Chiu-Chu Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | |
Collapse
|
13
|
Yıldız E. Ethics in nursing: A systematic review of the framework of evidence perspective. Nurs Ethics 2017; 26:1128-1148. [DOI: 10.1177/0969733017734412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Aim: To determine the current state of knowledge on nursing and ethics and to assess the knowledge and experience based on the evidence in this regard. Background: Although ethics is at the center of the nursing profession and the ethical issues affecting nurses are given much importance, few studies have focused on professional ethics in nursing. In this respect, ethics has become a concept that contains controversial and ambiguous situations. Design: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guide, a basic search algorithm, was taken. Data sources: Cochrane, PubMed, CINAHL Complete, PsycINFO, and ULAKBIM from 2012 to 2016. Review methods: Following a systematic search strategy, all papers were assessed in relation to inclusion criteria and type of study. When sufficient information was not available in the title and summary of the works, the necessary data were evaluated in full texts. Results: This review was completed with 27 articles meeting the research criteria. The evaluation identified six themes: (1) ethics and nursing, (2) ethical difficulties/ethical dilemmas and nursing, (3) ethical competence and nursing, (4) professional ethics and nursing, (5) ethics, education, and nursing, and (6) ethics in health research. Conclusion: As a result of the review, a synthesis of high evidence-level research relating to nursing ethics was obtained. The emphasis was on the importance of further research and education so that the ethical aspects of nursing can be better understood throughout the studies. Nursing researchers’ level of evidence on ethics and their orientation to high research design will shed light on uncertain and controversial aspects of the subject. Ethical consideration: Since this was a systematic review, no ethical approval was required. There is no conflict of interest in this literature review.
Collapse
|
14
|
Eklöf N, Hupli M, Leino-Kilpi H. Planning focus group interviews with asylum seekers: Factors related to the researcher, interpreter and asylum seekers. Nurs Inq 2017; 24. [PMID: 28304117 DOI: 10.1111/nin.12192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
The aim of this article was to discuss factors related to the researcher, interpreter and asylum seekers when planning focus group interviews with asylum seekers. Focus group interview is one of the basic data collection methods in descriptive nursing and health research. It has been used in multicultural research, allowing an opportunity to participate without literacy and to have linguistic and cultural support from other participants. Asylum seekers form a specific, vulnerable group, and the growing number of asylum seekers increases the need for research related to them. A culturally, methodologically and ethically high-quality focus group interview is based on the researcher's special knowledge and skills, acknowledgement of asylum seekers as both individuals and part of cultural and communal groups, and careful planning of the interpreter's role during the interviews.
Collapse
Affiliation(s)
- Niina Eklöf
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maija Hupli
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| |
Collapse
|
15
|
Nasrabadi AN, Shali M. Informed Consent: A Complex Process in Iran's Nursing Practice. ACTA ACUST UNITED AC 2017. [DOI: 10.11111/jkana.2017.23.3.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mahboobeh Shali
- Ph.D Student in Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Abstract
Advances in medical care may occur when a change in practice incorporates a new treatment or methodology. In surgery, this may involve the translation of a completely novel concept into a new procedure or device or the adaptation of existing treatment approaches or technology to a new clinical application. Regardless of the specifics, innovation should have, as its primary goal, the enhancement of care leading to improved outcomes from the patient's perspective. This policy statement examines innovation as it pertains to surgical care, focusing on some of the definitions that help differentiate applied innovation or innovative therapy from research. The ethical challenges and the potential for conflict of interest for surgeons or institutions seeking to offer innovative surgical therapy are examined. The importance of engaging patients and families as "innovation partners" to ensure complete transparency of expectations from the patient's and provider's perspectives is also examined, with specific emphasis on cultural competence and mutually respectful approaches. A framework for identifying, evaluating, and safely implementing innovative surgical therapy in children is provided.
Collapse
|