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Robertson EG, Komesaroff R, Eisenstat DD, Robertson A, Ludlow LE. A Pilot Evaluation of an Educational Video to Support Consent to a Pediatric Malignancy Biobank. Biopreserv Biobank 2024. [PMID: 38800954 DOI: 10.1089/bio.2024.0011] [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: 05/29/2024] Open
Abstract
Introduction: The collection of biological specimens is necessary to support basic and translational research. However, the complexity of biobanking introduces numerous ethical issues, particularly regarding informed consent. Objective: To evaluate the acceptability and perceived benefits of an educational video facilitating the consent process for the Children's Cancer Centre Biobank. Methods: We invited individuals who had previously consented to be (or their child to be) part of the Biobank, and health professionals who were involved in obtaining consent. Participants watched the video and completed a purpose-designed online survey. Results: A total of 16 health professionals (invited = 30) and 15 patients/caregivers (invited = 127) participated. Most patients/caregivers felt informed about the Biobank at consent, however, noted how overwhelmed they were at the time and that they did not engage with the written information. Overall, both patients/caregivers and health professionals rated the video favorably regarding the information provided and format. Participants valued that it was simple and clear, with several health professionals noting the need for linguistic translations to better support the families they work with. Most patients/caregivers agreed that the video provided enough information to begin considering participation. This aligned with the health professionals' feedback that the video was most effective when used as a conversation starter to help formalize the written consent. Conclusion: Our findings suggest that our video is an acceptable and beneficial tool to assist in the Biobank consenting process, from both the perspective of decision-makers and health professionals obtaining consent. It appears particularly valuable as a precursor to an interactive, formal consent discussion. Further work is required to determine whether our video has a significant impact on outcomes such as decision-making satisfaction and knowledge, and to determine the value to adolescents.
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Affiliation(s)
- Eden G Robertson
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
| | - Rebecca Komesaroff
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - David D Eisenstat
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Alexandra Robertson
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Louise E Ludlow
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Ellis LB, Barcroft J, St John E, Loughran D, Kyrgiou M, Phelps D. Digital consent in gynecology: an evaluation of patient experience. Arch Gynecol Obstet 2024; 309:611-619. [PMID: 38063894 PMCID: PMC10808288 DOI: 10.1007/s00404-023-07304-1] [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: 08/25/2023] [Accepted: 11/08/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The surgical consent process is a crucial discussion between patient and surgeon, which is predominantly documented utilizing hand-written forms. The exchange of individualized information allows the patient to make a truly informed decision. Digital consent (also known as electronic consent or e-consent) has been shown to improve accuracy of information provided without increasing the time taken to consent patients. We aimed to evaluate patient experience and effectiveness of digital consent in a gynecology department in a tertiary London Teaching Hospital. METHODS A questionnaire was designed and completed by 100 patients undergoing gynecological surgery: 50 consented using paper and 50 consented digitally. The questionnaire included 8 statements, with five possible answers to select, ranging from strongly agree to strongly disagree, on a standard five-point Likert Scale. Patients were all female and categorized into age groups (deciles) and asked whether consent was taken digitally or on paper. Data were collected between January and July 2021. RESULTS Most responses were positive with 87% (694/800) of responses to the questions being either strongly agree or agree. Patients who were consented using paper selected 'strongly agree' 43.5% (174/400) of the time in comparison to 64.8% (259/400) of the time when they were consented digitally. The majority, 86% (43/50), of digitally consented patients received a copy of the consent form in comparison to 18% (9/50) of those consented using paper. On average, the patients consented digitally were older than their paper-consented counterparts (49-58 and 59-68 respectively). The mean scores for the questions relating to the ease of reading the form, ease of understanding the form, understanding of the potential complications, and overall satisfaction were higher in those digitally consented (p < 0.05). DISCUSSION Overall, patients were satisfied with both methods of consent. However, individuals who were consented digitally reported higher levels of satisfaction throughout the consent process, compared to paper consent. These data suggest that digital consent is an acceptable alternative to paper consent for patients and facilitates adherence to national consent guidance, which stipulates patients should be given the information they request.
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Affiliation(s)
- Laura Burney Ellis
- Imperial College London, Imperial College Healthcare NHS Trust, IRDB, Du Cane Road, London, W12 0NN, UK.
| | - Jennifer Barcroft
- Imperial College London, Imperial College Healthcare NHS Trust, IRDB, Du Cane Road, London, W12 0NN, UK
| | - Edward St John
- Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO6 3LY, UK
- University of Portsmouth, University House, Winston Churchill Ave, Portsmouth, PO1 2UP, UK
- Concentric Health, Tramshed Tech, Cardiff, CF11 6BH, UK
| | | | - Maria Kyrgiou
- Imperial College London, Imperial College Healthcare NHS Trust, IRDB, Du Cane Road, London, W12 0NN, UK
| | - David Phelps
- Imperial College London, Imperial College Healthcare NHS Trust, IRDB, Du Cane Road, London, W12 0NN, UK
- University Hospitals Southampton NHS Foundation Trust, Princess Anne Hospital, Coxford Road, Southampton, SO16 5YA, UK
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Corneli A, Starling S, Choi Y, Vosylius J, Madre L, Mackinnon A, Tenaerts P. Participant comprehension and acceptability of enhanced versus text-only electronic informed consent: an innovative qualitative pilot study. Pilot Feasibility Stud 2024; 10:10. [PMID: 38233932 DOI: 10.1186/s40814-023-01432-w] [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: 07/17/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The use of electronic informed consent (eIC) in decentralized trials offers a pragmatic approach to enrolling participants across multiple geographic areas. METHODS Using a randomized, cross-over study design, we conducted a qualitative descriptive evaluation of two eIC approaches-text-only eIC and enhanced eIC-in a mock hypertension Phase III clinical trial. We assessed participant comprehension and acceptability (usability, satisfaction, and eIC preference). RESULTS A total of 24 individuals with hypertension participated in the study: 12 reviewed the text-only eIC first, followed by the enhanced eIC, and 12 reviewed the enhanced eIC first, followed by the text-only eIC. The study population was diverse in gender, age, race, and geographic location. We found no descriptive differences in participant comprehension and satisfaction between the two eIC approaches. However, more participants preferred the enhanced eIC, and participants indicated that the digital elements were personable and made them feel more informed, engaged, comfortable, and prepared to participate in clinical research. CONCLUSIONS Our findings suggest that enhancing the eIC process with digital elements may have beneficial outcomes among potential participants beyond comprehension and satisfaction.
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Affiliation(s)
- Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Summer Starling
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Yujung Choi
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
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De Sutter E, Barbier L, Borry P, Geerts D, Ioannidis JP, Huys I. Personalized and longitudinal electronic informed consent in clinical trials: How to move the needle? Digit Health 2024; 10:20552076231222361. [PMID: 38269372 PMCID: PMC10807334 DOI: 10.1177/20552076231222361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
Changes in the clinical trials landscape have been driven by advancements in digital technology. The use of electronic informed consent to inform research participants and to obtain their consent electronically has the potential to improve participant-researcher interactions over time, facilitate clinical trial participation, and increase efficiency in clinical trial conduct. A personalized electronic informed consent platform that enables long-term interactions with the research team could function as a tool to empower participant engagement in clinical trials. However, significant challenges persist impeding successful and widespread implementation. This Perspective provides insights into the opportunities and challenges for the implementation of electronic informed consent in clinical trials. It sets out key recommendations to promote the implementation of this innovative approach to the informed consent process, including the creation of uniform electronic informed consent platforms at regional and national level.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Liese Barbier
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - David Geerts
- KU Leuven Digital Society Institute, KU Leuven, Leuven, Belgium
| | - John P.A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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De Sutter E, Geerts D, Yskout K, Verreydt S, Borry P, Barbier L, Huys I. Testing and Practical Implementation of a User-Friendly Personalized and Long-Term Electronic Informed Consent Prototype in Clinical Research: Mixed Methods Study. J Med Internet Res 2023; 25:e46306. [PMID: 38113088 PMCID: PMC10762617 DOI: 10.2196/46306] [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: 02/08/2023] [Revised: 09/08/2023] [Accepted: 09/28/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Over the years, there has been increasing interest in electronic informed consent (eIC) in clinical research. The user-friendliness of an eIC application and its acceptance by stakeholders plays a central role in achieving successful implementation. OBJECTIVE This study aims to identify insights for the design and implementation of a user-friendly, personalized, and long-term eIC application based on a usability study with (potential) research participants and semistructured interviews with stakeholders on the practical integration of such an application into their daily practice. METHODS An eIC prototype was evaluated and refined through usability testing among Belgian citizens and iterative redesign. On the basis of a digital literacy questionnaire, a heterogeneous sample of participants was established. Participants needed to complete a series of usability tasks related to personalization and long-term interaction with the research team while using the "think aloud" technique. In addition, usability tests involved completing the System Usability Scale questionnaire and taking part in a semistructured feedback interview. Furthermore, semistructured interviews were conducted with ethics committee members, health care professionals, and pharmaceutical industry representatives active in Belgium and involved in clinical research. Thematic analysis was undertaken using the NVivo software (Lumivero). RESULTS In total, 3 iterations of usability tests were conducted with 10 participants each. Each cycle involved some participants who reported having low digital skills. The System Usability Scale scores related to the tasks on personalization and long-term interaction increased after each iteration and reached 69.5 (SD 8.35) and 71.3 (SD 16.1) out of 100, respectively, which represents above-average usability. Semistructured interviews conducted with health care professionals (n=4), ethics committee members (n=8), and pharmaceutical industry representatives (n=5) identified the need for an eIC system that can be easily set up. For example, a library could be established enabling stakeholders to easily provide background information about a clinical study, presented in the second layer of the interface. In contrast, some functionalities, such as informing participants about new studies through an eIC system, were not considered useful by stakeholders. CONCLUSIONS This study provides insights for the implementation of a user-friendly personalized and long-term eIC application. The study findings showed that usability testing is key to assessing and increasing the user-friendliness of an eIC application. Although this eIC system has the potential to be usable by a wide audience, participants with low digital literacy may not be able to use it successfully, highlighting the need for additional support for participants or other alternatives to an eIC system. In addition, key lessons emerging from the interviews included ensuring that the application is easy to implement in practice and is interoperable with other established systems.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, Catholic University (KU) Leuven, Leuven, Belgium
| | - David Geerts
- Catholic University (KU) Leuven Digital Society Institute, Catholic University (KU) Leuven, Leuven, Belgium
| | - Koen Yskout
- imec-DistriNet, Catholic University (KU) Leuven, Leuven, Belgium
| | - Stef Verreydt
- imec-DistriNet, Catholic University (KU) Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, Catholic University (KU) Leuven, Leuven, Belgium
| | - Liese Barbier
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, Catholic University (KU) Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, Catholic University (KU) Leuven, Leuven, Belgium
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Heyrman B, Meers S, Van De Velde A, Anguille S. Combined Results of Two Cross-Sectional Surveys on the Participation in Clinical Trials and the e-Consent Procedure in the Landscape of Haematology. Clin Pract 2023; 13:1520-1531. [PMID: 38131682 PMCID: PMC10742482 DOI: 10.3390/clinpract13060133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Despite the motivation of oncology patients to take part in clinical trials, only a minority of them are enrolled in clinical trials. Implementation of new practical procedures can become a barrier that withholds patients from participating in clinical trials. Treating physicians are crucial in augmenting trial accrual. The drivers that promote physicians to allocate patients for clinical trials need further assessment. We conducted two separate cross-sectional surveys, addressing patients with a haematological disease in one survey and haematologists in another survey. The patient survey was filled out by 420 patients. Significant relationships between the willingness to participate in a trial and trial knowledge (p < 0.001) and between doctor-patient relationship and participation willingness (p = 0.007) were noted. Patients above 60 years were less willing to use an electronic consent procedure vs. patients younger than 60 (p < 0.001). The physician questionnaire was completed by 42 participants of whom most (83%) were active in and (94%) motivated for clinical trials. Apart from the patient benefit and scientific interest, prestige was an equal motivator closely followed by financial remunerations. First goal was not to harm the patient. Our study confirms the high willingness of patients for trial participation and the need to rethink the structure of trial organisation. The e-consent procedure is not the method preferred by most patients above 60 years old.
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Affiliation(s)
- Bert Heyrman
- Ziekenhuis Netwerk Antwerpen, Department of Haematology, 2020 Antwerp, Belgium
| | - Stef Meers
- Algemeen Ziekenhuis KLINA, Department of Haematology, 2930 Brasschaat, Belgium
| | - Ann Van De Velde
- Department of Haematology, University Hospital Antwerp, 2650 Edegem, Belgium
| | - Sébastien Anguille
- Department of Haematology, University Hospital Antwerp, 2650 Edegem, Belgium
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Mitchell EJ, Appelbe D, Bravery A, Culliford L, Evans H, Farrin AJ, Gillies K, Hood K, Love SB, Sydes MR, Williamson PR, Wakefield N. e-Consent in UK academic-led clinical trials: current practice, challenges and the need for more evidence. Trials 2023; 24:657. [PMID: 37817277 PMCID: PMC10565982 DOI: 10.1186/s13063-023-07656-8] [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] [Received: 05/16/2023] [Accepted: 09/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, in-person healthcare visits were reduced. Consequently, trial teams needed to consider implementing remote methods for conducting clinical trials, including e-Consent. Although some clinical trials may have implemented e-Consent prior to the pandemic, anecdotes of uptake for this method increased within academic-led trials. When the increased use of this process emerged, representatives from several large academic clinical trial groups within the UK collaborated to discuss ways in which trialists can learn from one another when implementing e-Consent. METHODS A survey of UKCRC-registered Clinical Trials Units (CTUs) was undertaken in April-June 2021 to understand the implementation of and their views on the use of e-Consent and experiences from the perspectives of systems programmers and quality assurance staff on the use of e-Consent. CTUs not using e-Consent were asked to provide any reasons/barriers (including no suitable trials) and any plans for implementing it in the future. Two events for trialists and patient and public involvement (PPI) representatives were then held to disseminate findings, foster discussion, share experiences and aid in the identification of areas that the academic CTU community felt required more research. RESULTS Thirty-four (64%) of 53 CTUs responded to the survey, with good geographical representation across the UK. Twenty-one (62%) of the responding CTUs had implemented e-Consent in at least one of their trials, across different types of trials, including CTIMPs (Clinical Trial of Investigational Medicinal Product), ATIMPs (Advanced Therapy Medicinal Products) and non-CTIMPs. One hundred ninety-seven participants attended the two workshops for wide-ranging discussions. CONCLUSION e-Consent is increasingly used in academic-led trials, yet uncertainties remain amongst trialists, patients and members of the public. Uncertainties include a lack of formal, practical guidance and a lack of evidence to demonstrate optimal or appropriate methods to use. We strongly encourage trialists to continue to share their own experiences of the implementation of e-Consent.
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Affiliation(s)
- E J Mitchell
- Nottingham Clinical Trials Unit, School of Medicine, Applied Health Research Building, University Park, Nottingham, NG7 2RD, UK.
| | - D Appelbe
- Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - A Bravery
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - L Culliford
- Bristol Trials Centre, University of Bristol, Bristol Medical School, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - H Evans
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - A J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9NL, UK
| | - K Gillies
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - K Hood
- Centre for Trial Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - S B Love
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK
- BHF Data Science Centre, Health Data Research UK, 215 Euston Road, London, NW1 2BE, UK
| | - P R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - N Wakefield
- Nottingham Clinical Trials Unit, School of Medicine, Applied Health Research Building, University Park, Nottingham, NG7 2RD, UK
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Chimonas S, Lipitz-Snyderman A, Matsoukas K, Kuperman G. Electronic consent in clinical care: an international scoping review. BMJ Health Care Inform 2023; 30:e100726. [PMID: 37423643 PMCID: PMC10335420 DOI: 10.1136/bmjhci-2022-100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/21/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE Digital technologies create opportunities for improvement of consenting processes in clinical care. Yet little is known about the prevalence, characteristics or outcomes of shifting from paper to electronic consenting, or e-consent, in clinical settings. Thus questions remain around e-consent's impact on efficiency, data integrity, user experience, care access, equity and quality. Our objective was to scope all known findings on this critical topic. MATERIALS AND METHODS Through an international, systematic scoping review, we identified and assessed all published findings on clinical e-consent in the scholarly and grey literatures, including consents for telehealth encounters, procedures and health information exchanges. From each relevant publication, we abstracted data on study design, measures, findings and other study features. MAIN OUTCOME MEASURES Metrics describing or evaluating clinical e-consent, including preferences for paper versus e-consenting; efficiency (eg, time, workload) and effectiveness (eg, data integrity, care quality). User characteristics were captured where available. RESULTS A total of 25 articles published since 2005, most from North America or Europe, report on the deployment of e-consent in surgery, oncology and other clinical settings. Experimental designs and other study characteristics vary, but nearly all focus on procedural e-consents. Synthesis reveals relatively consistent findings around improved efficiency and data integrity with, and user preferences for, e-consent. Care access and quality issues are less frequently explored, with disparate findings. DISCUSSION AND CONCLUSION The literature is nascent and largely focused on issues that are immediate and straightforward to measure. As virtual care pathways expand, more research is urgently needed to ensure that care quality and access are advanced, not compromised, by e-consent.
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Affiliation(s)
- Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Gilad Kuperman
- Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Smales K, Lloyd A, Rayner S. Perry Starlight, Ali Orbit and Kim Cosmos' alien encounter: creating a picturebook as information for children and parents participating in research. JOURNAL OF DOCUMENTATION 2023. [DOI: 10.1108/jd-09-2022-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PurposeThis study explored whether the creation of an illustrated picturebook could explain the terms and practicalities of participatory, multi-method qualitative research to children aged four to eight years and their parents/carers, creating conditions to seek agreement to their participation, by using an age-appropriate design whilst adhering to ethical guidelines. The purpose of this paper is to explore how this was done addressing these issues.Design/methodology/approachDrawing on the researcher's previous professional experience working in children's publishing and taking an innovative and collaborative approach to giving information to child and parent/carer co-researchers, the researcher and an illustrator created a picturebook both as an eBook and a paperback book to recruit and explain research and co-researchers’ roles to young children and their parents/carers.FindingsThe picturebook successfully recruited 30 children and their parents/carers. Other children expressed their wish not to participate. These findings suggest that greater consideration should be given to the ways information is given to potential research participants, particularly the visual, material and paratextual elements of the information sheets and consent forms routinely used in research.Originality/valueThis paper offers insight into the publishing practicalities of creating innovative ways of giving information about research participation to children and parents/carers and how these ways might foster rich data collection.
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10
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de Man Y, Wieland-Jorna Y, Torensma B, de Wit K, Francke AL, Oosterveld-Vlug MG, Verheij RA. Opt-In and Opt-Out Consent Procedures for the Reuse of Routinely Recorded Health Data in Scientific Research and Their Consequences for Consent Rate and Consent Bias: Systematic Review. J Med Internet Res 2023; 25:e42131. [PMID: 36853745 PMCID: PMC10015347 DOI: 10.2196/42131] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Scientific researchers who wish to reuse health data pertaining to individuals can obtain consent through an opt-in procedure or opt-out procedure. The choice of procedure may have consequences for the consent rate and representativeness of the study sample and the quality of the research, but these consequences are not well known. OBJECTIVE This review aimed to provide insight into the consequences for the consent rate and consent bias of the study sample of opt-in procedures versus opt-out procedures for the reuse of routinely recorded health data for scientific research purposes. METHODS A systematic review was performed based on searches in PubMed, Embase, CINAHL, PsycINFO, Web of Science Core Collection, and the Cochrane Library. Two reviewers independently included studies based on predefined eligibility criteria and assessed whether the statistical methods used in the reviewed literature were appropriate for describing the differences between consenters and nonconsenters. Statistical pooling was conducted, and a description of the results was provided. RESULTS A total of 15 studies were included in this meta-analysis. Of the 15 studies, 13 (87%) implemented an opt-in procedure, 1 (7%) implemented an opt-out procedure, and 1 (7%) implemented both the procedures. The average weighted consent rate was 84% (60,800/72,418 among the studies that used an opt-in procedure and 96.8% (2384/2463) in the single study that used an opt-out procedure. In the single study that described both procedures, the consent rate was 21% in the opt-in group and 95.6% in the opt-out group. Opt-in procedures resulted in more consent bias compared with opt-out procedures. In studies with an opt-in procedure, consenting individuals were more likely to be males, had a higher level of education, higher income, and higher socioeconomic status. CONCLUSIONS Consent rates are generally lower when using an opt-in procedure compared with using an opt-out procedure. Furthermore, in studies with an opt-in procedure, participants are less representative of the study population. However, both the study populations and the way in which opt-in or opt-out procedures were organized varied widely between the studies, which makes it difficult to draw general conclusions regarding the desired balance between patient control over data and learning from health data. The reuse of routinely recorded health data for scientific research purposes may be hampered by administrative burdens and the risk of bias.
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Affiliation(s)
- Yvonne de Man
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Yvonne Wieland-Jorna
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Bart Torensma
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Koos de Wit
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Anneke L Francke
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Department of Public and Occupational Health, Location Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.,Tranzo, School of Social Sciences and Behavioural Research, Tilburg University, Tilburg, the Netherlands
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11
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Mazzochi AT, Dennis M, Chun HYY. Electronic informed consent: effects on enrolment, practical and economic benefits, challenges, and drawbacks-a systematic review of studies within randomized controlled trials. Trials 2023; 24:127. [PMID: 36810093 PMCID: PMC9942032 DOI: 10.1186/s13063-022-06959-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/24/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Enrolment is one of the most challenging aspects of conducting clinical trials, preceded by the process of informed consent (IC). Different strategies to improve recruitment in clinical trials have been used, including electronic IC. During COVID-19 pandemic, barriers to enrolment have been evident. Although digital technologies were acknowledged as the future of clinical research and potential advantages were shown for recruitment, electronic informed consent (e-IC) has not yet been globally adopted. The purpose of this review is to investigate the effect of using e-IC on enrolment, practical and economic benefits, challenges, and drawbacks when compared to traditional informed consent, through a systematic review. METHODS Embase, Global Health Library, Medline, and The Cochrane Library databases were searched. No limit was set for publication date, age, sex, or study design. We included all studies within a randomized controlled trial (RCT), published in English, Chinese or Spanish, evaluating the electronic consent process used in the parent RCT. Studies were included if any of the three components ((i) information provision, (ii) participant's comprehension, (iii) signature) of the IC process was designed as electronic, whether administered remotely or face-to-face. The primary outcome was the rate of enrolment to the parent trial. Secondary outcomes were summarized according to the various findings reported on the use of electronic consent. RESULTS From a total of 9069 titles, 12 studies were included in the final analysis with a total of 8864 participants. Five studies of high heterogeneity and risk of bias showed mixed results on the efficacy of e-IC on enrolment. Data of included studies suggested e-IC could improve comprehension and recall of study-related information. Meta-analysis could not be conducted due to different study designs and outcome measures and the predominantly qualitative findings. CONCLUSION Few published studies have investigated the impact of e-IC on enrolment and findings were mixed. e-IC may improve participant's comprehension and recall of information. High-quality studies are needed to evaluate the potential benefit of e-IC to increase clinical trial enrolment. TRIAL REGISTRATION PROSPERO CRD42021231035 . Registration date: 19-Feb-2021.
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Affiliation(s)
- Ana Teresita Mazzochi
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Martin Dennis
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ho-Yan Yvonne Chun
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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12
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De Sutter E, Borry P, Huys I, Barbier L. Informing a European guidance framework on electronic informed consent in clinical research: a qualitative study. BMC Health Serv Res 2023; 23:181. [PMID: 36810088 PMCID: PMC9942635 DOI: 10.1186/s12913-023-09173-5] [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: 10/19/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Electronic informed consent (eIC) may offer various advantages compared to paper-based informed consent. However, the regulatory and legal landscape related to eIC provides a diffuse image. By drawing from the perspectives of key stakeholders in the field, this study aims to inform the creation of a European guidance framework on eIC in clinical research. METHODS Focus group discussions and semi-structured interviews were conducted with 20 participants from six stakeholder groups. The stakeholder groups included representatives of ethics committees, data infrastructure organizations, patient organizations, and the pharmaceutical industry as well as investigators and regulators. All were involved in or knowledgeable about clinical research and were active in one of the European Union Member States or at a pan-European or global level. The framework method was used for data analysis. RESULTS Stakeholders underwrote the need for a multi-stakeholder guidance framework addressing practical elements related to eIC. According to the stakeholders, a European guidance framework should describe consistent requirements and procedures for implementing eIC on a pan-European level. Generally, stakeholders agreed with the definitions of eIC issued by the European Medicines Agency and the US Food and Drug Administration. Nevertheless, it was raised that, in a European guidance framework, it should be emphasized that eIC aims to support rather than replace the personal interaction between research participants and the research team. In addition, it was believed that a European guidance framework should include details on the legality of eIC across European Union Member States and the responsibilities of an ethics committee in the eIC assessment process. Although stakeholders supported the idea to include detailed information on the type of eIC-related materials to be submitted to an ethics committee, opinions varied on this regard. CONCLUSION The creation of a European guidance framework is a much needed factor to advance eIC implementation in clinical research. By collecting the views of multiple stakeholder groups, this study advances recommendations that may facilitate the development of such a framework. Particular consideration should go to harmonizing requirements and providing practical details related to eIC implementation on a European Union-wide level.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, 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
| | - Isabelle Huys
- grid.5596.f0000 0001 0668 7884Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Liese Barbier
- grid.5596.f0000 0001 0668 7884Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Muller SHA, van Thiel GJMW, Mostert M, van Delden JJM. Dynamic consent, communication and return of results in large-scale health data reuse: Survey of public preferences. Digit Health 2023; 9:20552076231190997. [PMID: 37599899 PMCID: PMC10434987 DOI: 10.1177/20552076231190997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Dynamic consent forms a comprehensive, tailored approach for interacting with research participants. We conducted a survey study to inquire how research participants evaluate the elements of consent, information provision, communication and return of results within dynamic consent in a hypothetical health data reuse scenario. We distributed a digital questionnaire among a purposive sample of patient panel members. Data were analysed using descriptive and nonparametric inferential statistics. Respondents favoured the potential to manage changing consent preferences over time. There was much agreement between people favouring closer and more specific control over data reuse approval and those in favour of broader approval, facilitated by an opt-out system or an independent data reuse committee. People want to receive more information about reuse, outcomes and return of results. Respondents supported an interactive model of research participation, welcoming regular, diverse and interactive forms of communication, like a digital communication platform. Approval for reuse and providing meaningful information, including meaningful return of results, are intricately related to facilitating better communication. Respondents favoured return of actionable research results. These findings emphasize the potential of dynamic consent for enabling participants to maintain control over how their data are being used for which purposes by whom. Allowing different options to shape a dynamic consent interface in health data reuse in a personalized manner is pivotal to accommodate plurality in a flexible though robust manner. Interaction via dynamic consent enables participants to tailor the elements of participation they deem relevant to their own preferences, engaging diverse perspectives, interests and preferences.
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Affiliation(s)
- Sam HA Muller
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ghislaine JMW van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno Mostert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes JM van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Budowle B, Sajantila A. Revisiting informed consent in forensic genomics in light of current technologies and the times. Int J Legal Med 2023; 137:551-565. [PMID: 36642749 PMCID: PMC9902322 DOI: 10.1007/s00414-023-02947-w] [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] [Received: 08/10/2022] [Accepted: 12/14/2022] [Indexed: 01/17/2023]
Abstract
Informed consent is based on basic ethical principles that should be considered when conducting biomedical and behavioral research involving human subjects. These principles-respect, beneficence, and justice-form the foundations of informed consent which in itself is grounded on three fundamental elements: information, comprehension, and voluntary participation. While informed consent has focused on human subjects and research, the practice has been adopted willingly in the forensic science arena primarily to acquire reference samples from family members to assist in identifying missing persons. With advances in molecular biology technologies, data mining, and access to metadata, it is important to assess whether the past informed consent process and in particular associated risks are concomitant with these increased capabilities. Given the state-of-the-art, areas in which informed consent may need to be modified and augmented are as follows: reference samples from family members in missing persons or unidentified human remains cases; targeted analysis of an individual(s) during forensic genetic genealogy cases to reduce an investigative burden; donors who provide their samples for validation studies (to include population studies and entry into databases that would be applied to forensic statistical calculations) to support implementation of procedures and operations of the forensic laboratory; family members that may contribute samples or obtain genetic information from a molecular autopsy; and use of medical and other acquired samples that could be informative for identification purposes. The informed consent process should cover (1) purpose for collection of samples; (2) process to analyze the samples (to include type of data); (3) benefits (to donor, target, family, community, etc. as applicable); (4) risks (to donor, target, family, community, etc. as applicable); (5) access to data/reports by the donor; (6) sample disposition; (7) removal of data process (i.e., expungement); (8) process to ask questions/assessment of comprehension; (9) follow-up processes; and (10) voluntary, signed, and dated consent. Issues surrounding these topics are discussed with an emphasis on addressing risk factors. Addressing informed consent will allow human subjects to make decisions voluntarily and with autonomy as well as secure the use of samples for intended use.
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Affiliation(s)
- Bruce Budowle
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
| | - Antti Sajantila
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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15
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Does receiving a SARS-CoV-2 antibody test result change COVID-19 protective behaviors? Testing risk compensation in undergraduate students with a randomized controlled trial. PLoS One 2022; 17:e0279347. [PMID: 36538498 PMCID: PMC9767325 DOI: 10.1371/journal.pone.0279347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Risk compensation, or matching behavior to a perceived level of acceptable risk, can blunt the effectiveness of public health interventions. One area of possible risk compensation during the SARS-CoV-2 pandemic is antibody testing. While antibody tests are imperfect measures of immunity, results may influence risk perception and individual preventive actions. We conducted a randomized control trial to assess whether receiving antibody test results changed SARS-CoV-2 protective behaviors. PURPOSE Assess whether objective information about antibody status, particularly for those who are antibody negative and likely still susceptible to SARS-CoV-2 infection, increases protective behaviors. Secondarily, assess whether a positive antibody test results in decreased protective behaviors. METHODS In September 2020, we enrolled 1076 undergraduate students, used fingerstick tests for SARS-CoV-2 antibodies, and randomized participants to receive their results immediately or delayed by 4 weeks. Two weeks later, participants completed a survey about their engagement in 4 protective behaviors (mask use, social event avoidance, staying home from work/school, ensuring physical distancing). We estimated differences between conditions for each of these behaviors, stratified by antibody status. For negative participants at baseline, we also estimated the difference between conditions for seroconversion over 8 weeks of follow-up. RESULTS For the antibody negative participants (n = 1029) and antibody positive participants (n = 47), we observed no significant differences in protective behavior engagement between those who were randomized to receive test results immediately or after 4 weeks. For the baseline antibody negative participants, we also observed no difference in seroconversion outcomes between conditions. CONCLUSIONS We found that receiving antibody test results did not lead to significant behavior change in undergraduate students whether the SARS-CoV-2 antibody result was positive or negative.
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LeCroy MN, Potter LN, Bandeen-Roche K, Bianco ME, Cappola AR, Carter EB, Dayan PS, Eckstrom E, Edwards DF, Farabi SS, Fisher SD, Giordano J, Hanson HA, Jenkins E, Juhn Y, Kaskel F, Stake CE, Reeds DN, Schleiss MR, Wafford QE, McColley SA. Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic. J Clin Transl Sci 2022; 7:e38. [PMID: 36845306 PMCID: PMC9947617 DOI: 10.1017/cts.2022.510] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the "Lifespan and Life Course Research: integrating strategies" "Un-Meeting" to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.
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Affiliation(s)
- Madison N. LeCroy
- Department of Pediatrics, Division of Academic General Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lindsey N. Potter
- Center for Health Outcomes and Population Equity (HOPE), Department of Population Health Sciences, Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Monica E. Bianco
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University, School of Medicine, St. Louis, MO, USA
| | - Peter S. Dayan
- Department of Emergency Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Eckstrom
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Dorothy F. Edwards
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research and Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Health Sciences Learning Center, Madison, WI, USA
| | - Sarah S. Farabi
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Sheehan D. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Judy Giordano
- University of Rochester Medical Center, Rochester, NY, USA
| | - Heidi A. Hanson
- Department of Surgery and Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Emerald Jenkins
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Young Juhn
- Precision Population Science Lab and Artificial Intelligence Program, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Frederick Kaskel
- Department of Pediatrics, Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, NY, USA
| | - Christine E. Stake
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Dominic N. Reeds
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Mark R. Schleiss
- Department of Pediatrics, Division of Infectious Diseases, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Q. Eileen Wafford
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susanna A. McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Tamuhla T, Tiffin N, Allie T. An e-consent framework for tiered informed consent for human genomic research in the global south, implemented as a REDCap template. BMC Med Ethics 2022; 23:119. [PMID: 36434585 PMCID: PMC9694827 DOI: 10.1186/s12910-022-00860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
Research involving human participants requires their consent, and it is common practice to capture consent information on paper and store those hard copies, presenting issues such as long-term storage requirements, inefficient retrieval of consent forms for reference or future use, and the potential for transcription errors when transcribing captured informed consent. There have been calls to move to electronic capture of the consent provided by research participants (e-consent) as a way of addressing these issues. A tiered framework for e-consent was designed using the freely available features in the inbuilt REDCap e-consent module. We implemented 'branching logic', 'wet signature' and 'auto-archiver' features to the main informed consent and withdrawal of consent documents. The branching logic feature streamlines the consent process by making follow-up information available depending on participant response, the 'wet signature' feature enables a timestamped electronic signature to be appended to the e-consent documents and the 'auto-archiver' allows for PDF copies of the e-consent documents to be stored in the database. When designing the content layout, we provided example participant information text which can be modified as required. Emphasis was placed on the flow of information to optimise participant understanding and this was achieved by merging the consent and participant information into one document where the consent questions were asked immediately after the corresponding participant information. In addition, we have provided example text for a generic human genomic research study, which can be easily edited and modified according to specific requirements. Building informed consent protocols and forms without prior experience can be daunting, so we have provided researchers with a REDCap template that can be directly incorporated into REDCap databases. It prompts researchers about the types of consent they can request for genomics studies and assists them with suggestions for the language they might use for participant information and consent questions. The use of this tiered e-consent module can ensure the accurate and efficient electronic capture and storage of the consents given by participants in a format that can be easily queried and can thus facilitate ethical and effective onward sharing of data and samples whilst upholding individual participant preferences.
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Affiliation(s)
- Tsaone Tamuhla
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nicki Tiffin
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.
| | - Taryn Allie
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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18
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Yusof MYPM, Teo CH, Ng CJ. Electronic informed consent criteria for research ethics review: a scoping review. BMC Med Ethics 2022; 23:117. [DOI: 10.1186/s12910-022-00849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The research shows a growing trend in using an electronic platform to supplement or replace traditional paper-based informed consent processes. Instead of the traditionally written informed consent document, electronic informed consent (eConsent) may be used to assess the research subject’s comprehension of the information presented. By doing so, respect for persons as one of the research ethical principles can be upheld. Furthermore, these electronic methods may reduce potential airborne infection exposures, particularly during the pandemic, thereby adhering to the beneficence and nonmaleficence principle. This scoping review aims to identify the ethics related criteria that have been included in electronic informed consent processes and to synthesize and map these criteria to research ethics principles, in order to identify the gaps, if any, in current electronic informed consent processes.
Methods
The search was performed based on internet search and three main databases: PubMed, SCOPUS and EBSCO. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation guideline was used to report this work.
Results
Of 34 studies that met the inclusion criteria, 242 essential original constructs were collated, and 7 concepts were derived. Digital content showed the highest percentage of collated original constructs (27%, n = 65) followed by accessibility (24%, n = 56), comprehension engagement (18%, n = 43), autonomy (14%, n = 34), confidentiality (11%, n = 25), language (5%, n = 13), and parental consent (1%, n = 2). Twenty-five new items were synthesized for eConsent criteria which may provide guidance for ethical review of research involving eConsent.
Conclusion
The current study adds significant value to the corpus of knowledge in research ethics by providing ethical criteria on electronic informed consent based on evidence-based data. The new synthesized items in the criteria can be readily used as an initial guide by the IRB/REC members during a review process on electronic informed consent and useful to the future preparation of a checklist.
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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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Cooksey KE, Mozersky J, DuBois J, Kuroki L, Marx CM, Politi MC. Challenges and Possible Solutions to Adapting to Virtual Recruitment: Lessons Learned from a Survey Study during the Covid-19 Pandemic. Ethics Hum Res 2022; 44:23-31. [PMID: 36316973 PMCID: PMC9631333 DOI: 10.1002/eahr.500148] [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: 11/05/2022]
Abstract
The Covid-19 pandemic required rapid changes to research protocols, including immediate transitions to recruiting research participants and conducting the informed consent process virtually. This case study details the challenges our research team faced adapting an in-person, behavioral-intervention and survey study to virtual recruitment. We reflect on the impact of these rapid changes on recruitment and retention, discuss protocol changes we made to address these challenges and the needs of potential and enrolled participants, and propose recommendations for future work. Using computer technology to display professional return phone numbers, being flexible by contacting potential participants through various means, minimizing email communication due to added regulatory requirements, and partnering with the institutional review board to shorten and improve the consent document and process were critical to study success. This case study can offer insight to other researchers as they navigate similar processes. Virtual recruitment is likely to continue; it is important to ensure that it facilitates, rather than hinders, equitable and just recruitment practices.
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Affiliation(s)
- Krista E Cooksey
- Research coordinator in the Division of Public Health Sciences in the Department of Surgery at Washington University School of Medicine
| | - Jessica Mozersky
- Assistant professor in the Bioethics Research Center in the Department of Medicine at Washington University School of Medicine
| | - James DuBois
- Steven J. Bander Professor of Medical Ethics and Professionalism in the Department of Medicine and the executive director of the Bioethics Research Center at Washington University School of Medicine
| | - Lindsay Kuroki
- Associate professor in the Division of Gynecologic Oncology in the Department of Obstetrics & Gynecology at Washington University School of Medicine
| | - Christine M Marx
- Research coordinator in the Division of Public Health Sciences in the Department of Surgery at Washington University School of Medicine
| | - Mary C Politi
- Professor in the Division of Public Health Sciences in the Department of Surgery at Washington University School of Medicine
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De Sutter E, Lalova-Spinks T, Borry P, Valcke P, Kindt E, Negrouk A, Verhenneman G, Derèze JJ, Storme R, Huys I. Rethinking informed consent in the time of COVID-19: An exploratory survey. Front Med (Lausanne) 2022; 9:995688. [PMID: 36237540 PMCID: PMC9552958 DOI: 10.3389/fmed.2022.995688] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Owing to the infectious nature of COVID-19, alternative solutions, such as electronic informed consent (eIC), needed to be implemented to inform research participants about study-related information and to obtain their consent. This study aimed to investigate stakeholders’ experiences with alternative consenting methods as well as their views on any regulatory or legal guidelines for eIC implementation in clinical research. Results may serve as the cornerstone to rethink the informed consent process in clinical research. Materials and methods This study consisted of an online survey among three stakeholder groups across European Union (EU) Member States and the United Kingdom. The stakeholder groups included (i) investigators, (ii) data protection officers (DPOs) or legal experts working in the pharmaceutical industry, academia, and academic biobanks, and (iii) ethics committee (EC) members. Data collection occurred between April and December 2021. The data collected were analyzed using descriptive and inferential statistics. Results The online survey was completed by 191 respondents, of whom 52% were investigators. Respondents were active in 24 out of the 27 EU Member States and the United Kingdom. The majority of each stakeholder group considered validated electronic methods moderately or extremely useful to re-consent previously enrolled research participants upon study amendments or to obtain consent from COVID-19 patients. Nevertheless, this exploratory survey identified that only 13% of DPOs/legal experts, 26% of investigators, and 41% of EC members had experience with eIC. In addition, results suggest that the legal acceptance of eIC across EU Member States and the United Kingdom is variable and that a definition of eIC, issued by national law or policy, is rarely available. The results also showed that the COVID-19 pandemic brought additional challenges to inform participants and to obtain their consent; for example, related to travel restrictions. Conclusion A number of alternative consenting methods were recommended, for example by the European Medicines Agency, to ensure clinical study continuation during the COVID-19 pandemic. Although stakeholders support the use of eIC in clinical research, it seems that the experience with eIC is low. To harmonize eIC practices as much as possible, further investments in multi-stakeholder, multi-national guidance are needed.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- *Correspondence: Evelien De Sutter,
| | - Teodora Lalova-Spinks
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Centre for IT and IP Law, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Peggy Valcke
- Centre for IT and IP Law, KU Leuven, Leuven, Belgium
| | - Els Kindt
- Centre for IT and IP Law, KU Leuven, Leuven, Belgium
| | | | - Griet Verhenneman
- Centre for IT and IP Law, KU Leuven, Leuven, Belgium
- University Hospitals Leuven, Leuven, Belgium
| | | | - Ruth Storme
- Ethics Committee Research, University Hospitals Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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22
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Simoens S, Abdallah K, Barbier L, Lacosta TB, Blonda A, Car E, Claessens Z, Desmet T, De Sutter E, Govaerts L, Janssens R, Lalova T, Moorkens E, Saesen R, Schoefs E, Vandenplas Y, Van Overbeeke E, Verbaanderd C, Huys I. How to balance valuable innovation with affordable access to medicines in Belgium? Front Pharmacol 2022; 13:960701. [PMID: 36188534 PMCID: PMC9523170 DOI: 10.3389/fphar.2022.960701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Countries are struggling to provide affordable access to medicines while supporting the market entry of innovative, expensive products. This Perspective aims to discuss challenges and avenues for balancing health care system objectives of access, affordability and innovation related to medicines in Belgium (and in other countries). Methods: This Perspective focuses on the R&D, regulatory approval and market access phases, with particular attention to oncology medicines, precision medicines, orphan medicines, advanced therapies, repurposed medicines, generics and biosimilars. The authors conducted a narrative review of the peer-reviewed literature, of the grey literature (such as policy documents and reports of consultancy agencies), and of their own research. Results: Health care stakeholders need to consider various initiatives for balancing innovation with access to medicines, which relate to clinical and non-clinical outcomes (e.g. supporting the conduct of pragmatic clinical trials, treatment optimisation and patient preference studies, optimising the use of real-world evidence in market access decision making), value assessment (e.g. increasing the transparency of the reimbursement system and criteria, tailoring the design of managed entry agreements to specific types of uncertainty), affordability (e.g. harnessing the role of generics and biosimilars in encouraging price competition, maximising opportunities for personalising and repurposing medicines) and access mechanisms (e.g. promoting collaboration and early dialogue between stakeholders including patients). Conclusion: Although there is no silver bullet that can balance valuable innovation with affordable access to medicines, (Belgian) policy and decision makers should continue to explore initiatives that exploit the potential of both the on-patent and off-patent pharmaceutical markets.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Khadidja Abdallah
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Liese Barbier
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | | | - Alessandra Blonda
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Elif Car
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Zilke Claessens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Thomas Desmet
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Evelien De Sutter
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Laurenz Govaerts
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Rosanne Janssens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Teodora Lalova
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- KU Leuven Centre for IT & IP Law (CiTiP), Leuven, Belgium
| | - Evelien Moorkens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Robbe Saesen
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Elise Schoefs
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Yannick Vandenplas
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Eline Van Overbeeke
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Ciska Verbaanderd
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- Anticancer Fund, Strombeek-Bever, Brussels, Belgium
| | - Isabelle Huys
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
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Nyholm Gaarskjær A, Crookshanks Duroux M, Hogreffe R. Participant comprehension and perspectives regarding the convenience, security, and satisfaction with teleconsent compared to in-person consent: A parallel-group pilot study among Danish citizens. Contemp Clin Trials Commun 2022; 28:100927. [PMID: 35669485 PMCID: PMC9163420 DOI: 10.1016/j.conctc.2022.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/09/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Teleconsent via video conferencing enables decentralized trials with remote consent and has the additional benefit of allowing a real-time reaction to potential misunderstandings. However, participant acceptance of and satisfaction with teleconsent versus in-person consent processes are unknown. Methods We conducted a parallel-group pilot study to evaluate participant comprehension and perspectives regarding the convenience, security, and satisfaction with teleconsent compared to in-person consent among Danish citizens for a hypothetical research study. Results There were no statistically significant differences in perceptions of security or satisfaction between teleconsent and in-person consent arms. However, participants viewed teleconsent as more convenient than in-person consent, as no transportation was needed and the process was less time-consuming. Recruitment was also faster in the teleconsent arm, and more people dropped out of the in-person arm, citing difficulties with transportation and time. Conclusion Decentralized clinical trials have been demonstrated to increase recruitment and enrollment rates, improve trial efficiency, and decrease dropout rates and trial delays. We add to this literature by suggesting that patients perceive teleconsent as similar to in-person consent, suggesting this is a feasible and acceptable substitution for in-person consent in multisite, decentralized trials. Future work should include patient perspectives from a larger, more diverse group of participants.
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Affiliation(s)
- Anne Nyholm Gaarskjær
- Molecular Pharmacology, Department of Health Science and Technology (HST), Faculty of Medicine, Aalborg University, Denmark
| | - Meg Crookshanks Duroux
- Molecular Pharmacology, Department of Health Science and Technology (HST), Faculty of Medicine, Aalborg University, Denmark
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Bromberg JR, Nimaja E, Kiragu AW, Lawson KA, Lee L, Nasr IW, Pruitt C, Ruest SM, Mello MJ. Developing and Implementing Electronic Consent Procedures in Response to Covid‐19 Restrictions. Ethics Hum Res 2022; 44:39-44. [PMID: 35802791 PMCID: PMC9349659 DOI: 10.1002/eahr.500135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Covid‐19 pandemic resulted in unprecedented restrictions on many public, private, and workplace activities throughout the United States and elsewhere. When restrictions were imposed, we were conducting a type III hybrid effectiveness‐implementation trial in 10 pediatric trauma centers. In response to several pandemic‐based restrictions, we had to develop procedures for engaging with potential research participants while limiting nonclinical, in‐person interactions. This manuscript describes the procedures and challenges of obtaining electronic informed consent and assent in a multisite trauma center‐based research study. We developed, tested, and trained staff to implement three options for obtaining informed consent. Twenty‐five participants were enrolled in the effectiveness‐implementation multisite trial during the first six months of utilization of the consent options, with eleven of these individuals enrolled using hybrid or electronic consent procedures. The challenges we identified involving electronic consent procedures included confusion over who would complete the electronic consent process and difficulties reconnecting with families. Lessons learned can strengthen electronic consent and assent procedures for future studies. More research is needed to further strengthen this process and increase its utilization.
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Affiliation(s)
- Julie R. Bromberg
- Research associate in the Department of Emergency Medicine at The Warren Alpert Medical School of Brown University and a research program manager at the Injury Prevention Center at Rhode Island Hospital‐Hasbro Children's Hospital
| | - Evelyn Nimaja
- Senior research assistant at the Injury Prevention Center at Rhode Island Hospital‐Hasbro Children's Hospital
| | - Andrew W. Kiragu
- Associate professor of pediatrics at the University of Minnesota, an associate of the Children's Respiratory and Critical Care Specialist Group, and a pediatric intensivist at Hennepin Healthcare
| | - Karla A. Lawson
- Director of the Dell Children's Trauma and Injury Research Center at Dell Children's Medical Center and an associate professor of surgery and perioperative care at the University of Texas at Austin Dell Medical School
| | - Lois Lee
- Associate professor of pediatrics and emergency medicine at the Harvard Medical School and a senior associate of medicine in the Division of Emergency Medicine at Boston Children's Hospital
| | - Isam W. Nasr
- Director of the Pediatric Trauma Program in the Division of Pediatric Surgery at the Johns Hopkins Children's Center and an assistant professor of surgery within the Johns Hopkins Department of Surgery
| | - Charles Pruitt
- Associate professor of pediatrics at the University of Utah and a child advocacy coordinator for the Division of Pediatric Emergency Medicine at Primary Children's
| | - Stephanie M. Ruest
- Assistant professor of the Departments of Pediatrics and Emergency Medicine at The Warren Alpert Medical School of Brown University and a pediatric emergency physician at the Hasbro Children's Hospital
| | - Michael J. Mello
- Professor in the Department of Emergency Medicine at The Warren Alpert Medical School at Brown University, a professor of health services, policy, and practice at the Brown University School of Public Health, the director of the Master of Science in Population Medicine program at The Warren Alpert Medical School of Brown University, and the director of the Injury Prevention Center at Rhode Island Hospital‐Hasbro Children's Hospital
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25
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Lambert Y, Galindo M, Suárez-Mutis M, Mutricy L, Sanna A, Garancher L, Cairo H, Hiwat H, Bordalo Miller J, Gomes JH, Marchesini P, Adenis A, Nacher M, Vreden S, Douine M. Tailoring Mobile Data Collection for Intervention Research in a Challenging Context: Development and Implementation in the Malakit Study. JMIR Form Res 2022; 6:e29856. [PMID: 35708763 PMCID: PMC9247814 DOI: 10.2196/29856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 12/09/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. Objective This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. Methods The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. Results Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators’ feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03% (147/4849) of form records requiring correction. Conclusions The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators’ experience. Trial Registration ClinicalTrials.gov NCT03695770; https://clinicaltrials.gov/ct2/show/NCT03695770
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Affiliation(s)
- Yann Lambert
- Centre d'Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Muriel Galindo
- Centre d'Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Martha Suárez-Mutis
- Parasitic Disease Laboratory, Institute Oswaldo Cruz, Foundation Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Louise Mutricy
- Centre d'Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Alice Sanna
- Centre d'Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | | | - Hedley Cairo
- Malaria Program, Ministry of Health of Suriname, Paramaribo, Suriname
| | - Helene Hiwat
- Malaria Program, Ministry of Health of Suriname, Paramaribo, Suriname
| | - Jane Bordalo Miller
- Desenvolvimento, Prevenção, Acompanhamento e Cooperação de Fronteiras, Oiapoque, Brazil
| | | | - Paola Marchesini
- Malaria Technical Group, Vector Transmissible and Zoonotic Diseases Coordination, Ministry of Health, Brasilia, Brazil
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Stephen Vreden
- Foundation for Scientific Research Suriname, Paramaribo, Suriname
| | - Maylis Douine
- Centre d'Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
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26
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De Sutter E, Meszaros J, Borry P, Huys I. Digitizing the Informed Consent Process: A Review of the Regulatory Landscape in the European Union. Front Med (Lausanne) 2022; 9:906448. [PMID: 35692551 PMCID: PMC9174519 DOI: 10.3389/fmed.2022.906448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Rapid technological advancements are reshaping the conduct of clinical research. Electronic informed consent (eIC) is one of these novel advancements, allowing to interactively convey research-related information to participants and obtain their consent. The COVID-19 pandemic highlighted the importance of establishing a digital, long-distance relationship between research participants and researchers. However, the regulatory landscape in the European Union (EU) is diverse, posing a legal challenge to implement eIC in clinical research. Therefore, this study takes the necessary steps forward by providing an overview of the current regulatory framework in the EU, relevant to eIC. Methods We reviewed and analyzed the key EU regulations, such as the EU General Data Protection Regulation (GDPR) and the Clinical Trials Regulation (CTR). We investigated the legality of eIC in several EU Member States, Switzerland, and the United Kingdom. To this end, we contacted the medicines agencies of various countries to clarify the national requirements related to the implementation and use of eIC in clinical research. Our research was complemented by comparing the legal acceptance of eIC between the EU and the United States. Results In the EU, a distinction must be made between eIC for participation in clinical research and eIC for processing the participants’ personal data, complying respectively with requirements laid down by the CTR and the GDPR. On a national level, countries were classified into three groups: (1) countries accepting and regulating the use of eIC, (2) countries accepting the use of eIC without explicitly regulating it, and (3) countries not accepting the use of eIC. As a result, the regulation of eIC through laws and guidelines shows a large variety among EU Member States, while in the United States, it is harmonized through the Code of Federal Regulations. Conclusion Various requirements must be considered when implementing eIC in clinical research. Nevertheless, requirements across the EU Member States may differ significantly, whereas, in the United States, efforts have already been made to achieve a harmonized approach.
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Affiliation(s)
- Evelien De Sutter
- Division of Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- *Correspondence: Evelien De Sutter,
| | - Janos Meszaros
- Division of Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, 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
- Division of Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Centre for IT and IP Law (CiTiP), KU Leuven, Leuven, Belgium
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Huh KY, Jeong SU, Moon SJ, Kim MJ, Yang W, Jeong M, Song I, Kwak YG, Lee S, Kim MG. METORY: Development of a Demand-Driven Blockchain-Based Dynamic Consent Platform Tailored for Clinical Trials. Front Med (Lausanne) 2022; 9:837197. [PMID: 35646983 PMCID: PMC9136007 DOI: 10.3389/fmed.2022.837197] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
The recent advent of the dynamic consent concept intensified the data integrity issue in clinical trials. Incorporating blockchain technology into a dynamic consent platform can be a feasible solution. Due to various clinical trial settings, a demand-driven development strategy is required. We developed a blockchain-based dynamic consent platform named METORY tailored for clinical trials. The platform consisted of three parts: web and mobile application user interface, study management platform, and blockchain platform. Hyperledger Fabric, an enterprise-grade private blockchain framework, was used to integrate blockchain into the study consent platform. We conducted user acceptance tests and applied feedback to the improvement of the platform. Identity and role-based access control was constructed by combining mobile-application-based certificate system and access control functionalities in Hyperledger fabric. Data were encrypted using SHA-256 prior to transmission to blockchain server and TLS protocol was used for in-transit encryption. File-system level encryption was separated implemented within the security measures from Amazon RDS. Users' experience in the clinical trial was acceptable in the ease and usefulness of the platform.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Sang-un Jeong
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
| | - Seol Ju Moon
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
| | - Min-Ji Kim
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
| | - Wooseok Yang
- Clinical Trial Center, Seoul National University Hospital, Seoul, South Korea
| | - Myeonggyu Jeong
- Clinical Trial Center, Seoul National University Hospital, Seoul, South Korea
| | - Ildae Song
- Department of Pharmaceutical Science and Technology, Kyungsung University, Busan, South Korea
| | - Yong-Geun Kwak
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Pharmacology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- *Correspondence: SeungHwan Lee
| | - Min-Gul Kim
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Pharmacology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, South Korea
- Min-Gul Kim
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Chatters R, Cooper CL, O'Cathain A, Murphy C, Lane A, Sutherland K, Burton C, Cape A, Tunnicliffe L. Learning from COVID-19 related trial adaptations to inform efficient trial design-a sequential mixed methods study. BMC Med Res Methodol 2022; 22:128. [PMID: 35488193 PMCID: PMC9051017 DOI: 10.1186/s12874-022-01609-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many clinical trial procedures were often undertaken in-person prior to the COVID-19 pandemic, which has resulted in adaptations to these procedures to enable trials to continue. The aim of this study was to understand whether the adaptations made to clinical trials by UK Clinical Trials Units (CTUs) during the pandemic have the potential to improve the efficiency of trials post-pandemic. METHODS This was a mixed methods study, initially involving an online survey administered to all registered UK CTUs to identify studies that had made adaptations due to the pandemic. Representatives from selected studies were qualitatively interviewed to explore the adaptations made and their potential to improve the efficiency of future trials. A literature review was undertaken to locate published evidence concerning the investigated adaptations. The findings from the interviews were reviewed by a group of CTU and patient representatives within a workshop, where discussions focused on the potential of the adaptations to improve the efficiency of future trials. RESULTS Forty studies were identified by the survey. Fourteen studies were selected and fifteen CTU staff were interviewed about the adaptations. The workshop included 15 CTU and 3 patient representatives. Adaptations were not seen as leading to direct efficiency savings for CTUs. However, three adaptations may have the potential to directly improve efficiencies for trial sites and participants beyond the pandemic: a split remote-first eligibility assessment, recruitment outside the NHS via a charity, and remote consent. There was a lack of published evidence to support the former two adaptations, however, remote consent is widely supported in the literature. Other identified adaptations may benefit by improving flexibility for the participant. Barriers to using these adaptations include the impact on scientific validity, limitations in the role of the CTU, and participant's access to technology. CONCLUSIONS Three adaptations (a split remote-first eligibility assessment, recruitment outside the NHS via a charity, and remote consent) have the potential to improve clinical trials but only one (remote consent) is supported by evidence. These adaptations could be tested in future co-ordinated 'studies within a trial' (SWAT).
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Affiliation(s)
- Robin Chatters
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regents Court, Regent Street, Sheffield, S1 4DA, England.
| | - Cindy L Cooper
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regents Court, Regent Street, Sheffield, S1 4DA, England
| | - Alicia O'Cathain
- Medical Care Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, King's College London, London, UK
| | - Athene Lane
- Bristol Randomised Trials Collaboration in the Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Katie Sutherland
- Sheffield Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Regents Court, Regent Street, Sheffield, S1 4DA, England
| | - Christopher Burton
- Academic Unit of Primary Medical Care, The University of Sheffield, Sheffield, UK
| | - Angela Cape
- King's Clinical Trials Unit, King's College London, London, UK
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Kogetsu A, Kato K. Framework and Practical Guidance for the Ethical Use of Electronic Methods for Communication With Participants in Medical Research. J Med Internet Res 2022; 24:e33167. [PMID: 35442208 PMCID: PMC9069285 DOI: 10.2196/33167] [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: 08/26/2021] [Revised: 01/02/2022] [Accepted: 02/06/2022] [Indexed: 11/13/2022] Open
Abstract
Online communication with participants, including online recruitment, electronic informed consent, and data communication, is one of the fields to which information and communication technology (ICT) has been applied in medical research. Online communication provides various benefits, especially for genome research and rare disease research. However, ethical challenges that are derived from or exacerbated by online communication need to be addressed. Here, we present an overview of such ethical issues and provide practical guidance for the ethical implementation of ICT. We specify the ethical issues in the context of using online communication for medical research by an analysis based on the eight ethical principles for clinical research. Informed by this ethical context, we then develop a novel framework for the governance of medical research involving ICT, which consists of eight categories: five research processes (ie, design of research, recruitment, informed consent, data communication, and dissemination and return of results) and three overarching perspectives related to multiple processes of research (ie, access to research and online dialog, community involvement, and independent review). Finally, we present a practical guidance chart for researchers, patient partners, independent reviewers, and funding agencies. We believe that our study will contribute to the ethical implementation of online communication in medical research.
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Affiliation(s)
- Atsushi Kogetsu
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kazuto Kato
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Simon CM, Wang K, Shinkunas LA, Stein DT, Meissner P, Smith M, Pentz R, Klein DW. Communicating With Diverse Patients About Participating in a Biobank: A Randomized Multisite Study Comparing Electronic and Face-to-Face Informed Consent Processes. J Empir Res Hum Res Ethics 2022; 17:144-166. [PMID: 34410195 PMCID: PMC8712348 DOI: 10.1177/15562646211038819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Some individuals' understanding of informed consent (IC) information may improve with electronic delivery, but others may benefit from face-to-face (F2F). This randomized, multisite study explores how individuals from diverse backgrounds understand electronic IC documents versus F2F, their confidence in understanding, and enrollment in research. A total of 501 patients at two U.S. biobanks with diverse populations participated. There were no overall differences between electronic and F2F understanding, but F2F predicted higher confidence in understanding and enrollment. Ethnicity and a higher educational level predicted higher understanding and confidence. Study findings suggest that electronic consent may lead to better understanding for non-Hispanic patients of higher socioeconomic status. F2F processes may lead to better understanding and higher enrollment of patients from Hispanic and lower socioeconomic levels. Researchers should carefully consider how they implement electronic IC processes and whether to maintain an F2F process to better address the needs and limitations of some populations.
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Affiliation(s)
| | - Kai Wang
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | | - Rebecca Pentz
- School of Medicine, Emory University, Atlanta, GA, USA
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Hu Z, Ouyang C, Hahne J, Khoshnood K, Zhang J, Liu X, Wu Y, Wang X. Knowledge and Attitudes of Research Participants in China Toward Electronic Informed Consent in Clinical Trials: A Cross Sectional Study. J Empir Res Hum Res Ethics 2022; 17:362-372. [PMID: 35088620 DOI: 10.1177/15562646221075884] [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: 11/15/2022]
Abstract
This study aims to investigate the knowledge and attitudes of participants and potential participants in clinical trials toward electronic informed consent. We conducted a survey-based cross-sectional study in Hunan Province, China in March 2021. A total of 547 respondents were included in this study. All questions in an 8-item survey section assessing participants' knowledge of electronic informed consent received correct answers from at least 70% of participants. In terms of attitude scores, most participants (86.3%) believed that electronic informed consent is more convenient than the paper-based version, and more than half (51.2%) believed that electronic informed consent could completely replace the paper-based version. Responses indicated that common concerns about electronic informed consent were its security and confidentiality, legal benefits, and implications for rights protection.
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Affiliation(s)
- Zhanqing Hu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
| | - Chenxi Ouyang
- School of Pharmacy, 118393Hunan University of Chinese Medicine, Changsha, 410208, Hunan, PR China
| | - Jessica Hahne
- Yale School of Public Health, 50296Yale University, 60 College Street, New Haven, CT 06520, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, 50296Yale University, 60 College Street, New Haven, CT 06520, USA
| | - Jinqiang Zhang
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
| | - Xiyu Liu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
- Clinical Research Center, 504354The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
| | - Ying Wu
- School of Public Administration, Central South University, Changsha 410075, Hunan, PR China
| | - Xiaomin Wang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
- Clinical Research Center, 504354The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
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De Sutter E, Geerts D, Borry P, Coteur K, Bamps D, Marynissen H, Ampe E, Geenens E, Depré M, Huys I. Co-creation with research participants to inform the design of electronic informed consent. Digit Health 2022; 8:20552076221109068. [PMID: 35783466 PMCID: PMC9243370 DOI: 10.1177/20552076221109068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to provide recommendations for a personalized electronic informed consent interface that is adapted to research participants’ needs and could enable a longitudinal interaction between the participants and the research team. Methods The co-creation process consisted of three co-creation workshops, one focus group discussion, and four semi-structured interviews. In total, 24 participants, who had taken part in four disparate clinical studies in Belgium, were involved. Descriptive statistics and qualitative content analysis were applied to analyze the survey data and audio recordings. Results Varying perceptions on the type and amount of information described in an informed consent form were reported. Other findings were related to the structure and presentation of information, setting preferences for data sharing, and electronically signing new informed consent versions. Regarding the long-term interaction, most of the participants wanted to receive progress updates, including the results, of the study in which they had taken part. They proposed to receive a notification, preferably via email, in case new information is made available on the electronic informed consent interface. Conclusions To optimally support the design of an electronic informed consent interface, it is key to understand the research participants’ needs. Study findings suggest that an electronic informed consent interface may be a promising technological application to interactively provide study-related information and to keep participants informed during and after the clinical study.
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Affiliation(s)
- Evelien De Sutter
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - David Geerts
- KU Leuven Digital Society Institute, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Department of Public Health and Primary Care, Center for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Kristien Coteur
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Dorien Bamps
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Heleen Marynissen
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Els Ampe
- Center for Clinical Pharmacology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Els Geenens
- Center for Clinical Pharmacology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marleen Depré
- Center for Clinical Pharmacology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
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Abstract
BACKGROUND When the COVID-19 pandemic hit in 2020, researchers in the P30 Center for the Study of Symptom Science, Metabolomics, and Multiple Chronic Conditions at Emory University's Nell Hodgson Woodruff School of Nursing faced major challenges in recruitment and data collection because of limited access to the clinic and community facilities and the risk of COVID-19 exposure associated with in-person study contact. OBJECTIVES The purpose of this article is to (a) describe how a cadre of pilot/supplement principal investigators adapted their studies to allow for safe and trustworthy data collection during the COVID-19 pandemic (March 2020 through date of publication) and (b) discuss steps that facilitated the technical aspects of remote data collection, especially involving biological specimens. RESULTS Four pilot studies and two administrative supplements within the center-all at different stages of execution-adopted various alternative remote recruitment, enrollment, and data and specimen collection approaches to continue their research endeavors in a way that maximized the safety of both the research participants and the research teams. DISCUSSION The article concludes with a discussion on the importance of a participant-centered approach when using remote methods, actions, or steps initiated to facilitate the technical aspects of remote data collection and reflections on the continued use of remote research strategies beyond the COVID-19 pandemic.
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De Sutter E, Borry P, Geerts D, Huys I. Personalized and long-term electronic informed consent in clinical research: stakeholder views. BMC Med Ethics 2021; 22:108. [PMID: 34332572 PMCID: PMC8325412 DOI: 10.1186/s12910-021-00675-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background The landscape of clinical research has evolved over the past decade. With technological advances, the practice of using electronic informed consent (eIC) has emerged. However, a number of challenges hinder the successful and widespread deployment of eIC in clinical research. Therefore, we aimed to investigate the views of various stakeholders on the potential advantages and challenges of eIC. Methods Semi-structured interviews were conducted with 39 participants from 5 stakeholder groups from across 11 European countries. The stakeholder groups included physicians, patient organization representatives, regulator representatives, ethics committee members, and pharmaceutical industry representatives, and all were involved in clinical research. Interviews were analyzed using the framework method. Results Interviewees identified that a powerful feature of eIC is its personalized approach as it may increase participant empowerment. However, they identified several ethical and practical challenges, such as ensuring research participants are not overloaded with information and offering the same options to research participants who would prefer a paper-based informed consent rather than eIC. According to the interviewees, eIC has the potential to establish efficient long-term interactions between the research participants and the research team in order to keep the participants informed during and after the study. Interviewees emphasized that a personal interaction with the research team is of utmost importance and this cannot be replaced by an electronic platform. In addition, interviewees across the stakeholder groups supported the idea of having a harmonized eIC approach across the European Member States. Conclusions Interviewees reported a range of design and implementation challenges which needs to be overcome to foster innovation in informing research participants and obtaining their consent electronically. It was considered important that the implementation of eIC runs alongside the face-to-face contact between research participants and the research team. Moreover, interviewees expect that eIC could offer the opportunity to enable a personalized approach and to strengthen continuous communication over time. If successfully implemented, eIC may facilitate the engagement of research participants in clinical research. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00675-7.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - David Geerts
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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De Sutter E, Coopmans B, Vanendert F, Dooms M, Allegaert K, Borry P, Huys I. Clinical Research in Neonates: Redesigning the Informed Consent Process in the Digital Era. Front Pediatr 2021; 9:724431. [PMID: 34540773 PMCID: PMC8441012 DOI: 10.3389/fped.2021.724431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Currently, many initiatives are devoted to optimizing informed consent for participation in clinical research. Due to the digital transformation in health care, a shift toward electronic informed consent (eIC) has been fostered. However, empirical evidence on how to implement eIC in clinical research involving neonates is lacking. Methods: Semi-structured interviews were conducted with 31 health care professionals active in Belgium or the Netherlands. All health care professionals had experience in conducting clinical research involving neonates. Interviews were audio-recorded, transcribed and analyzed using the framework method. Results: Interviewees generally supported the use of eIC in clinical research involving neonates. For example, eIC could enable parents to receive study feedback via the eIC system. Requirements were expressed for parental involvement to decide on which feedback would be appropriate to return. Moreover, experts specialized in presenting information and designing electronic systems should be involved. Broad consensus among health care professionals indicates that the face-to-face-interaction between parents and the research team is vital to establish a relationship of trust. Therefore, it is necessary that the use of eIC runs alongside personal interactions with the parents. Concerns were raised about the accessibility of eIC to parents. For this reason, it was suggested that parents should always be given the possibility to read and sign a paper-based informed consent form or to use eIC. Conclusions: Health care professionals' views indicate that the use of eIC in clinical research with neonates may offer various opportunities. Further development and implementation will require a multi-stakeholder approach.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Birte Coopmans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Femke Vanendert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marc Dooms
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Clinical Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | - 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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