Revised Common Rule Changes to the Consent Process and Consent Form

Regulatory compliance and readability of informed consent forms in industry-sponsored drug development clinical trials

BACKGROUND/AIMS

An informed consent form is essential in drug development clinical trials. This study aimed to evaluate regulatory compliance and readability of informed consent forms currently being used in industry-sponsored drug development clinical trials.

METHODS

This descriptive, cross-sectional study evaluated the informed consent forms of industry-sponsored drug development clinical trials conducted at the Faculty of Medicine, Chiang Mai University, between 2019 and 2020. The informed consent form's compliance with the three major ethical guidelines and regulations (i.e. International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use E6(R2) Good Clinical Practice; Declaration of Helsinki; and the revised Common Rule) were analyzed. The document length and the readability scores (using Flesch Reading Ease and Flesch-Kincaid Reading Grade) were assessed.

RESULTS

Of 64 reviewed informed consent forms, the average page length was 22.0 ± 7.4 pages. More than half of their length was mainly devoted to three elements: trial procedures (22.9%), risks and discomforts (19.1%), and confidentiality and the limit of confidentiality (10.1%). Although most of the required elements of the informed consent form content were included in most informed consent forms, we identified four elements with often missing information in the form: aspects of research that are experimental (n = 43, 67.2%), involvement of whole-genome sequencing (n = 35, 54.7%), commercial profit sharing (n = 31, 48.4%), and posttrial provisions (n = 28, 43.8%).

CONCLUSION

The informed consent forms in industry-sponsored drug development clinical trials were long but incomplete. Our findings draw attention to ongoing challenges in industry-sponsored drug development clinical trials, where deficient informed consent form quality continues to exist.

The Efficient Disposal of Biomedical Waste Is Critical to Public Health: Insights from the Central Pollution Control Board Guidelines in India

Biomedical waste (BMW), encompassing hazardous medical materials, poses environmental and public health risks if not correctly managed. The Central Pollution Control Board (CPCB) in India is a statutory organization that oversees BMW disposal standards, aimed at mitigating these hazards. BMW mismanagement is a major problem and potentially poses threats to the environment as well as public health. During the coronavirus disease 2019 (COVID-19) pandemic, increased use of personal protective equipment (PPE) and other medical equipment was witnessed which led to a marked raised BMW generation. To ensure proper and optimized BMW management, CPCB established guidelines and rules to be followed by the medical facilities as well as the common BMW treatment facilities (CBWTFs). The challenges in implementing proper waste management practices were lack of awareness and inadequate infrastructure. Strategies for better BMW management were proposed, including color-coded bins, improved infrastructure, advanced technology, and awareness campaigns. Highlighting CPCB's vital role, this emphasizes healthcare facilities' proactive role in implementing and evolving regulations for sustainable BMW disposal, ensuring both public health and environmental well-being through compliance and responsible waste management partnerships.

Factors Associated with IRB Review Time in a Non-Federally Funded Study Using an sIRB of Record

From 2018 to 2020, U.S. federal mandates began requiring the use of a single institutional review board (sIRB) of record for federally funded, multisite studies. With an interest in the efficiency of site activation, we compared the frequency with which local review and approval and three different reliance options (ways to establish a reliance agreement between the sIRB and the relying institution) were used during this period in a multisite, non-federally funded study (ClinicalTrials.gov identifier: NCT03928548). Using general linear models, we analyzed the relationships between local reliance or approval and sIRB of record approval times and (a) the regulatory option selected and (b) relying-site and process characteristics. Eighty-five sites received sIRB approval through 72 submissions (40% using local review, 46% using the SMART IRB agreement, 10% using an IRB authorization agreement, and 4% using a letter of support). Median time to establish a local reliance or study approval and sIRB approval were longest for sites using a SMART IRB agreement. Study-site region and the time of submission were significantly associated with local reliance or approval time, which averaged 129 and 107 days faster for Midwestern (p = 0.03) or Western (p = 0.02) sites, respectively, and 70 days slower for Northeastern sites (p = 0.42) compared with sites in the South, and 91 days slower when regulatory communication was initiated during or after February 2019 compared with before (p = 0.02). Similar relationships between sIRB approval time and region and time frame were observed; in addition, approval time was 103 days slower for sites affiliated with a research 1 (R1) university versus not (p = 0.02). Region of the country, time frame, and R1 university affiliation were associated with variations in study-site activation in a non-federally funded, multisite study.

Targeted BRCA1/2 population screening among Ashkenazi Jewish individuals using a web-enabled medical model: An observational cohort study

PURPOSE

This study aimed to evaluate uptake and follow-up using internet-assisted population genetic testing (GT) for BRCA1/2 Ashkenazi Jewish founder pathogenic variants (AJPVs).

METHODS

Across 4 cities in the United States, from December 2017 to March 2020, individuals aged ≥25 years with ≥1 Ashkenazi Jewish grandparent were offered enrollment. Participants consented and enrolled online with chatbot and video education, underwent BRCA1/2 AJPV GT, and chose to receive results from their primary care provider (PCP) or study staff. Surveys were conducted at baseline, at 12 weeks, and annually for 5 years.

RESULTS

A total of 5193 participants enrolled and 4109 (79.1%) were tested (median age = 54, female = 77.1%). Upon enrollment, 35.1% of participants selected a PCP to disclose results, and 40.5% of PCPs agreed. Of those tested, 138 (3.4%) were AJPV heterozygotes of whom 21 (15.2%) had no significant family history of cancer, whereas 86 (62.3%) had a known familial pathogenic variant. At 12 weeks, 85.5% of participants with AJPVs planned increased cancer screening; only 3.7% with negative results and a significant family history reported further testing.

CONCLUSION

Although continued follow-up is needed, internet-enabled outreach can expand access to targeted GT using a medical model. Observed challenges for population genetic screening efforts include recruitment barriers, improving PCP engagement, and increasing uptake of additional testing when indicated.

Ethical considerations of academic surgical research

Ethical considerations surrounding clinical research have been a topic of intense debate and discussion for many years, however, issues specific to the surgeon-scientist are rarely discussed. This article summarizes ethical issues pertinent to the surgeon-scientist including conflicts of interest, use of human biospecimens, data integrity, manuscript authorship, and mentorship for trainees. The methods include a review of the current and past literature on each of these topics with a brief overview of how it relates to the surgeon-scientist. Case examples are provided throughout to provide further discussion points related to the topic. The purpose of this review is to promote awareness of the ethical challenges that the surgeon-scientist faces when engaging in basic science research in order to spark discussion and encourage integrity and ethical behavior.