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Feinberg IZ, Gajra A, Hetherington L, McCarthy KS. Simplifying informed consent as a universal precaution. Sci Rep 2024; 14:13195. [PMID: 38851754 PMCID: PMC11162480 DOI: 10.1038/s41598-024-64139-9] [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: 02/14/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024] Open
Abstract
One barrier to participating in clinical research is that patients with low literacy skills (1 in 5 US adults) may struggle to understand the informed consent document (ICD). Writing consents using health literacy and plain language guidelines including simplified syntax and semantics can increase understandability and facilitate inclusivity of research populations with literacy challenges. Our study aim was to evaluate a simplified ICD for understandability while considering factors known to relate to comprehension (reading skills and working memory). We performed an on-line survey of 192 adults ages 18-77 in Georgia. Participants performed significantly better on the simplified ICD test. We built an additional model with all version x measure interactions (i.e., age, sex, race, urbanicity, GMVT, WM). This model did not significantly improve model fit, F < 1.00, suggesting that individual differences did not moderate the effect of simplification. Our findings suggest that using plain language and simplified syntax and semantics in ICD as a universal precaution may reduce cognitive reading burden for adults regardless of differences in reading skill or working memory. Increasing understandability in ICD may help improve targets for clinical trial enrollment.
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Affiliation(s)
- Iris Z Feinberg
- Department of Learning Sciences, College of Education and Human Development, Georgia State University, Atlanta, GA, USA.
| | - Ajeet Gajra
- Hematology Oncology Associates of CNY, East Syracuse, NY, USA
| | | | - Kathryn S McCarthy
- Department of Learning Sciences, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
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García-Álvarez JM, García-Sánchez A. Readability and Comprehension of Anesthesia Informed Consent Forms in a Spanish County Hospital: An Observational Study. NURSING REPORTS 2024; 14:1338-1352. [PMID: 38921711 PMCID: PMC11206610 DOI: 10.3390/nursrep14020101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: The wording of informed consent forms could hinder their comprehension and hinder patients' autonomous choice. The objective of this study was to analyze the readability and comprehension of anesthesia informed consent forms in a Spanish county hospital. (2) Methods: Descriptive and cross-sectional study carried out on patients who were going to undergo anesthetic techniques. The readability of the forms was analyzed using the INFLESZ tool and their subjective comprehension using an ad hoc questionnaire. (3) Results: The analyzed forms presented a "somewhat difficult" legibility. A total of 44.2% of the patients decided not to read the form, mainly because they had previously undergone surgery with the same anesthetic technique. The language used in the forms was considered inadequate by 49.5% of the patients and 53.3% did not comprehend it in its entirety. A statistically significant negative correlation of age and INFLESZ readability score with the overall questionnaire score was found. A statistically significant association was observed as a function of age and educational level with the different criteria of the questionnaire. (4) Conclusions: The anesthesia informed consent forms presented low readability with limited comprehension. It would be necessary to improve their wording to favor comprehension and to guarantee patients' freedom of choice.
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Affiliation(s)
| | - Alfonso García-Sánchez
- Faculty of Nursing, Catholic University of Murcia (UCAM), Guadalupe, 30107 Murcia, Spain;
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Aristizabal P, Nataraj S, Ma AK, Kumar NV, Perdomo BP, Martinez ME, Nodora J, Liu L, Lee E, Thornburg CD. Social Determinants of Health and Informed Consent Comprehension for Pediatric Cancer Clinical Trials. JAMA Netw Open 2023; 6:e2346858. [PMID: 38079173 PMCID: PMC10714248 DOI: 10.1001/jamanetworkopen.2023.46858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Ensuring valid informed consent (IC) prior to enrollment in clinical trials is a fundamental ethical right. Objective To assess whether social determinants of health (SDOH) and related sociocontextual factors are associated with parental IC comprehension in therapeutic childhood cancer clinical trials. Design, Setting, and Participants This cross-sectional study prospectively enrolled 223 parents of children with newly diagnosed cancer at Rady Children's Hospital San Diego, a large quaternary academic center in California, from October 1, 2014, to March 31, 2021. Linear mixed effects models were used to assess whether IC comprehension overall and by domain (purpose, procedures, and randomization; risks and benefits; alternatives; and voluntariness) were associated with SDOH and sociocontextual factors. Data were analyzed from January 1, 2022, to July 31, 2023. Exposures Informed consent for a therapeutic childhood cancer clinical trial. Main Outcomes and Measures The primary outcome of interest was IC comprehension and its associations with SDOH (marital status, language, educational attainment, employment, insurance type, socioeconomic status, and health literacy) and sociocontextual factors (ethnicity, satisfaction with informed consent, and cancer type). Results Of 223 parents, 172 (77.1%) were aged 18 to 44 years, 111 (49.8%) were Hispanic, 152 (68.2%) were women, and 163 (73.1%) were married. In terms of race, 2 (0.9%) were American Indian or Alaska Native, 22 (9.9%) were Asian or Pacific Islander, 8 (3.6%) were Black, 149 (66.8%) were White, and 42 (18.8%) were more than 1 race. In multivariable linear mixed-effects analyses, limited vs adequate health literacy was associated with lower comprehension of informed consent overall (mean [SD], 68.28 [11.81] vs 79.24 [11.77]; β estimate, -9.02 [95% CI, -12.0 to -6.07]; P < .001) and with lower comprehension of the purpose, procedures, and randomization (mean [SD], 65.00 [12.64] vs 76.14 [11.53]; β estimate, -7.87 [95% CI, -10.9 to -4.85]; P < .001); risks and benefits (mean [SD], 62.84 [20.24] vs 73.14 [20.86]; β estimate, -10.1 [95% CI, -15.6 to -4.59]; P < .001); alternatives (mean [SD], 54.27 [43.18] vs 82.98 [34.24]; β estimate, -14.3 [95% CI, -26.1 to -2.62]; P .02); and voluntariness (mean [SD], 76.52 [24.33] vs 95.39 [13.89]; β estimate, -9.14 [95% CI, -14.9 to -3.44]; P = .002) domains. Use of Spanish vs English language for medical communication was associated with lower comprehension overall (mean [SD], 66.45 [12.32] vs 77.25 [12.18]; β estimate, -5.30 [95% CI, -9.27 to -1.34]; P = .01) and with lower comprehension of the purpose, procedures, and randomization (mean [SD], 63.33 [11.98] vs 74.07 [12.52]; β estimate, -4.33 [95% CI, -8.43 to -0.23]; P = .04) and voluntariness (mean [SD], 70.83 [24.02] vs 92.54 [17.27]; β estimate, -9.69 [95% CI, -16.8 to -2.56]; P = .009) domains. Conclusions and Relevance In this cross-sectional study including parents of children with newly diagnosed cancer who provided IC for their child's participation in a therapeutic clinical trial, limited health literacy and use of Spanish language for medical communication were associated with lower comprehension of IC. These findings suggest that, in this setting, parents with limited health literacy or those who use Spanish language for medical communication may not fully comprehend IC and therefore may not make truly informed decisions. These findings support the investigation of interventions, across pediatric disciplines, tailored to the participant's language and health literacy level to improve IC comprehension, particularly in racial and ethnic minority populations.
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Affiliation(s)
- Paula Aristizabal
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
- Peckham Center for Cancer & Blood Disorders, Rady Children’s Hospital San Diego, San Diego, California
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Dissemination and Implementation Science Center, University of California, San Diego, Altman Clinical and Translational Research Institute, La Jolla
| | - Shilpa Nataraj
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Pediatrics, Division of Hematology Oncology, Stanford University, Stanford, California
| | - Arissa K. Ma
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Family Medicine, Kaiser Permanente, Long Beach, California
| | - Nikhil V. Kumar
- School of Medicine, University of California, San Diego, La Jolla
- currently affiliated with Department of Pediatrics, University of California Irvine, Irvine, California
| | - Bianca P. Perdomo
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
| | - Maria Elena Martinez
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
| | - Jesse Nodora
- Division of Population Sciences, Disparities and Community Engagement, University of California San Diego Moores Cancer Center, La Jolla, California
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
| | - Lin Liu
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California, San Diego, La Jolla
| | - Courtney D. Thornburg
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California, San Diego, La Jolla
- Peckham Center for Cancer & Blood Disorders, Rady Children’s Hospital San Diego, San Diego, California
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Dukaew N, Na Takuathung M, Sakuludomkan W, Chairaksa K, Klinjan P, Morakote N, Koonrungsesomboon N. Regulatory compliance and readability of informed consent forms in industry-sponsored drug development clinical trials. Clin Trials 2023; 20:517-527. [PMID: 37194292 DOI: 10.1177/17407745231174528] [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: 05/18/2023]
Abstract
BACKGROUND/AIMS An informed consent form is essential in drug development clinical trials. This study aimed to evaluate regulatory compliance and readability of informed consent forms currently being used in industry-sponsored drug development clinical trials. METHODS This descriptive, cross-sectional study evaluated the informed consent forms of industry-sponsored drug development clinical trials conducted at the Faculty of Medicine, Chiang Mai University, between 2019 and 2020. The informed consent form's compliance with the three major ethical guidelines and regulations (i.e. International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use E6(R2) Good Clinical Practice; Declaration of Helsinki; and the revised Common Rule) were analyzed. The document length and the readability scores (using Flesch Reading Ease and Flesch-Kincaid Reading Grade) were assessed. RESULTS Of 64 reviewed informed consent forms, the average page length was 22.0 ± 7.4 pages. More than half of their length was mainly devoted to three elements: trial procedures (22.9%), risks and discomforts (19.1%), and confidentiality and the limit of confidentiality (10.1%). Although most of the required elements of the informed consent form content were included in most informed consent forms, we identified four elements with often missing information in the form: aspects of research that are experimental (n = 43, 67.2%), involvement of whole-genome sequencing (n = 35, 54.7%), commercial profit sharing (n = 31, 48.4%), and posttrial provisions (n = 28, 43.8%). CONCLUSION The informed consent forms in industry-sponsored drug development clinical trials were long but incomplete. Our findings draw attention to ongoing challenges in industry-sponsored drug development clinical trials, where deficient informed consent form quality continues to exist.
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Affiliation(s)
- Nahathai Dukaew
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Research Center for Food and Herbal Product Trials and Development (CR-FAH), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mingkwan Na Takuathung
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Research Center for Food and Herbal Product Trials and Development (CR-FAH), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wannachai Sakuludomkan
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Research Center for Food and Herbal Product Trials and Development (CR-FAH), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanyarat Chairaksa
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Preeyaporn Klinjan
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Research Center for Food and Herbal Product Trials and Development (CR-FAH), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nimit Morakote
- Department of Parasitology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nut Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Research Center for Food and Herbal Product Trials and Development (CR-FAH), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Katz NT, Alpert AB, Aristizabal MP, McDaniels-Davidson C, Sacks BH, Sanft T, Chou CL, Martinez ME. Partnering With Patients and Caregivers in Cancer Care: Lessons From Experiences With Transgender, Hispanic, and Pediatric Populations. Am Soc Clin Oncol Educ Book 2023; 43:e397264. [PMID: 37200592 DOI: 10.1200/edbk_397264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A cancer diagnosis thrusts patients and caregivers into a foreign world of health care with systems, protocols, and norms that can leave little room for individual needs and circumstances. Quality and efficacious oncology care requires clinicians to partner with patients and caregivers to understand and incorporate their needs, values, and priorities into information sharing, decision making, and care provision. This partnership is necessary for effective patient- and family-centered care and access to individualized and equitable information, treatment, and research participation. Partnering with patients and families also requires oncology clinicians to see that our personal values, preconceived ideas, and established systems exclude certain populations and potentially lead to poorer care for all patients. Furthermore, inequitable access to participation in research and clinical trials can contribute to an unequal burden of cancer morbidity and mortality. Leveraging the expertise of the authorship team with transgender, Hispanic, and pediatric populations, this chapter provides insights and suggestions for oncology care that are applicable across patient populations to mitigate stigma and discrimination and improve the quality of care for all patients.
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Affiliation(s)
- Naomi T Katz
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Palliative Care Service, Alfred Health, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Murdoch Children's Research Insitute, Melbourne, VIC, Australia
| | - Ash B Alpert
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - M Paula Aristizabal
- Department of Pediatrics, Division of Hematology, University of California and Peckman Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, CA
- Moores Cancer Center, University of California, San Diego, CA
| | - Corinne McDaniels-Davidson
- Moores Cancer Center, University of California, San Diego, CA
- School of Public Health, San Diego State University, San Diego, CA
| | - Bronwyn H Sacks
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Insitute, Melbourne, VIC, Australia
| | - Tara Sanft
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Calvin L Chou
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- Veterans Affairs Helathcare System, San Francisco, CA
| | - Maria Elena Martinez
- Moores Cancer Center, University of California, San Diego, CA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA
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Russell AM, Shepherd V, Woolfall K, Young B, Gillies K, Volkmer A, Jayes M, Huxtable R, Perkins A, Noor NM, Nickolls B, Wade J. Complex and alternate consent pathways in clinical trials: methodological and ethical challenges encountered by underserved groups and a call to action. Trials 2023; 24:151. [PMID: 36855178 PMCID: PMC9973248 DOI: 10.1186/s13063-023-07159-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Informed consent is considered a fundamental requirement for participation in trials, yet obtaining consent is challenging in a number of populations and settings. This may be due to participants having communication or other disabilities, their capacity to consent fluctuates or they lack capacity, or in emergency situations where their medical condition or the urgent nature of the treatment precludes seeking consent from either the participant or a representative. These challenges, and the subsequent complexity of designing and conducting trials where alternative consent pathways are required, contribute to these populations being underserved in research. Recognising and addressing these challenges is essential to support trials involving these populations and ensure that they have an equitable opportunity to participate in, and benefit from, research. Given the complex nature of these challenges, which are encountered by both adults and children, a cross-disciplinary approach is required. DISCUSSION A UK-wide collaboration, a sub-group of the Trial Conduct Working Group in the MRC-NIHR Trial Methodology Research Partnership, was formed to collectively address these challenges. Members are drawn from disciplines including bioethics, qualitative research, trials methodology, healthcare professions, and social sciences. This commentary draws on our collective expertise to identify key populations where particular methodological and ethical challenges around consent are encountered, articulate the specific issues arising in each population, summarise ongoing and completed research, and identify targets for future research. Key populations include people with communication or other disabilities, people whose capacity to consent fluctuates, adults who lack the capacity to consent, and adults and children in emergency and urgent care settings. Work is ongoing by the sub-group to create a database of resources, to update NIHR guidance, and to develop proposals to address identified research gaps. CONCLUSION Collaboration across disciplines, sectors, organisations, and countries is essential if the ethical and methodological challenges surrounding trials involving complex and alternate consent pathways are to be addressed. Explicating these challenges, sharing resources, and identifying gaps for future research is an essential first step. We hope that doing so will serve as a call to action for others seeking ways to address the current consent-based exclusion of underserved populations from trials.
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Affiliation(s)
- Amy M Russell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Victoria Shepherd
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Kerry Woolfall
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anna Volkmer
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Mark Jayes
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexander Perkins
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nurulamin M Noor
- Medical Research Council Clinical Trials Unit at University College London (MRC CTU at UCL), Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Beverley Nickolls
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | - Julia Wade
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
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Symons TJ, Straiton N, Gagnon R, Littleford R, Campbell AJ, Bowen AC, Stewart AG, Tong SYC, Davis JS. Consumer perspectives on simplified, layered consent for a low risk, but complex pragmatic trial. Trials 2022; 23:1055. [PMID: 36578070 PMCID: PMC9795139 DOI: 10.1186/s13063-022-07023-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND For decades, the research community has called for participant information sheets/consent forms (PICFs) to be improved. Recommendations include simplifying content, reducing length, presenting information in layers and using multimedia. However, there are relatively few studies that have evaluated health consumers' (patients/carers) perspectives on the type and organisation of information, and the level of detail to be included in a PICF to optimise an informed decision to enter a trial. We aimed to elicit consumers' views on a layered approach to consent that provides the key information for decision-making in a short PICF (layer 1) with additional optional information that is accessed separately (layer 2). We also elicited consumers' views on the optimal content and layout of the layered consent materials for a large and complex Bayesian adaptive platform trial (the SNAP trial). METHODS We conducted a qualitative multicentre study (4 focus groups and 2 semi-structured interviews) involving adolescent and adult survivors of Staphylococcus aureus bloodstream infection (22) and their carers (2). Interview transcripts were examined using inductive thematic analysis. RESULTS Consumers supported a layered approach to consent. The primary theme that emerged was the value of agency; the ability to exert some control over the amount of information read before the consent form is signed. Three other themes emerged; the need to prioritise participants' information needs; the importance of health literacy; the importance of information about a trial's benefits (over its risks) for decision-making and the interplay between the two. CONCLUSIONS Our findings suggest that consumers may challenge the one-size-fits-all approach currently applied to the development of PICFs in countries like Australia. Consumers supported a layered approach to consent that offers choice in the amount of information to be read before deciding whether to enter a trial. A 3-page PICF was considered sufficient for decision-making for the SNAP trial, provided that further information was available and accessible.
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Affiliation(s)
- Tanya J. Symons
- grid.1013.30000 0004 1936 834XDepartment of Medicine and Health Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Nicola Straiton
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rosie Gagnon
- grid.15822.3c0000 0001 0710 330XMiddlesex University, London, UK
| | - Roberta Littleford
- grid.1003.20000 0000 9320 7537Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD Australia
| | - Anita J. Campbell
- grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Australia ,grid.414659.b0000 0000 8828 1230Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Asha C. Bowen
- grid.410667.20000 0004 0625 8600Department of Infectious Diseases, Perth Children’s Hospital, Nedlands, Australia ,grid.414659.b0000 0000 8828 1230Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia ,grid.1012.20000 0004 1936 7910Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Adam G. Stewart
- grid.1003.20000 0000 9320 7537Centre for Clinical Research, Faculty of Medicine, University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, QLD Australia
| | - Steven Y. C. Tong
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joshua S. Davis
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Newcastle, Australia ,grid.413648.cInfection Research Program, Hunter Medical Research Institute, Newcastle, Australia ,grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Australia
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O'Sullivan Greene E, Shiely F. Recording and reporting of recruitment strategies in trial protocols, registries, and publications was nonexistent. J Clin Epidemiol 2022; 152:248-256. [PMID: 36273772 DOI: 10.1016/j.jclinepi.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate how trialists record and report their recruitment strategies and the recruiter details in trial protocols, registries, and publications. STUDY DESIGN AND SETTING A retrospective study of ovarian cancer (OC) trials between 2010 and 2021. We reviewed 154 trial publications, 30 protocols, 105 registry entries, and 26 trial websites associated with 88 phase III OC trials. RESULTS None of the 88 trials reviewed published a recruitment strategy or made reference to an available recruitment strategy for the trial. Only 31% (n = 28) made reference to the recruiter but this was reported only in the protocol so we have no evidence these named recruiters performed the task. None of the trials reviewed which closed early or extended recruitment timelines due to slow accrual, reported measures taken to improve recruitment rates before stoppages or changes took place. There were disparities in the reported target recruitment numbers between the protocol, the publication, and the registry. CONCLUSION Recruitment strategies exist, and we are sure most trial centers use recruitment strategies, but they need to be recorded and reported, as part of the supplementary material if not the main publication, so we can evaluate their effectiveness.
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Affiliation(s)
| | - Frances Shiely
- Trials Research and Methodologies Unit, HRB Clinical Research Facility, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.
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De Sutter E, Verreydt S, Yskout K, Geerts D, Borry P, Outtier A, Ferrante M, Vandermeulen C, Vanmechelen N, Van der Schueren B, Huys I. Using provocative design to foster electronic informed consent innovation. BMC Med Inform Decis Mak 2022; 22:296. [PMCID: PMC9669523 DOI: 10.1186/s12911-022-02039-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background The development of technological applications in clinical research, such as electronic informed consent (eIC), is on the rise. The involvement of end users throughout the design process of eIC is of utmost importance to improve the current informed consent process. Methods Using a provocative design, we conducted interviews with 30 clinical research participants. Provotypes were used as a starting base to discuss various aspects relevant to eIC. By providing a medium to encourage divergent thinking, participants’ views and concerns were solicited. Thematic analysis was undertaken using NVivo. Results The majority of participants placed trust in the principal investigator or the hospital to perform the role of eIC hosting party. Differing opinions were reported on the amount of information required related to stakeholders’ access to an eIC system, and thus, to participants’ personal data, to enable trust in an eIC system. Nevertheless, this study indicates a general willingness of participants to share personal data with physicians and pharmaceutical companies on an international level, and to receive requests for new research studies via an eIC system. Participants suggested to tailor an eIC system based upon their preferences, for example, regarding whom they want to share their personal data with. Moreover, they expressed a desire to choose how they can contact the research team, and to indicate which study-related information they would like to receive electronically. In addition, positive opinions were voiced on the integration of a test to assess participants’ understanding before providing their eIC. Conclusions Following a research through design approach, insights have been generated which inform the design of eIC. Provotypes were designed to help participants think beyond what is familiar to them. Study findings revealed that not all situations were perceived as provocative, because of participants’ motivation to advance scientific research and the trust they place in the research team. Nevertheless, the use of provocative design resulted in additional insights, generated by clinical research participants, which could be considered in the further design of eIC. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-02039-6.
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Affiliation(s)
- Evelien De Sutter
- grid.5596.f0000 0001 0668 7884Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Stef Verreydt
- grid.5596.f0000 0001 0668 7884Distributed and Secure Software (DistriNet), Department of Computer Science, KU Leuven, Leuven, Belgium
| | - Koen Yskout
- grid.5596.f0000 0001 0668 7884Distributed and Secure Software (DistriNet), Department of Computer Science, KU Leuven, Leuven, Belgium
| | - David Geerts
- grid.5596.f0000 0001 0668 7884KU Leuven Digital Society Institute, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- grid.5596.f0000 0001 0668 7884Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - An Outtier
- grid.5596.f0000 0001 0668 7884Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marc Ferrante
- grid.5596.f0000 0001 0668 7884Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Corinne Vandermeulen
- grid.5596.f0000 0001 0668 7884Leuven University Vaccinology Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nele Vanmechelen
- grid.5596.f0000 0001 0668 7884Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- grid.5596.f0000 0001 0668 7884Department of Endocrinology, University Hospitals Leuven, KU Leuven, Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- grid.5596.f0000 0001 0668 7884Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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10
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Symons T, Davis JS. Creating concise and readable patient information sheets for interventional studies in Australia: are we there yet? Trials 2022; 23:794. [PMID: 36131293 PMCID: PMC9490706 DOI: 10.1186/s13063-022-06712-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Participant information sheets and consent forms (PICFs) used in interventional studies are often criticised for being hard to read and understand. We assessed the readability and its correlates of a broad range of Australian PICFs. Methods We analysed the participant information sheet portion of 248 PICFs. Readability scores were measured using three formulae: the Flesch Reading Ease, the Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook (SMOG). We investigated how various features (including sponsor type and PICF type) correlated with PICF length and readability and examined compliance with other measures known to improve readability. Results For a sample of 248 PICFs, the mean (standard deviation) Flesch Reading Ease score was 49.3 (5.7) and for the Flesch-Kincaid Grade Level 11.4 (1.1). The mean (SD) SMOG score was 13.2 (0.9). The median document length was 3848 words (8 pages). Commercial PICFs were more than twice as long as non-commercial, but statistically more readable (p = 0.03) when analysed using the SMOG formula. Subgroup analyses indicated that PICFs for self-consenters were statistically more readable than those for proxy consenters. The use of tables, but not the use of illustrations was associated with better readability scores. Conclusions The PICFs in our sample are long and complex, and only 3 of the 248 achieved the recommended readability score of grade 8 or below. The broader use of best practice principles for writing health information for consumers and the development of more context-sensitive templates could improve their utility.
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Affiliation(s)
- Tanya Symons
- Department of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Joshua S Davis
- Menzies School of Health Research, and Charles Darwin University, Casuarina, Northern Territory, Australia. .,Department of Infectious Diseases, John Hunter Hospital, Newcastle, Australia.
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11
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Espinoza-Gutarra MR, Duma N, Aristizabal P, Segarra-Vazquez B, Borno H, Halbert CH, Simon MA, Velazquez AI. The Problem of Hispanic/Latinx Under-Representation in Cancer Clinical Trials. JCO Oncol Pract 2022; 18:380-384. [PMID: 35544652 DOI: 10.1200/op.22.00214] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Narjust Duma
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Paula Aristizabal
- University of California San Diego, Department of Pediatrics, Division of Pediatric Hematology/Oncology, San Diego, CA.,Rady Children's Hospital San Diego, Peckham Center for Cancer and Blood Disorders, San Diego, CA.,University of California San Diego Moores Cancer Center, Population Sciences Disparities and Community Engagement, San Diego, CA
| | | | - Hala Borno
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | - Melissa A Simon
- Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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12
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Almeida-Magana R, Maroof H, Grierson J, Clow R, Dinneen E, Al-Hammouri T, Muirhead N, Brew-Graves C, Kelly J, Shaw G. E-Consent-a guide to maintain recruitment in clinical trials during the COVID-19 pandemic. Trials 2022; 23:388. [PMID: 35550639 PMCID: PMC9096749 DOI: 10.1186/s13063-022-06333-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/23/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed daunting challenges when conducting clinical research. Adopting new technologies such as remote electronic consent (e-Consent) can help overcome them. However, guidelines for e-Consent implementation in ongoing clinical trials are currently lacking. The NeuroSAFE PROOF trial is a randomized clinical trial evaluating the role of frozen section analysis during RARP for prostate cancer. In response to the COVID-19 crisis, recruitment was halted, and a remote e-Consent solution was designed. The aim of this paper is to describe the process of implementation, impact on recruitment rate, and patients' experience using e-Consent. METHODS A substantial amendment of the protocol granted the creation of a remote e-Consent framework based on the REDCap environment, following the structure and content of the already approved paper consent form. Although e-Consent obviated the need for in-person meeting, there was nonetheless counselling sessions performed interactively online. This new pathway offered continuous support to patients through remote consultations. The whole process was judged to be compliant with regulatory requirements before implementation. RESULTS Before the first recruitment suspension, NeuroSAFE PROOF was recruiting an average of 9 patients per month. After e-Consent implementation, 63 new patients (4/month) have been enrolled despite a second lockdown, none of whom would have been recruited using the old methods given restrictions on face-to-face consultations. Patients have given positive feedback on the use of the platform. Limited troubleshooting has been required after implementation. CONCLUSION Remote e-Consent-based recruitment was critical for the continuation of the NeuroSAFE PROOF trial during the COVID-19 pandemic. The described pathway complies with ethical and regulatory guidelines for informed consent, while minimizing face-to-face interactions that increase the risk of COVID-19 transmission. This guide will help researchers integrate e-Consent to ongoing or planned clinical trials while uncertainty about the course of the pandemic continues. TRIAL REGISTRATION NeuroSAFE PROOF trial NCT03317990 . Registered on 23 October 2017. Regional Ethics Committee reference 17/LO/1978.
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Affiliation(s)
- Ricardo Almeida-Magana
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Hanna Maroof
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Rosie Clow
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Eoin Dinneen
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Tarek Al-Hammouri
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Nicola Muirhead
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Chris Brew-Graves
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - John Kelly
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Greg Shaw
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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13
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Christiansen JM, Meyer AM, Pickert L, Pfister R, Polidori MC. Challenges in the performance of real-life studies in older patients: focus on long-term care facilities. GERIATRIC CARE 2022. [DOI: 10.4081/gc.2022.10384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Research on geriatric conditions and atypical disease presentation in poorly studied patients’ groups is becoming increasingly important. Aim of the present investigation was addressing prevalence and prognostic significance of aortic valve stenosis (AVS) in older residents of long-term care facilities (LTCF). For the planned recruitment of 500 LTCF guests of a German metropolitan area, study investigators were trained and in the performance of a cardiologic examination and of the comprehensive geriatric assessment- based multidimensional prognostic index (MPI). After five attempts to obtain permission to conduct the study in 30 institutions, patients’ recruitment was stopped with 22 participants included from one institution. AVS was suspected in two patients, in agreement with the reported prevalence data. The MPI value correlated with social support (P=0.002) and geriatric syndromes (P=0.004). This structured attempt at investigating presence and prognostic signature of AVS in older LTCF guests was challenged by logistic obstacles strongly hindering diagnosis of potentially treatable conditions which, if undisclosed, negatively impact on survival and quality of life.
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14
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Wisgalla A, Hasford J. Four reasons why too many informed consents to clinical research are invalid: a critical analysis of current practices. BMJ Open 2022; 12:e050543. [PMID: 35246415 PMCID: PMC8900041 DOI: 10.1136/bmjopen-2021-050543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Informed consent (IC) is a central ethical and legal requirement for clinical research that aims to protect the autonomy of participants. To enable an autonomous decision and valid consent, adequate understanding must be ensured. However, a considerable proportion of participants do not understand the relevant aspects about participation in research, for example, approximately 45% could not name at least one risk. As such, the inadequate understanding of IC has been known for several decades, and it still constitutes a severe problem for the ethical conduct of research. Through delineating the most pressing deficits of current IC procedures that lead to insufficient understanding, we aim to encourage the discussion among stakeholders, for example, clinical researchers, and to provide the grounds for practical solutions. MAIN ARGUMENTS: (1) IC documents are too long to be read completely, thus, make it very difficult for potential participants to identify the material facts about the trial. (2) The low readability of the IC documents disadvantages persons with limited literacy. (3) The therapeutic misconception frequently prevents participants to realise that the primary purpose of clinical research is to benefit future patients. (4) Excessive risk disclosures, insufficient information about expected benefits and framing effects compromise a rational risk/benefit assessment. CONCLUSION Due to these deficits, practices of IC in clinical research too often preclude adequate understanding of prospective participants, thus, invalidating IC. The gap between the well-specified ethical norm to enable IC and its insufficient translation into practice can no longer be accepted, as participant rights and the public trust in responsible research are at stake. Hence, immediate action is needed to address the prevailing deficits.
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Affiliation(s)
- Anne Wisgalla
- Association of Medical Ethics Committees in Germany, Berlin, Germany
| | - Joerg Hasford
- Association of Medical Ethics Committees in Germany, Berlin, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
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15
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Gangeri L, Alfieri S, Greco M, Scrignaro M, Bianchi E, Casali P, Ferraris D, Borreani C. Expectations, experiences and preferences of patients and physicians in the informed consent process for clinical trials in oncology. Support Care Cancer 2021; 30:1911-1921. [PMID: 34618238 DOI: 10.1007/s00520-021-06599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the present study was to explore (1) informed consent (IC) representations, level of understanding, needs, and factors that influence the willingness of cancer patients to participate in randomized controlled trials (RCTs) (phase I) and (2) representations, experiences, and critical issues of physicians involved in the same process (phase II). METHODS Semi-structured interviews were conducted with 20 cancer patients who had been asked to enroll in a phase II/III RCT (phase I). Two focus groups were conducted with 13 physicians enrolled in the same process (phase II). The content produced was analyzed through a thematic analysis. RESULTS The themes that emerged in the first phase I were grouped into six categories: IC representation, randomization, experimentation, meeting with the physician, factors that influence the willingness to participate, and trial participants' needs. The themes emerged in the phase II were grouped into four: IC representation, critical issues of the IC, relationship, and recruitment of trial participants. Each theme is articulated into sub-themes and deeply discussed. CONCLUSION This study highlights (1) the gap between what is ethically demanded in a RCT consultation and the reality of the situation and (2) the difference in perceptions between patients and physicians with reference to the meaning, objectives, and level of understanding of IC.
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Affiliation(s)
- Laura Gangeri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - Margherita Greco
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marta Scrignaro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Elisabetta Bianchi
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Paolo Casali
- Adult Mesenchymal Tumour Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Davide Ferraris
- Lega Italiana per la Lotta contro i Tumori (LILT), Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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16
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Rothwell E, Brassil D, Barton-Baxter M, Brownley KA, Dickert NW, Ford DE, Kraft SA, McCormick JB, Wilfond BS. Informed consent: Old and new challenges in the context of the COVID-19 pandemic. J Clin Transl Sci 2021; 5:e105. [PMID: 34192059 PMCID: PMC8193198 DOI: 10.1017/cts.2021.401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/07/2021] [Accepted: 03/18/2021] [Indexed: 01/23/2023] Open
Abstract
In this paper, we address how the COVID-19 pandemic has impacted informed consent for clinical research through examining experiences within Clinical and Translation Science Award (CTSA) institutions. We begin with a brief overview of informed consent and the challenges that existed prior to COVID-19. Then, we discuss how informed consent processes were modified or changed to address the pandemic, consider what lessons were learned, and present research and policy steps to prepare for future research and public health crises. The experiences and challenges for CTSA institutions offer an important perspective for examining what we have learned about informed consent and determining the next steps for improving the consent process.
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Affiliation(s)
- Erin Rothwell
- Department of Ob/Gyn, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Marietta Barton-Baxter
- University of Kentucky Center for Clinical and Translational Science, Lexington, KY, USA
| | - Kimberly A. Brownley
- Department of Psychiatry, School of Medicine, NC Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neal W. Dickert
- Emory University School of Medicine, Department of Medicine, and Georgia Clinical and Translational Science Alliancet, Atlanta, GA, USA
| | - Daniel E. Ford
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer B. McCormick
- Department of Humanities, College of Medicine, Pennsylvania State University, and Penn State Clinical and Translational Science Institute, Hershey, PA, USA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute; Department of Pediatrics, University of Washington School of Medicine; Institute of Translational Health Sciences, Seattle, WA, USA
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17
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Murphy M, McCaughan E, Carson MA, Donovan M, Wilson RH, Fitzsimons D. Nothing to lose: a grounded theory study of patients' and healthcare professionals' perspectives of being involved in the consent process for oncology trials with non-curative intent. BMC Palliat Care 2020; 19:166. [PMID: 33126874 PMCID: PMC7602307 DOI: 10.1186/s12904-020-00661-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/29/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Clinical cancer research trials may offer little or no direct clinical benefit to participants where a cure is no longer possible. As such, the decision-making and consent process for patient participation is often challenging. AIM To gain understanding of how patients make decisions regarding clinical trial participation, from the perspective of both the patient and healthcare professionals involved. METHODS In-depth, face to face interviews using a grounded theory approach. This study was conducted in a regional Cancer Centre in the United Kingdom. Of the 36 interviews, 16 were conducted with patients with cancer that had non-curative intent and 18 with healthcare professionals involved in the consent process. RESULTS 'Nothing to lose' was identified as the core category that underpinned all other data within the study. This highlighted the desperation articulated by participants, who asserted trial participation was the 'only hope in the room'. The decision regarding participation was taken within a 'trusting relationship' that was important to both patients and professionals. Both were united in their 'fight against cancer'. These two categories are critical in understanding the decision-making/consent process and are supported by other themes presented in the theoretical model. CONCLUSION This study presents an important insight into the complex and ethically contentious situation of consent in clinical trials that have non-curative intent. It confirms that patients with limited options trust their doctor and frequently hold unrealistic hopes for personal benefit. It highlights a need for further research to develop a more robust and context appropriate consent process.
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Affiliation(s)
- Mary Murphy
- Resuscitation Services, Elliott Dynes Building, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Eilís McCaughan
- School of Nursing and Midwifery, Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Matthew A Carson
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Monica Donovan
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Richard H Wilson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
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18
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De Sutter E, Zaçe D, Boccia S, Di Pietro ML, Geerts D, Borry P, Huys I. Implementation of Electronic Informed Consent in Biomedical Research and Stakeholders' Perspectives: Systematic Review. J Med Internet Res 2020; 22:e19129. [PMID: 33030440 PMCID: PMC7582148 DOI: 10.2196/19129] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023] Open
Abstract
Background Informed consent is one of the key elements in biomedical research. The introduction of electronic informed consent can be a way to overcome many challenges related to paper-based informed consent; however, its novel opportunities remain largely unfulfilled due to several barriers. Objective We aimed to provide an overview of the ethical, legal, regulatory, and user interface perspectives of multiple stakeholder groups in order to assist responsible implementation of electronic informed consent in biomedical research. Methods We conducted a systematic literature search using Web of Science (Core collection), PubMed, EMBASE, ACM Digital Library, and PsycARTICLES. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for reporting this work. We included empirical full-text studies focusing on the concept of electronic informed consent in biomedical research covering the ethical, legal, regulatory, and user interface domains. Studies written in English and published from January 2010 onward were selected. We explored perspectives of different stakeholder groups, in particular researchers, research participants, health authorities, and ethics committees. We critically appraised literature included in the systematic review using the Newcastle-Ottawa scale for cohort and cross-sectional studies, Critical Appraisal Skills Programme for qualitative studies, Mixed Methods Appraisal Tool for mixed methods studies, and Jadad tool for randomized controlled trials. Results A total of 40 studies met our inclusion criteria. Overall, the studies were heterogeneous in the type of study design, population, intervention, research context, and the tools used. Most of the studies’ populations were research participants (ie, patients and healthy volunteers). The majority of studies addressed barriers to achieving adequate understanding when using electronic informed consent. Concerns shared by multiple stakeholder groups were related to the security and legal validity of an electronic informed consent platform and usability for specific groups of research participants. Conclusions Electronic informed consent has the potential to improve the informed consent process in biomedical research compared to the current paper-based consent. The ethical, legal, regulatory, and user interface perspectives outlined in this review might serve to enhance the future implementation of electronic informed consent. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020158979; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158979
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Drieda Zaçe
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Maria Luisa Di Pietro
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - David Geerts
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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19
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Patients' and physicians' disagreement on patients' understanding of clinical cancer trial information: a pairwise pilot study of mirroring subjective assessments compared with objective measurements. Trials 2019; 20:301. [PMID: 31142346 PMCID: PMC6542135 DOI: 10.1186/s13063-019-3416-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informed consent is a prerequisite for patients included in clinical trials. Trial design, inclusion criteria and legal requirements are increasingly complex. This complexity challenges design and delivery of written and oral trial information to ensure understandable information. To evaluate the level of concordance between patients' and informing physicians' assessments regarding patient understanding of trial information, we carried out a study based on paired questionnaire data from patients and their physicians. These assessments of patient understanding were further correlated with patients' factual knowledge of the information provided. METHODS This pilot study included patients and physicians immediately after the patients had received information on one of 23 ongoing phase III randomised cancer trials at two Swedish sites. In total, 46 patients and 17 physicians contributed data based on two new questionnaires with seven mirroring questions, where concordance was analysed with McNemar's test. These assessments of patients' self-estimated understanding were further correlated with the Patient Understanding of Research (Q-PUR) questionnaire that assesses factual knowledge of the information provided. RESULTS For each question, 47-61% of the patient-physician pairs were in concordance regarding their assessments of patients' 'fully understanding' or 'not fully understanding' various aspects of the trial information. For the discordant pairs, the physicians rated patient understanding lower than the patients themselves, for all seven questions. This difference was significant for five of the questions (P ≤ 0.017). The median Q-PUR knowledge score was 11 out of 12, but this score did not significantly correlate with the assessments, either from patients or from physicians. CONCLUSIONS This study demonstrated a trend for physicians to rate the level of understanding of trial information among potential trial patients lower than the patients themselves. Application of Q-PUR revealed high knowledge scores, but without correlation to the assessments. These findings need validation in an independent setting, with an improved instrument with mirroring questions, and a better-matched measurement of patients' factual knowledge. These results suggest that physicians need to improve their ability to assess patient understanding of clinical trial information, in order to be able to tailor the patients' information individually.
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