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Guetterman TC, Haggins A, Montas S, Black J, Harney D, Fetters MD, Silbergleit R, Dickert NW. Institutional Review Boards' Assessment of Local Context: A Mixed Methods Study. Ethics Hum Res 2024; 46:2-13. [PMID: 38240398 DOI: 10.1002/eahr.500195] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The nature of the review of local context by institutional review boards (IRBs) is vague. Requirements for single IRB review of multicenter trials create a need to better understand interpretation and implementation of local-context review and how to best implement such reviews centrally. We sought a pragmatic understanding of IRB local-context review by exploring stakeholders' attitudes and perceptions. Semistructured interviews with 26 IRB members and staff members, institutional officials, and investigators were integrated with 80 surveys of similar stakeholders and analyzed with qualitative theme-based text analysis and descriptive statistical analysis. Stakeholders described what they considered to be local context, the value of local-context review, and key processes used to implement review of local context in general and for emergency research conducted with an exception from informed consent. Concerns and potential advantages of centralized review of local context were expressed. Variability in perspectives suggests that local-context review is not a discrete process, which presents opportunities for defining pathways for single IRB review.
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Affiliation(s)
- Timothy C Guetterman
- Assistant professor in the Department of Family Medicine at the University of Michigan
| | - Adrianne Haggins
- Assistant professor in the Department of Emergency Medicine at the University of Michigan
| | - Sacha Montas
- Assistant professor in the Department of Emergency Medicine at the University of Michigan
| | - Joy Black
- Clinical research project manager in the Department of Emergency Medicine at the University of Michigan
| | - Deneil Harney
- Administrative manager in the Department of Emergency Medicine at the University of Michigan
| | - Michael D Fetters
- Who passed away on July 16, 2023, was a professor in the Department of Family Medicine at the University of Michigan
| | - Robert Silbergleit
- Professor in the Department of Emergency Medicine at the University of Michigan
| | - Neal W Dickert
- Associate professor in the Department of Medicine at the Emory University School of Medicine
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2
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Johnson AR, Rigtrup LM, VanBuren J, Rothwell E, Dean JM. An Approach to Reviewing Local Context for Exception from Informed Consent Trials Using a Single IRB. Ethics Hum Res 2021; 43:42-48. [PMID: 34751515 PMCID: PMC10353538 DOI: 10.1002/eahr.500109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the context of emergency research, researchers can ask the institutional review board (IRB) to waive the regulatory requirement that individuals provide informed consent when enrolling in research studies. A requirement of the waiver of informed consent is that the reviewing IRB must review and approve a community consultation and public disclosure plan. It is critical that an IRB serving as the single IRB (sIRB) for multisite research be thoroughly versed in the local context concerns for each participating site to determine whether the site's community is being adequately consulted about the research in which individuals will be enrolled under an exception to the informed consent requirement. We designed an sIRB review model for evaluating site-specific community consultation plans that included a local evaluation and feedback step, and we piloted the model with a four-site, pediatric exception from informed consent (EFIC) clinical trial. We identified three key roles for the model: the sIRB, the investigators, and the representative of the institution's human research protection program (HRPP). We successfully collected the information and local input needed to evaluate each site's community consultation plan and applied the information to a thorough IRB review, despite the geographic distance between the study site and the sIRB.
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Affiliation(s)
- Ann R Johnson
- Director of the institutional review board and Human Research Protection Program at the University of Utah
| | - Lisa M Rigtrup
- Manager of the institutional review board at the University of Utah
| | - John VanBuren
- Associate professor and statistician in the Department of Pediatrics at the University of Utah
| | - Erin Rothwell
- Professor and social scientist in the Department of Obstetrics and Gynecology at the University of Utah
| | - J Michael Dean
- Professor and vice chairman for research in the Department of Pediatrics at the University of Utah
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3
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Fernandez Lynch H, Dickert NW, Zettler PJ, Joffe S, Largent EA. Regulatory flexibility for COVID-19 research. J Law Biosci 2020; 7:lsaa057. [PMID: 32908674 PMCID: PMC7454723 DOI: 10.1093/jlb/lsaa057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
Clinical research is critical to combatting COVID-19, but regulatory requirements for human subjects protection may sometimes pose a challenge in pandemic circumstances. Although regulators have offered some helpful guidance for research during the pandemic, we identify further compliance challenges regarding institutional review board (IRB) review and approval, informed consent, emergency research, and research involving incarcerated people. Our proposals for regulatory flexibility in these areas seek to satisfy the goals of protecting participants and promoting the development of high-quality evidence to improve patient care. These recommendations may have relevance beyond the COVID-19 pandemic to enhance the efficiency of research oversight and participant protection more broadly.
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Affiliation(s)
| | | | - Patricia J Zettler
- Moritz College of Law, The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Singh S, Cheek JA, Babl FE, Hoch JS. Review article: A primer for clinical researchers in the emergency department: Part X. Understanding economic evaluation alongside emergency medicine research. Emerg Med Australas 2019; 31:710-714. [PMID: 31237083 DOI: 10.1111/1742-6723.13320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/12/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
In this series we address research topics in emergency medicine. While traditionally there was an almost exclusive focus on the efficacy and effectiveness of interventions in emergency research, analysis of the costs and the societal impact of different approaches and pathways have become increasingly important. In this paper we will address what health economics means and discuss the different types and key features of economic evaluation relevant for clinical researchers.
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Affiliation(s)
- Sonia Singh
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California, USA
| | - John A Cheek
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey S Hoch
- Center for Heathcare Policy and Research, University of California at Davis, Sacramento, California, USA.,Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, California, USA
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McRae AD, Perry JJ, Brehaut J, Brown E, Curran J, Emond M, Hohl C, Taljaard M, Stiell IG. Engaging emergency clinicians in emergency department clinical research. CAN J EMERG MED 2018; 20:443-7. [PMID: 29378670 DOI: 10.1017/cem.2017.434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this panel was to generate recommendations to promote the engagement of front-line emergency department (ED) clinicians in clinical and implementation research. METHODS Panel members conducted semi-structured interviews with 37 Canadian adult and pediatric emergency medicine researchers to elicit barriers and facilitators to clinician engagement in research activities, and to glean strategies for promoting clinician engagement. RESULTS Responses were organized by themes, and, based on these responses, recommendations were developed and refined in an iterative fashion by panel members. CONCLUSIONS We offer eight recommendations to promote front-line clinician engagement in clinical research activities. Recommendations to promote clinician engagement specifically address the creation of a research-friendly culture in the ED, minimizing the burden of data collection on clinical staff through the careful design of data collection tools and the use of research staff, and communication between researchers and clinical staff to promote adherence to study protocols.
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Whitesides LW, Baren JM, Biros MH, Fleischman RJ, Govindarajan PR, Jones EB, Pancioli AM, Pentz RD, Scicluna VM, Wright DW, Dickert NW. Impact of individual clinical outcomes on trial participants' perspectives on enrollment in emergency research without consent. Clin Trials 2016; 14:180-186. [PMID: 28359192 DOI: 10.1177/1740774516677276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence suggests that patients are generally accepting of their enrollment in trials for emergency care conducted under exception from informed consent. It is unknown whether individuals with more severe initial injuries or worse clinical outcomes have different perspectives. Determining whether these differences exist may help to structure post-enrollment interactions. METHODS Primary clinical data from the Progesterone for the Treatment of Traumatic Brain Injury trial were matched to interview data from the Patients' Experiences in Emergency Research-Progesterone for the Treatment of Traumatic Brain Injury study. Answers to three key questions from Patients' Experiences in Emergency Research-Progesterone for the Treatment of Traumatic Brain Injury study were analyzed in the context of enrolled patients' initial injury severity (initial Glasgow Coma Scale and Injury Severity Score) and principal clinical outcomes (Extended Glasgow Outcome Scale and Extended Glasgow Outcome Scale relative to initial injury severity). The three key questions from Patients' Experiences in Emergency Research-Progesterone for the Treatment of Traumatic Brain Injury study addressed participants' general attitude toward inclusion in the Progesterone for the Treatment of Traumatic Brain Injury trial (general trial inclusion), their specific attitude toward being included in Progesterone for the Treatment of Traumatic Brain Injury trial under the exception from informed consent (personal exception from informed consent enrollment), and their attitude toward the use of exception from informed consent in the Progesterone for the Treatment of Traumatic Brain Injury trial in general (general exception from informed consent enrollment). Qualitative analysis of interview transcripts was performed to provide contextualization and to determine the extent to which respondents framed their attitudes in terms of clinical experience. RESULTS Clinical data from Progesterone for the Treatment of Traumatic Brain Injury trial were available for all 74 patients represented in the Patients' Experiences in Emergency Research-Progesterone for the Treatment of Traumatic Brain Injury study (including 46 patients for whom the surrogate was interviewed due to the patient's cognitive status or death). No significant difference was observed regarding acceptance of general trial inclusion or acceptance of general exception from informed consent enrollment between participants with favorable neurological outcomes and those with unfavorable outcomes relative to initial injury. Agreement with personal enrollment in Progesterone for the Treatment of Traumatic Brain Injury trial under exception from informed consent, however, was significantly higher among participants with favorable outcomes compared to those with unfavorable outcomes (89% vs 59%, p = 0.003). There was also a statistically significant relationship between more severe initial injury and increased acceptance of personal exception from informed consent enrollment ( p = 0.040) or general exception from informed consent use ( p = 0.034) in Progesterone for the Treatment of Traumatic Brain Injury trial. Many individuals referenced personal experience as a basis for their attitudes, but these references were not used to support negative views. CONCLUSION Patients and surrogates of patients with unfavorable clinical outcomes were somewhat less accepting of their own inclusion in the Progesterone for the Treatment of Traumatic Brain Injury trial under exception from informed consent than were patients or surrogates of patients with favorable clinical outcomes. These findings suggest a need to identify optimal strategies for communicating with patients and their surrogates regarding exception from informed consent enrollment when clinical outcomes are poor.
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Affiliation(s)
- Louisa W Whitesides
- 1 Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jill M Baren
- 2 Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle H Biros
- 3 Hennepin County Medical Center, Department of Emergency Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ross J Fleischman
- 4 Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Prasanthi R Govindarajan
- 5 Department of Emergency Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth B Jones
- 6 Department of Emergency Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Arthur M Pancioli
- 7 Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Rebecca D Pentz
- 8 Department of Hematology and Oncology, School of Medicine, Emory University, Atlanta, GA, USA
| | | | - David W Wright
- 10 Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Neal W Dickert
- 11 Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA.,12 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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7
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Sims CA, Isserman JA, Holena D, Sundaram LM, Tolstoy N, Greer S, Sonnad S, Pascual J, Reilly P. Exception from informed consent for emergency research: consulting the trauma community. J Trauma Acute Care Surg 2013; 74:157-65; discussion 165-6. [PMID: 23271091 PMCID: PMC4111088 DOI: 10.1097/ta.0b013e318278908a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research investigating the resuscitation and management of unstable trauma patients is necessary to improve care and save lives. Because informed consent for research is impossible in emergencies, the Federal Drug Administration has established an Exception from Informed Consent (EFIC) Policy that mandates "community consultation" as a means of protecting patient autonomy. We hypothesized that the trauma community represents a heterogeneous population whose attitudes regarding EFIC and willingness to participate in emergency research are influenced by status as a patient, family, or geographic community member. METHODS In the context of an upcoming trial, trauma patients as well as family and community members were asked to rank statements regarding EFIC and willingness to participate in emergency research using a 5-point Likert-type scale. Higher total scores reflected a more positive attitude regarding EFIC (range, 4-20; neutral = 12) and willingness (range, 21-105, neutral = 63). The influence of demographics, education, and interpersonal violence were evaluated by Kruskal-Wallis and Mann-Whitney U-tests (p < 0.05). RESULTS Overall, the 309 participants (trauma patients, n = 172; family, n = 73; community, n = 64) were positive about EFIC (median, 16; interquartile range, [IQR], 14-18) and demonstrated high willingness scores (median, 82; IQR, 76-88.5). EFIC and willingness were not influenced by age, sex, race, or education. Victims of interpersonal violence and their family members had lower EFIC scores than those with other mechanisms (median [IQR], 16 [14-18] vs. 16 [13-16]; p = 0.04) but similar willingness. Although EFIC scores were similar between groups, trauma patients had significantly lower willingness than family (median [IQR], 74 [68-77] vs. 77 [70-85]; p = 0.03) or community members (median [IQR], 76 [70-84]; p = 0.01). CONCLUSION Trauma patients, families, and the geographic community expressed a high degree of support for EFIC and willingness to participate in emergency research, although support was influenced by injury mechanism and group status. Consultation efforts for emergency research should extend beyond the geographic community to include trauma victims and their families. LEVEL OF EVIDENCE Epidemiologic, level III.
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Affiliation(s)
- Carrie A Sims
- Center for Resuscitation Science, Trauma Center at Penn, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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