Patient Consent in the Era of De-Identified Research Databases

Exploring consent to randomized placebo-controlled clinical trials in oncology

AIMS

Randomized placebo-controlled trials are critical for advancing knowledge in oncology, yet little is known about optimal communication for informed consent. This study aimed to identify patient preferences for and satisfaction with three consultation styles (information-focused, emotion-focused and collaborative) in simulated discussions of four clinical trial concepts (randomization, placebo, tissue analysis and oncologists' recommendation).

METHODS

In total 75 Australian cancer patients and carers, or both, viewed videotaped simulated consultations with a doctor and patient discussing a randomized, placebo-controlled trial. Their satisfaction and preferences for both consultation style and information were assessed. The patients' characteristics and decision-making preferences were also evaluated as potential predictors for consultation style preference.

RESULTS

Participants preferred a collaborative consultation style when discussing randomization (74.6%), placebo (71.4%) and oncologist's recommendation (77%). However an emotion-focused consultation style was preferred when discussing tissue analysis (81%). The participants represented a highly information-seeking group, although most favoured collaborative or passive roles in treatment decision-making. Limited variables were identified that predict consultation style preference.

CONCLUSION

While supporting the value of a collaborative approach to clinical trial communications, the study finding that tissue analysis requires a more emotion-focused approach highlights a new focus for trial communication and confirms the need for doctors to remain flexible in their consultation style.

Setting up a Prospective Thyroid Biobank for Translational Research: Practical Approach of a Single Institution (2004-2009, Pasteur Hospital, Nice, France)

In the last few years, conditions for setting up a human biobank in France have been upgraded by taking into account (1) the new laws and regulations that integrate the ethical and societal dimension of biobanking and delineate the risks for patients associated with the procurement of human cells and tissues, (2) the increasing request by scientists for human samples with proven biological quality and sophisticated sets of annotations, including information produced through the evergrowing use of molecular biology in pathology, and (3) establishment of procedures concerning the safety of the personnel working with biological products. For this purpose, health authorities and national research institutes in France have provided significant support for the set up of biobanks. The present work was conducted to describe how we set up a biobank targeting diseases of a specific organ (thyroid gland), with the aim of rapidly developing translational research projects. The prospective experience of a single institution (Pasteur Hospital, Nice, France) over a 6-year period (2004-2009) is presented from the practical point of view of a surgical pathology laboratory. We describe different procedures required to obtain high-quality thyroid biological resources and clinical annotations. The procedures were established for the management of biological products obtained from 1454 patients who underwent thyroid surgery. The preanalytical steps leading to the storage of frozen specimens were carried out in parallel with diagnostic procedures. As the number of international networks for research programs using biological products is steadily increasing, it is crucial to harmonize the procedures used by biobanks. In this regard, the described thyroid biobank has been set up using criteria established by the French National Cancer Institute (Institut National du Cancer) to guarantee the quality of different collections stored in biobanks.

[The Nice CHU biobank experience to collect patients' informed consent for research context (2004-2009)]

Over the last 10 years, significant financial support from the French National Institute of Cancer (INCa), the Ministry of Health (DGOS), and the Health and Research National Institute (Inserm) helped biobanks--of which tumour banks represent a prominent example of hospital-based infrastructures--to improve their operations, and in some instances to adopt the rules of Biological Ressource Centers as defined by OECD. Nowadays, the use of biological samples of human origin is strictly subordinated to regulations that integrate bioethical principles. However, in spite of the establishment of these regulations, requirement to obtain an authorisation and/or to register the biological collections with the Ministry of Research, many uncertainties persist. While French regulations mandate that samples can be used for research as long as patients did not oppose to such use, many biobank curators face practical and theoretical issues when establishing a Material Transfer Agreement with scientists, due to the lack of harmonization between national regulations--particularly due to a different perception of privacy and free will in anglo-american and other countries--and different demands on the side of private industry or editorial boards of scientific journals. The goal of this article is (1) to describe the procedure followed to collect patients' informed consent at the Biobank of CHU de Nice and (2) to assess the number of obtained consents in comparison to the number of collected samples between 01/09/2004 and 31/12/2009, the number of consents obtained before or after collecting the samples, and the number of patients' refusal to collect their biological resources. This balance-sheet is settled for the three major collections (thoracic, thyroid and head and neck tissues) from the Biobank of CHU de Nice. Results show that 88 % of consents were obtained during this period (82 % in a prospective manner and 6 % in a retrospective manner). Refusal was notified by writing in nine cases only. The percentage of consents varies slightly according to the collection involved and is stable from 2004 to 2009. Overall, our procedure is quite efficient at obtaining informed consents from a majority of patients for whom the tumour bank stores biological samples. This situation provides optimal conditions for the use of collected samples in the context of national and international research projects.