Date post: | 16-Feb-2017 |
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Healthcare |
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NPRM • Broad consent for future, unlimited
research
• Increase investigator independence
• Surprising, less attention given to:
– Transparency
– Trust
– Partnership – (Grady et al., 2015)
Federal Regulations
• Broad consent for future purposes
– NIH Genomic Data Sharing Policies
– HIPPA 2013 amendment
• For the most part, minimal risk research
• However, informed consent is not
engaged in a meaningful manner
Informed Consent
• Informed consent is the cornerstone for the ethical conduct of research
– Yet, it is seriously flawed
• Clinical informed consent for study specific research over 45 year period (Falagas et al., 2009)
• 54% understood aims
• 50% understood randomization and risks
• 47% knew participation was voluntary
• 44% knew they could withdrawal
• 57% understood the benefits
Promote Comprehension
• Multimedia
• Simplified paper based forms
• Teach Back
• Comprehension quizzes
Challenges to Broad Consent
• Clinical Setting
– Not the best time
– Conflicting consent choices
• Limited Public Knowledge about
Research (Rothwell et al., 2012; Botkin et al., 2014)
• Unknown future research uses
Participant Comprehension
• Should continue, but if we are concerned
with
– Public Trust
– Improving safeguards/confidentiality
– Partnership
• Should we focus on the investigator’s
responsibilities’ too?
Commitment Letter/Oath
• FDA has required an Investigator
Commitment Letter for decades (www.fda.gov)
• I agree to conduct the study(ies) in accordance with the relevant, current
protocol(s) and will only make changes in a protocol after notifying the
sponsor, except when necessary to protect the safety, rights, or welfare
of subjects
• I agree to personally conduct or supervise the described investigation(s).
• I agree to inform any patients, or any persons used as controls, that the
drugs are being used for investigational purposes and I will ensure that
the requirements relating to obtaining informed consent in 21 CFR Part
50 and institutional review board (IRB) review and approval in 21 CFR
Part 56 are met.
Questions
• What can improve safeguards of
biospecimen research?
• What can improve confidentiality?
• What can improve privacy?
• What can help with public trust?
• What can help build partnerships?
Culture of Investigator Research
with Biospecimens • Communicating to research subjects
about how investigators are committed to
responsibly use biospecimens may help
promote transparency and trust with
research subjects.
Methods
• Purpose
– Broad consent
– Oath/Commitment letter
• Qualitative Descriptive Interviews (n =18)
– Intermountain West
Methods
• Conducting in person and over the
telephone
• Interviews ranged from 15-50 minutes
• September 2015
• Notes and written summaries uploaded
into Atlas.ti (Fasick, 2001; Halcomb & Davidson, 2006)
Results
• moving purpose of consent;
• awareness and accountability;
• gray areas;
• comparisons to clinical care; and
• components of investigator oath.
Moving Purpose of Consent
• Changing interpretations of IRBs – We wrote in our consent form ‘researching genes’
and few years later they did not think that included
‘sequencing genes.’
• Hard to comprehend “unlimited” – Its scary because it’s unlimited, how do you
communicate that
• Difficulties of practical implementation in
the clinical setting
Moving Purpose of Consent
• Gives the option to say no or seek more
information
– Is broad consent trust in the regulatory
process? Is it trust in the investigator? Or is
just to give the option to say no?
Awareness and Accountability
with Oath • Gives awareness to research subjects
and investigators
– It will bring awareness so I guess that helps
with trust
• Tells research subjects you are doing this
for the right reason
– Have to let them know you are doing this for
the right reasons
Awareness and Accountability
with Oath • Unsure about improving trust
• Investigator accountability – Too many [investigators] have done things wrong
and that is just the ones we know about
– Not vouch for other investigator behavior
– To drop the hammer on questionable behavior
• Promotes respect of donations among
investigators
– Investigators do not appreciate the donation
Quotes Questioning Oath
• An oath would raise suspicious
• [Investigators are] trying to do the right
thing
• Another hoop to jump through
Gray Areas
• No definitive right or wrong answers
– There are such grey areas with research with
biospecimens.
– PhDs have no oath so they have to do what
they think or hope is right
• Investigator independence
– A lot of independence
– Integrity of the investigator is essential
Gray Areas
• Rapid changes in genomics and
technology
– Fluid is the definition of investigator research
– Need to stop and think about each case
individually the next time you use them
Comparisons to Clinical Care • Different but similar to clinical care
– Dealing with DNA not patients
– I’m not a physician, I’m a researcher.
• Their research may have implications for
individual health
– An investigator might have to wait five years
to see the outcomes of their research but it
might still yield life saving information
• Lack a relationship with research subject
Components of an Oath
• Transparency
• Awareness about the importance
• Respect to research subjects/donors
• Communication practices
• Safeguards
• Risks/Benefits/Examples
General Conclusions
• Investigator oath well received
• Transparency trust
• Accountability trust
• Changing nature of biospecimen research
– From broad societal impact to also include
individual impact
• Changing perception of research by the
public
• Efforts to promote research subjects’
comprehension should continue
Investigator Oath
• Do you really think an oath will work?
• Can it hurt?
• Should participants be aware of the oath?
• Is there another approach?
• Example of HIPPA
– Could we apply lessons learned?
FDA Investigator Commitment
Letter • I agree to conduct the study(ies) in accordance with the relevant,
current protocol(s) and will only make changes in a protocol after notifying the sponsor, except when necessary to protect the safety, rights, or welfare of subjects
• I agree to personally conduct or supervise the described investigation(s).
• I agree to inform any patients, or any persons used as controls, that the drugs are being used for investigational purposes and I will ensure that the requirements relating to obtaining informed consent in 21 CFR Part 50 and institutional review board (IRB) review and approval in 21 CFR Part 56 are met.
• I agree to report to the sponsor adverse experiences that occur in the course of the investigation(s) in accordance with 21 CFR 312.64. I have read and understand the information in the investigator’s brochure, including the potential risks and side effects of the drug.
FDA Investigator Commitment
Letter continued • I agree to ensure that all associates, colleagues, and employees
assisting in the conduct of the study(ies) are informed about their obligations in meeting the above commitments.
• I agree to maintain adequate and accurate records in accordance with 21 CFR 312.62 and to make those records available for inspection in accordance with 21 CFR 312.68.
• I will ensure that an IRB that complies with the requirements of 21 CFR Part 56 will be responsible for the initial and continuing review and approval of the clinical investigation. I also agree to promptly report to the IRB all changes in the research activity and all unanticipated problems involving risks to human subjects or others. Additionally, I will not make any changes in the research without IRB approval, except where necessary to eliminate apparent immediate hazards to human subjects.
• I agree to comply with all other requirements regarding the obligations of clinical investigators and all other pertinent requirements in 21 CFR Part 312.
Transparency and Awareness:
• to respect your donation to science by
allowing use of your biospecimen in
research.
• to respect your biospecimen as a limited
resource and use it wisely and carefully.
• to be open and transparent about
research with your biospecimen.
Respect to Donors/ Investigator
Promises • to appreciate the your donation for research and science in
general.
• to use the biospecimen in thoughtful and well-designed research in order to improve the well being of our society and health.
• to use the biospecimen only in research that is well designed and intended to have a benefit to society.
• to remember this is a donation from a person and not just data.
• to conduct research with this donation to improve health and prevent disease.
• to respect that all achievements in health and science are the result of previous work of others who have conducted beneficial and thoughtful research and to try to continue to build upon this knowledge for the health care of our society.
Communication
• to acknowledge that although research is
to improve health in general, there may
be times when it impacts your individual
health.
• to publish results for other investigators to
learn and build upon for future research.
Safeguards
• to adhere to all privacy, ethical and
confidential safeguards that are in place
for this research.
• to seek approval for my research from
appropriate institutional, ethics, or
governing committees before beginning
research
Risks and Benefits/Example of
Importance • to remember that there are some risks with
this donation and to seek to minimize these risks
• to not release the biospecimen donation to anyone who does not have appropriate approval and who would not adhere to the ethical standards in this oath.
• 16. to seek help when needed if I am unsure about the integrity of the research or the welfare of the donors.