July 6, 2017: New article compares different approaches for notification and authorization in pragmatic clinical research

Dr. Kevin Weinfurt and colleagues in the Regulatory/Ethics Core of the NIH Collaboratory recently published an article in the American Journal of Bioethics regarding how acceptable different approaches to notification and authorization are to potential participants in pragmatic research. The authors conducted a series of interviews using 24 different hypothetical scenarios reflecting different types of studies and approaches to notification and authorization.

Key findings:

  • People have significant difficulty understanding (1) randomization and (2) that all the data are collected during routine care, and no extra visits or tests are required.

  • For some types of pragmatic research, many of the respondents viewed

    • Active alternatives to written consent—such as oral consent—as acceptable.

    • Less active approaches to notification—such as no notification ahead of time or broad notification—as unacceptable.

When using written consent in cases where researchers are testing accepted medical interventions that have known clinical risks but with no incremental risks of participating in the research, it was acceptable to omit the clinical risks from the consent documents, thereby shortening the form. A significant portion (28-49%) of respondents would decline to participate regardless of notification approach, which could lead to non-trivial consent bias (in other words, there could be significant differences in people who decline vs people who agree to participate). Based on these findings, the authors suggest alternate approaches to notification and authorization should be further developed and tested.

Weinfurt KP, Bollinger JM, Brelsford KM, et al. 2016. Patients’ views concerning research on medical practices: Implications for consent. AJOB Empirical Bioethics. 7:76–91. doi:10.1080/23294515.2015.1117536.