Informed Consent: A Monthly Review

February 2020

This digest aggregates and distills key content around informed consent from a broad spectrum of peer-reviewed journals and grey literature, and from various practice domains and organization types including international agencies, INGOs, governments, academic and research institutions, consortiums and collaborations, foundations, and commercial organizations. We acknowledge that this scope yields an indicative and not an exhaustive digest product.

Informed Consent: A Monthly Review is a service of the Center for Informed Consent Integrity, a program of the GE2P2 Global Foundation. The Foundation is solely responsible for its content. Comments and suggestions should be directed to:

Paige Fitzsimmons, MA
Associate Fellow
GE2P2 Global Foundation

David R. Curry
President & CEO
GE2P2 Global Foundation

PDF Version: GE2P2 Global_Informed Consent – A Monthly Review_February 2020

Do patients and research subjects have a right to receive their genomic raw data? An ethical and legal analysis

Do patients and research subjects have a right to receive their genomic raw data? An ethical and legal analysis
Research Article
Christoph Schickhardt, Henrike Fleischer & Eva C. Winkler
BMC Medical Ethics volume, 16 January 2020; 21(7)
Open Access
As Next Generation Sequencing technologies are increasingly implemented in biomedical research and (translational) care, the number of study participants and patients who ask for release of their genomic raw data is set to increase. This raises the question whether research participants and patients have a legal and moral right to receive their genomic raw data and, if so, how this right should be implemented into practice.
In a first step we clarify some central concepts such as “raw data”; in a second step we sketch the international legal framework. The third step provides an extensive ethical analysis which comprehends two parts: an evaluation of whether there is a prima facie moral right to receive one’s raw data, and a contextualization and discussion of the right in light of potentially conflicting interests and rights of the data subject herself and third parties; in a last fourth step we emphasize the main practical consequences of the ethical analyses and propose recommendations for the release of raw data.
In several legislations like the new European General Data Protection Regulation, patients do in principle have the right to receive their raw data. However, the procedural implementation of this right and whether it involves genetic counselling is at the discretion of the Member States. Even more questions remain with respect to the research context. The ethical analysis suggests that patients and research subjects have a moral right to receive their genomic raw data and addresses aspects which are also of relevance for the legal discussion such as the costs of release of raw data and its impact on academic freedom.
Taking into account the specific nature and implications of genomic raw data and the contexts of research and health care, several concerns and potentially conflicting interests of the data subjects themselves and involved researchers, physicians, biomedical institutions and relatives arise. Instead of using them to argue in favor of restrictions of the data subjects’ legal and moral right to genomic raw data, the concerns should be addressed through provision of information and other measures. To this end, we propose relevant recommendations.

Exploring broad consent in the context of the 100,000 Genomes Project: a mixed methods study

Exploring broad consent in the context of the 100,000 Genomes Project: a mixed methods study
Lisa M. Ballard, Rachel H. Horton, Sandi Dheensa, Angela Fenwick & Anneke M. Lucassen
European Journal of Human Genetics, 9 January 2020
The 100,000 Genomes Project (100kGP)—a hybrid clinical-research initiative—was set up to analyse whole-genome sequences (WGS) from patients living with a rare disease or cancer. The project positioned participant consent as being of central importance, but consent in the context of genomic testing raises challenging issues. In this mixed method study, we surveyed 1337 100kGP participants regarding their experiences of taking part in the project and conducted in-depth interviews with 24 survey respondents to explore these findings further. Survey responses were analysed using descriptive statistics and interview data were analysed thematically. The consent approach of the 100kGP resulted in a proportion of our study’s participants not understanding the complexities of the project and what types of results they might receive; for example, 20% of participants who we surveyed from the cancer arm did not recall what decisions they had made regarding additional findings. It is not surprising that a project such as this, with such diverse aims and participant groups, would throw up at least some challenges. However, participants reported being satisfied with their experience of the project to date. Our study highlights that in the context of consent for more complex endeavours, such as the 100kGP, it is important to assess (and document) an agreement to take part, but complicated decisions about what and when to communicate may need revisiting over time in response to changing contexts. We discuss the implications of our findings with reference to participants of the 100kGP and the newly formed NHS Genomic Medicine Service.

The Consent Form in the Chinese CRISPR Study: In Search of Ethical Gene Editing

The Consent Form in the Chinese CRISPR Study: In Search of Ethical Gene Editing
Guest Editorial
David Shaw
Journal of Bioethical Inquiry, 3 January 2020
Open Access
This editorial provides an ethical analysis of the consent materials and other documents relating to the recent creation and birth of twin girls who had their genes edited using CRISPR-cas9 in a controversial Chinese research study. It also examines the “draft ethical principles” published by the leader of the research study. The results of the analysis further intensify serious ethical concerns about the conduct of this study.

Would you like to participate in this trial? The practice of informed consent in intrapartum research in the last 30 years

Would you like to participate in this trial? The practice of informed consent in intrapartum research in the last 30 years
Research Article
Mariana Widmer, Mercedes Bonet, Ana Pilar Betrán
PLOS One, 24 January 2020
Open Access
Informed consent is the cornerstone of the ethical conduct and protection of the rights and wellbeing of participants in clinical research. Therefore, it is important to identify the most appropriate moments for the participants to be informed and to give consent, so that they are able to make a responsible and autonomous decision. However, the optimal timing of consent in clinical research during the intrapartum period remains controversial, and currently, there is no clear guidance.
We aimed to describe practices of informed consent in intrapartum care clinical research in the last three decades, as reported in uterotonics for postpartum haemorrhage prevention trials.
This is a secondary analysis of the studies included in the Cochrane review entitled “Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis” published in 2018. All the reports included in the Cochrane network meta-analysis were eligible for inclusion in this analysis, except for those reported in languages other than English, French or Spanish. We extracted and synthesized data on the time each of the components of the informed consent process occurred.
We assessed data from 192 studies, out of 196 studies included in the Cochrane review. The majority of studies (59.9%, 115 studies) reported that women were informed about the study, without specifying the timing. When reported, most studies informed women at admission to the facility for childbirth. Most of the studies reported that consent was sought, but only 59.9% reported the timing, which in most of the cases, was at admission for childbirth. Among these, 32 studies obtained consent in the active phase of labour, 17 in the latent phase and in 10 studies the labour status was unknown. Women were consented antenatally in 6 studies and in 8 studies the consent was obtained indistinctly during antenatal care or at admission. Most of the studies did not specified who was the person who sought the informed consent.
Practices of informed consent in trials on use of uterotonics for prevention of postpartum haemorrhage showed variability and substandard reporting. Informed consent sought at admission for childbirth was the most frequent approach implemented in these trials.

Assessing for Quality Informed Consent With Subjects Enrolling in Clinical Research

Assessing for Quality Informed Consent With Subjects Enrolling in Clinical Research
Laura R. Holtz
SAGE Research Methods Cases: Medicine and Health, 2020
Research subjects are asked to participate in the informed consent process before participating in research. The elements and regulatory requirements of informed consent are well documented. However, there is less known about the quality of informed consent discussions that are occurring with potential subjects. There is evidence that these discussions may be lacking in quality to effectively meet the intended goals. Research professionals may need additional training, skills, and tools to help increase subject’s understanding of informed consent. It is necessary to identify the characteristics of quality informed consent. In addition, tools and strategies, such as Teach Back and Documentation of Informed Consent process, can be utilized to operationalize the assessment of understanding when conducting informed consent. Quality may lead to increased engagement and compliance with study protocols and reductions in subject withdrawals. Both research staff and participants will benefit with increased confidence by addressing quality in informed consent.

Assessing readability and comprehension of informed consent materials for medical device research: A survey of informed consents from FDA’s Center for Devices and Radiological Health

Assessing readability and comprehension of informed consent materials for medical device research: A survey of informed consents from FDA’s Center for Devices and Radiological Health
Fabienne Santel, Isatu Bah, Katherine Kim, Ja-An Lin, Jack McCracken, Adaeze Teme
Contemporary Clinical Trials, October 2019; 85
Legally effective informed consent has been a long-standing requirement for FDA-regulated clinical studies. However, informed consent forms (ICFs) are often thought to be too long, too complex, and too difficult for participants to understand. In this article, investigators from the FDAs Center for Devices and Radiological Health (CDRH) surveyed 399 ICFs from approved investigational device exemption (IDE) applications for fiscal years 2015 and 2016 to evaluate the readability of ICFs.

The investigators collected data from the ICFs, using variables related to structure, readability, and comprehension.

The investigators found that the mean grade-reading levels of the ICFs ranged from 10th grade to college level (Table 2), higher than the recommended 6th to 8th grade level, when measured by major readability evaluation tools (the SMOG readability grade level formula, the Flesch-Kincaid Index Grade Level Readability Formula, the Flesch Reading Ease test, and the Dale-Chall readability formula).

Overall, the ICFs and informed consent (IC) processes, as described in the IDE application, lacked components that enhanced participants’ comprehension, such as short sentences (e.g., no more than 8 to 10 to words) and the use of pictures, tables, and diagrams.

CDRH investigators believe that information about ICFs’ readability, comprehension, and structure will help support current and future efforts to improve the IC process. The intent of the article is to demonstrate that improvements are needed in the IC process and to encourage clinical trial stakeholders to consider implementing those approaches that optimize patient comprehension in the development of their IC processes.

Electronic Informed Consent in Clinical Research

Electronic Informed Consent in Clinical Research
White Paper
Medidata, 2019
Open Access
Executive Summary
Medidata is conducting a study to understand the regulatory positions, adoption and the variability regarding electronic informed consent (eConsent) around the world. This exercise has come about due to the extensive number of regulatory relevant inquiries Medidata gets from sponsors and organizations managing trials in research. The life science industry is keen to have the option to leverage electronic means for consenting trial participants but are uncertain of the regulatory positions on the topic. The only way to seek clarity on this topic was to directly engage with relevant authorities.

The study initially focused on the countries in the European geographic region but has evolved to other regions including Asia Pacific and the Americas. The study prioritized countries where there was an aspiration to utilize electronic informed consent by organizations running clinical trials…

Ethics and access when consent must come first [BOOK CHAPTER]

Ethics and access when consent must come first [BOOK CHAPTER]
Hugh Busher, Alison Fox
Implementing Ethics in Educational Ethnography
Taylor & Francis, 2019; Chapter 4
Open Access
Formalised procedures to obtain and document informed consent from research participants are at the heart of the shift from informal to formalised research ethics. Critiques claim that the requirements to obtain consent from all potential participants before the onset of a study will make it impossible to do ethnographic research and participant observation in institutional settings such as schools. Drawing on experiences from an ethnographic research project in secondary schools in Norway, the aim of this chapter is to discuss the ethical considerations and, embedded in these, the methodological and analytical challenges involved in doing participant observation in schools where not all pupils and parents have consented to participation in the research. The chapter suggests possible ways forward for tackling these challenges for ethnographic researchers working in schools.

A ResearchKit app to deliver paediatric electronic consent: Protocol of an observational study in adolescents with arthritis

A ResearchKit app to deliver paediatric electronic consent: Protocol of an observational study in adolescents with arthritis
Research Paper
Chitra Lalloo, Quynh Pham, Joseph Cafazzo, Elizabeth Stephenson, Jennifer Stinson
Contemporary Clinical Trials Communications, 14 January 2020
Open Access
ResearchKit is an open-source software framework designed to streamline the process of screening and consenting participants into research studies. By digitizing traditionally analog processes, ResearchKit has potential to increase the reach, efficiency, and scalability of mobile health (mHealth) research. The model has been successfully applied in adult settings. However, to our knowledge, no group has sought to adapt ResearchKit for a pediatric research environment in Canada. The potential benefits for building paediatric mHealth apps compatible with remote eConsent are numerous: (1) access to studies can be broadened from small groups of children and families who live in close proximity to research sites to whole populations across geographical boundaries, (2) increased convenience for study participants because they can complete consent on their smartphone from their home, rather than in person or on paper, and (3) large-scale study enrollment can be conducted with fewer resources than traditional face-to-face methods. We describe the rationale and design of a proof-of-concept observational study focused on implementing remote eConsent in a Canadian pediatric population. A community-based sample of adolescents with arthritis will be remotely onboarded to use the iCanCope pain self-management app for 8-weeks. Outcomes will focus on: (1) fidelity and acceptability of the eConsent process, (2) fidelity of the iCanCope app in terms of engagement and acceptability, (3) participant study experience including level of perceived support and acceptability of study tasks, and (4) clinical outcomes related to use of the iCanCope app over an 8-week period.