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Lin X, Yuen JYE, Chan WQJ, Divakar TG, Keong NCH, Lee LCH, Kumar S, Tan CS, Soon KCP, Chew YPA, Yazid HM, Saleh FJM, Cai F, Chai FC, Azwan NFM, Faizal NM, Lou SC, Tan SSP, Jarimin CM, Stanley GM, Hussien K, Sanmwan N, Amran NH, Ramli N, Neo SXM, Tan LCS, Tan EK, Lum E. Using the consolidated framework for implementation research to guide a pilot of implementing an institution level patient informed consent process for clinical research at an outpatient setting. Pilot Feasibility Stud 2023; 9:6. [PMID: 36635739 PMCID: PMC9835029 DOI: 10.1186/s40814-023-01234-0] [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: 12/12/2021] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Singapore, research teams seek informed patient consent on an ad hoc basis for specific clinical studies and there is typically a role separation between operational and research staff. With the enactment of the Human Biomedical Research Act, there is increased emphasis on compliance with consent-taking processes and research documentation. To optimize resource use and facilitate long-term research sustainability at our institution, this study aimed to design and pilot an institution level informed consent workflow (the "intervention") that is integrated with clinic operations. METHODS We used the Consolidated Framework for Implementation Research (CFIR) as the underpinning theoretical framework and conducted the study in three stages: Stage 1, CFIR constructs were used to systematically identify barriers and facilitators of intervention implementation, and a simple time-and-motion study of the patient journey was used to inform the design of the intervention; Stage 2, implementation strategies were selected and mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy; Stage 3, we piloted and adapted the implementation process at two outpatient clinics and evaluated implementation effectiveness through patient participation rates. RESULTS We identified 15 relevant CFIR constructs. Implementation strategies selected to address these constructs were targeted at three groups of stakeholders: institution leadership (develop relationships, involve executive boards, identify and prepare champions), clinic management team (develop relationships, identify and prepare champions, obtain support and commitment, educate stakeholders), and clinic operations staff (develop relationships, assess readiness, conduct training, cyclical tests of change, model and simulate change, capture and share local knowledge, obtain and use feedback). Time-and-motion study in clinics identified the pre-consultation timepoint as the most appropriate for the intervention. The implementation process was adapted according to clinic operations staff and service needs. At the conclusion of the pilot, 78.3% of eligible patients provided institution level informed consent via the integrated workflow implemented. CONCLUSIONS Our findings support the feasibility of implementing an institution level informed consent workflow that integrates with service operations at the outpatient setting to optimize healthcare resources for research. The CFIR provided a useful framework to identify barriers and facilitators in the design of the intervention and its implementation process.
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Affiliation(s)
- Xuling Lin
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Joanne Yong Ern Yuen
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Wei Quan Jeremy Chan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Tushar Gosavi Divakar
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Nicole Chwee Har Keong
- grid.276809.20000 0004 0636 696XDepartment of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Lester Chee How Lee
- grid.276809.20000 0004 0636 696XDepartment of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Sumeet Kumar
- grid.276809.20000 0004 0636 696XDepartment of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Chew Seah Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Kim Chin Pauline Soon
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Yee Pheng Amy Chew
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Heriati Mohd Yazid
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Farah Julieanna Mohd Saleh
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Fenglong Cai
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Fui Chih Chai
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Nur Fakhirah Mohamed Azwan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Nurhidayah Mohamad Faizal
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Siew Choo Lou
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Siew Sin Priscilla Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Cut Marini Jarimin
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Gowri Michael Stanley
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Khadijah Hussien
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Nurhazah Sanmwan
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Nur Hidayah Amran
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Nurliana Ramli
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Shermyn Xiu Min Neo
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Louis Chew Seng Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Eng King Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Elaine Lum
- grid.428397.30000 0004 0385 0924Health Services & Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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