Implementing a research governance framework for clinical and public health research

Developing a clinical trial governance framework for pharmaceutical industry-funded clinical trials

Rising concerns relating to pharmaceutical sponsor bias in the conduct of clinical trials have compelled the need to develop a clinical trial governance framework. This article describes the development of the Conflict of Interest in Research (COIR), a clinical trial governance framework. The COIR, consisting of three process phases (initiation, concurrent, and ongoing), developed following a needs assessment, using a four-stage methodology, and evaluated against the International Conference on Harmonization--Good Clinical Practice (ICH-GCP) guidelines. The Conflict of Interest Resolution algorithm, the backbone of COIR, enables constant surveillance to detect/resolve conflicts at all stages of the clinical trial life-cycle. COIR promotes interaction between the regulatory system and the sponsors, independent of individuals. COIR enables rapid detection of scientific and financial conflicts, to prevent subject harm and, to assure optimal funds utilization, the latter feature helped to reduce a significant burden for the ethics committee, as it lacks financial expertise. COIR is a semi-automated Oracle system, requires manpower, and is affected by human expertise and subjectivity. Complete automation to overcome this limitation will still need human expertise to scale changing trial regulations. Nevertheless, the COIR has won the distinction of the "most favored site" from pharmaceutical sponsors and is anticipated to be adopted by other clinical trial sites.

Research governance and change in research ethics practices at a major Australian university

Recent revisions of the National Statement on Ethical Conduct in Human Research and the Australian Code for the Responsible Conduct of Research put a great emphasis on research governance. Institutional responsibility for the governance of the research is not limited only to the ethical review by the Human Research Ethics Committee (HREC), but also to the accountability for quality, safety, privacy, risk management and financial management of the research. Despite the development of proposed research governance frameworks, many Australian institutions do not have such structures in place and rely excessively on HRECs to perform administrative functions that are not their responsibility. In this paper we report on implementation of a research governance framework at University of New South Wales which led to reduced HREC workload and allowed more attention to its core functions. We present the approach undertaken by the university to separate the ethical review process by HREC from the research governance. We recommend that with proper research governance frameworks in place, the role of HRECs and the institutional responsibility of governance of the research can be defined clearly.

Self-audit as part of a research governance framework for health research

Clinical research is an area of increasing activity for hospitals, universities and research institutions, which requires formal governance and oversight to manage risks. Monitoring research practice should be a part of research governance activities. However, formal audits have proved time consuming for researchers and auditors. To increase attention to good research practice and screen for poor practice, the Department of Epidemiology and Preventive Medicine at Monash University and the Alfred Research and Ethics Unit in Melbourne have developed a brief self-audit tool for researchers. We evaluated the self-audit using a questionnaire for researchers. The results were positive, with most respondents believing that it promoted good research practice.

A case study evaluation of ethics review systems for multicentre clinical trials

OBJECTIVE

To evaluate the difference in time taken for ethics and site governance approval for multicentre clinical trials using two different systems of ethics review.

DESIGN

We evaluated the times to final ethics and governance approval for two international, multicentre clinical trials of treatment for metastatic colorectal cancer: the MAX trial, using a non-centralised ethics review system, and the CO.20 trial, using the new New South Wales centralised ethics review system.

MAIN OUTCOME MEASURE

Time from trial submission to overall study approval.

RESULTS

The median time taken to obtain ethics approval for the MAX trial at 16 NSW sites was 100 days (range, 36-161 days). The median time to obtain central ethics approval for the CO.20 trial at 14 NSW sites was 77 days, with an additional 60 days (range 20-79 days) required to obtain site-specific research governance approval.

CONCLUSIONS

Any difference in time to approval between the review systems was outweighed by the overall time taken. However, the time spent by both the coordinating centre and local sites in collation, submission and correspondence was greatly reduced, and the centralised process allowed for standardised documentation at all study sites.