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Murphy M, McCaughan E, Thompson G, Carson MA, Hanna JR, Donovan M, Wilson RH, Fitzsimons D. Trusting relationships between patients with non-curative cancer and healthcare professionals create ethical obstacles for informed consent in clinical trials: a grounded theory study. BMC Palliat Care 2023; 22:85. [PMID: 37393250 DOI: 10.1186/s12904-023-01204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Clinical trial participation for patients with non-curative cancer is unlikely to present personal clinical benefit, which raises the bar for informed consent. Previous work demonstrates that decisions by patients in this setting are made within a 'trusting relationship' with healthcare professionals. The current study aimed to further illuminate the nuances of this relationship from both the patients' and healthcare professionals' perspectives. METHODS Face-to-face interviews using a grounded theory approach were conducted at a regional Cancer Centre in the United Kingdom. Interviews were performed with 34 participants (patients with non-curative cancer, number (n) = 16; healthcare professionals involved in the consent process, n = 18). Data analysis was performed after each interview using open, selective, and theoretical coding. RESULTS The 'Trusting relationship' with healthcare professionals underpinned patient motivation to participate, with many patients 'feeling lucky' and articulating an unrealistic hope that a clinical trial could provide a cure. Patients adopted the attitude of 'What the doctor thinks is best' and placed significant trust in healthcare professionals, focusing on mainly positive aspects of the information provided. Healthcare professionals recognised that trial information was not received neutrally by patients, with some expressing concerns that patients would consent to 'please' them. This raises the question: Within the trusting relationship between patients and healthcare professionals, 'Is it possible to provide balanced information?'. The theoretical model identified in this study is central to understanding how the trusting professional-patient relationship influences the decision-making process. CONCLUSION The significant trust placed on healthcare professionals by patients presented an obstacle to delivering balanced trial information, with patients sometimes participating to please the 'experts'. In this high-stakes scenario, it may be pertinent to consider strategies, such as separation of the clinician-researcher roles and enabling patients to articulate their care priorities and preferences within the informed consent process. Further research is needed to expand on these ethical conundrums and ensure patient choice and autonomy in trial participation are prioritised, particularly when the patient's life is limited.
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Affiliation(s)
- Mary Murphy
- Resuscitation Services, Elliott Dynes Building Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Eilís McCaughan
- School of Nursing and Midwifery Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Gareth Thompson
- School of Nursing and Midwifery Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Matthew A Carson
- School of Nursing and Midwifery Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Jeffrey R Hanna
- School of Nursing and Midwifery Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Monica Donovan
- School of Nursing and Midwifery Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Richard H Wilson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery Medical Biology Centre, Queen's University Belfast, Belfast, UK.
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Roschka S, Leddig T, Bullerjahn M, Richter G, Liedtke W, Langanke M, Hoffmann W. Secondary use of health care data and left-over biosamples within the 'Medical Informatics Initiative' (MII): a quasi-randomized controlled evaluation of patient perceptions and preferences regarding the consent process. BMC Med Inform Decis Mak 2022; 22:184. [PMID: 35840947 PMCID: PMC9287940 DOI: 10.1186/s12911-022-01922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/01/2022] [Indexed: 12/01/2022] Open
Abstract
Background Data collected during routine health care and ensuing analytical results bear the potential to provide valuable information to improve the overall health care of patients. However, little is known about how patients prefer to be informed about the possible usage of their routine data and/or biosamples for research purposes before reaching a consent decision. Specifically, we investigated the setting, the timing and the responsible staff for the information and consent process. Methods We performed a quasi-randomized controlled trial and compared the method by which patients were informed either in the patient admission area following patient admission by the same staff member (Group A) or in a separate room by another staff member (Group B). The consent decision was hypothetical in nature. Additionally, we evaluated if there was the need for additional time after the information session and before taking the consent decision. Data were collected during a structured interview based on questionnaires where participants reflected on the information and consent process they went through. Results Questionnaire data were obtained from 157 participants in Group A and 106 participants in Group B. Overall, participants in both groups were satisfied with their experienced process and with the way information was provided. They reported that their (hypothetical) consent decision was freely made. Approximately half of the interested participants in Group B did not show up in the separate room, while all interested participants in Group A could be informed about the secondary use of their routine data and left-over samples. No participants, except for one in Group B, wanted to take extra time for their consent decision. The hypothetical consent rate for both routine data and left-over samples was very high in both groups. Conclusions The willingness to support medical research by allowing the use of routine data and left-over samples seems to be widespread among patients. Information concerning this secondary data use may be given by trained administrative staff immediately following patient admission. Patients mainly prefer making a consent decision directly after information is provided and discussed. Furthermore, less patients are informed when the process is organized in a separate room. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01922-6.
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Affiliation(s)
- Sybille Roschka
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany. .,Core Unit Data Integration Center, University Medicine Greifswald, Walther-Rathenau-Straße 49a, 17489, Greifswald, Germany.
| | - Torsten Leddig
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany
| | - Mandy Bullerjahn
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany.,Division Patient Management, Department Patient Admission, University Medicine Greifswald, Fleischmannstr. 8, 17489, Greifswald, Germany
| | - Gesine Richter
- Institute of Experimental Medicine, Division of Biomedical Ethics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Wenke Liedtke
- Department of Social Work, Protestant University of Applied Sciences Rhineland-Westphalia-Lippe, Immanuel-Kant-Str. 18-20, 44803, Bochum, Germany
| | - Martin Langanke
- Department of Social Work, Protestant University of Applied Sciences Rhineland-Westphalia-Lippe, Immanuel-Kant-Str. 18-20, 44803, Bochum, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Germany
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Dikkers FG, San Giorgi MRM, Rinkel RNPM, Remacle M, Giovanni A, Wierzbicka M, Seedat R, Campos G, Sandhu GS. Informed consent for suspension microlaryngoscopy: what should we tell the patient? A consensus statement of the European Laryngological Society. Eur Arch Otorhinolaryngol 2022. [PMID: 35821269 DOI: 10.1007/s00405-022-07429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Informed consent for any surgical intervention is necessary, as only well-informed patients can actively participate in the decision-making process about their care, and better understand the likely or potential outcomes of their treatment. No consensus exists on informed consent for suspension microlaryngoscopy (SML). MATERIALS AND METHODS Informed consent procedures in nine countries on five continents were studied. RESULTS Several risks can be discerned: risks of SML as procedure, anesthesiologic risks of SML, specific risks of phonosurgery, risks of inadequate glottic exposure or unexpected findings, risks of not treating. SML has recognized potential complications, that can be divided in temporary (minor) complications, and lasting (major) complications. CONCLUSION SML is a safe procedure with low morbidity, and virtually no mortality. Eleven recommendations are provided.
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Gebremariam A, Yalew AW, Hirpa S, Wondimagegnehu A, Kaba M, Assefa M, Mitiku I, Kantelhardt EJ, Jemal A, Addissie A. Application of the rapid ethical assessment approach to enhance the ethical conduct of longitudinal population based female cancer research in an urban setting in Ethiopia. BMC Med Ethics 2018; 19:87. [PMID: 30428895 PMCID: PMC6237025 DOI: 10.1186/s12910-018-0328-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background Rapid Ethical Assessment (REA) is an approach used to design context tailored consent process for voluntary participation of participants in research including human subjects. There is, however, limited evidence on the design of ethical assessment in studies targeting cancer patients in Ethiopia. REA was conducted to explore factors that influence the informed consent process among female cancer patients recruited for longitudinal research from Addis Ababa Population-based Cancer Registry. Methods Qualitative study employing rapid ethnographic approach was conducted from May–July, 2017, at the Tikur Anbessa Specialized Referral Hospital. In-depth and key informants’ interviews were conducted among purposively selected 16 participants. Regular de-briefings among the study team helped to identify emerging themes and ensure saturation. Interviews and debriefings were tape recorded in Amharic, and transcribed and translated to English. Coding of the transcripts was facilitated by use of NVivo software. Thematic analysis was employed to respond to the initial questions and interpret findings. Results Perceived barriers to voluntary study participation included lack of reporting back study results of previous studies, the decision making status of women, hopelessness or fatigue in the patients, shyness of the women, data collectors approach to the patient, and patient’s time constraints. Most of the patients preferred oral over written consent and face-to-face interview over telephone interview. Provision of detail information about the study, using short and understandable tool, competent, compassionate and respectful enumerators of the same gender were suggested to assure participation. Due to the perceived severity, the use of the term “cancer” was associated with fear and anxiety. Alternatively, uses of phrases like “breast or cervical illness/disease” were suggested during patient interviews. Conclusions Voluntary participation is not straight forward but affected by different factors. Using competent, compassionate and respectful enumerators, short and precise questioning tools to limit the time of the interview could improve voluntary participation. Moreover, careful consideration of the patients and families concept of the disease such as wording and information has to be taken into account. This assessment helped in improving the consent process of the ongoing project on breast and cervical cancer patients.
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Affiliation(s)
- Alem Gebremariam
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia. .,School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Alemayehu Worku Yalew
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Selamawit Hirpa
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abigiya Wondimagegnehu
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mirgissa Kaba
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mallia P. WASP (Write a Scientific Paper): Ethics approval for a research study (2). Early Hum Dev 2018; 124:49-51. [PMID: 29731261 DOI: 10.1016/j.earlhumdev.2018.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Research Ethics Committees are composed of a minimum of five members which include a lay person, a member from a different institution and at least another three members which should be versed in ethics. Legal and expert advisors can be sought by the committee. The REC will require a detailed protocol from the researcher including the curriculum of the principal investigator and all other researchers under him/her. The protocol should include all details of the research to be undertaken including a detailed description, the reasons for the research, literature pertaining to the research, a clear description of the target population, the actual consent form including what information is to be given to the participants, a declaration where necessary that things prohibited by the law (such as use of embryonic stem cells if this is the case in the country [2] will not be researchers, and a declaration that the relevant directives and rules and procedures which the REC falls under will be followed. The REC will also require a description of any risks and what actions are to be undertaken to eliminate hazards. The researchers must adhere only to the protocol given and any changes, minor or major, must be reported to the REC and approved.
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Hughes JG, Russell W, Breckons M, Richardson J, Lloyd-Williams M, Molassiotis A. "I assumed that one was a placebo": exploring the consent process in a sham controlled acupressure trial. Complement Ther Med 2014; 22:903-8. [PMID: 25440382 DOI: 10.1016/j.ctim.2014.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/26/2014] [Accepted: 07/11/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In clinical trials where participants are likely to be able to distinguish between true and sham interventions, informing participants that they may receive a sham intervention increases the likelihood of participants 'breaking the blind' and invalidating trial findings. The present study explored participants' perceptions of the consent process in a sham controlled acupressure trial which did not explicitly indicate participants may receive a sham intervention. DESIGN Nested qualitative study within a randomised sham controlled trial of acupressure wristbands for chemotherapy-related nausea. Convenience sample of 26 patients participated in semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Transcripts analysed thematically using framework analysis. SETTING Study conducted within three geographical sites in the UK: Manchester, Liverpool, and Plymouth. RESULTS All participants indicated that they believed they were fully informed when providing written consent to participate in the trial. Participants' perceived it was acceptable to employ a sham intervention within the trial of acupressure wristbands without informing potential participants that they may receive a sham treatment. Despite the fact that participants were not informed that one of the treatment arms was a sham intervention the majority indicated they assumed one of the treatment arms would be placebo. CONCLUSIONS Many trials of acupuncture and acupressure do not inform participants they may receive a sham intervention. The current study indicates patients' perceive this approach to the consent process as acceptable. However, the fact participants assume one treatment may be placebo threatens the methodological basis for utilising this approach to the consent process.
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Affiliation(s)
- John Gareth Hughes
- Royal London Hospital for Integrated Medicine, UCLH NHS Trust, United Kingdom.
| | - Wanda Russell
- School of Nursing, Midwifery & Social Work, University of Manchester, United Kingdom.
| | - Matthew Breckons
- Institute of Health & Society, Newcastle University, United Kingdom.
| | - Janet Richardson
- Faculty of Health & Human Sciences, Plymouth University, United Kingdom.
| | - Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group, Division of Primary Care, University of Liverpool, United Kingdom.
| | - Alex Molassiotis
- School of Nursing, Midwifery & Social Work, University of Manchester, United Kingdom.
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