Quality of Informed Consent in Phase III Clinical Trials in Portugal: The Participants’ Perspective

Authors

  • Pedro L. Ferreira Centre for Health Studies and Research. Universidade de Coimbra. Coimbra. https://orcid.org/0000-0002-9448-9542
  • Ana Barradas Centre for Health Studies and Research. Universidade de Coimbra. Coimbra.
  • Inês Ribeiro Centre for Health Studies and Research. Universidade de Coimbra. Coimbra.

DOI:

https://doi.org/10.20344/amp.20570

Keywords:

Informed Consent, Clinical Trials, Phase III as Topic, Comprehension, Patient Reported Outcome Measures

Abstract

Introduction: Some studies show that participants do not always fully understand the informed consent form (ICF), which is one of the reasons for dropouts. This study aimed to adapt the Quality of Informed Consent (QuIC) questionnaire into a valid instrument to be applied to the Portuguese population and to measure its reliability and validity in the Portuguese population, by applying it to a sample of participants in controlled trials.
Methods: The QuIC questionnaire was developed to assess the quality of informed consent in clinical trials and consists of two parts, addressing both the objective (part A) and the subjective (part B) understanding. After being translated and validated into Portuguese, it was implemented in 100 cardiac participants of phase III clinical trials in a University Hospital Center.
Results: The QuIC-PT questionnaire showed excellent stability over time and good validity. All patients evaluated their participation and their health positively and recognized the main purpose of the clinical trial. Almost all participants understood their role in helping future patients and the purpose of the trial and realized that, by signing the ICF, they were participating in a clinical trial. However, none of them knew that their experimental treatment was not proven to be the best alternative for their condition.
Conclusion: The QuIC-PT questionnaire seems to be a valid and useful instrument to evaluate the participants’ understanding of the ICF. In this study, we found that some concepts, like ‘study protocol’ or ‘randomization’, were not well understood by participants when signing the ICF, especially by participants with lower education levels. They also believed that the experimental intervention would solve their health condition. Greater awareness about the importance of the informed consent process and ICF is necessary so that participants can fully understand the protocol, especially the risks involved, and their rights as participants.

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References

Comissão de Ética para a Investigação Clínica. Dados estatísticos globais do ano 2022. 2022. [cited 2023 May 24]. Available from: https://www.ceic.pt/indicadores-ceic.

Dankar FK, Gergely M, Dankar SK. Informed consent in biomedical research. Comput Struct Biotechnol J. 2019;17:463-74. DOI: https://doi.org/10.1016/j.csbj.2019.03.010

European Medicines Agency. Guideline for good clinical practice E6 (R2). 2016. [cited 2023 May 24]. Available from: https://www.ema.europa.eu/en/iche6-r2-good-clinical-practice-scientific-guideline.

Nelson-Marten P, Rich BA. A historical perspective of informed consent in clinical practice and research. Semin Oncol Nurs. 1999;15:81-8. DOI: https://doi.org/10.1016/S0749-2081(99)80065-5

Beauchamp TL. Informed consent: its history, meaning, and present challenges. Camb Q Healthc Ethics. 2011;20:515-23. DOI: https://doi.org/10.1017/S0963180111000259

Portugal. Decree-Law no. 73/2015. Official Gazette, I Series, no. 144 (2015/07/27). p.5027-8.

Jenkins V, Fallowfield L. Reasons for accepting or declining to participate in randomized clinical trials for cancer therapy. Br J Cancer. 2000;82:1783-8. DOI: https://doi.org/10.1054/bjoc.2000.1142

Grand MM, O’Brien PC. Obstacles to participation in randomised cancer clinical trials: a systematic review of the literature. J Med Imaging Radiat Oncol. 2012;56:31-9. DOI: https://doi.org/10.1111/j.1754-9485.2011.02337.x

Krieger JL, Neil JM, Strekalova YA, Sarge MA. Linguistic strategies for improving informed consent in clinical trials among low health literacy patients. J Natl Cancer Inst. 2016;109:djw233. DOI: https://doi.org/10.1093/jnci/djw233

Montalvo W, Larson E. Participant comprehension of research for which they volunteer: a systematic review. J Nurs Scholarsh. 2014;46:423-31. DOI: https://doi.org/10.1111/jnu.12097

Kotz D, Viechtbauer W, Spigt M, Crutzen R. Details about informed consent procedures of randomized controlled trials should be reported transparently. J Clin Epidemiol. 2019;109:133-5. DOI: https://doi.org/10.1016/j.jclinepi.2019.01.007

Beskow LM, Weinfurt KP. Exploring understanding of “understanding”: the paradigm case of biobank consent comprehension. Am J Bioeth. 2019;19:6-18. DOI: https://doi.org/10.1080/15265161.2019.1587031

Ruiz de Hoyos M, Villamañán-Bueno E, Fernández de Uzquiano E, Gómez-Salcedo P, Río-Durango M, Frías-Iniesta J. Informed consent process in clinical trials: development of a patient-reported questionnaire. Farm Hosp. 2020;44:254-71.

Cohn EG, Jia H, Smith WC, Erwin K, Larson EL. Measuring the process and quality of informed consent for clinical research: development and testing. Oncol Nurs Forum. 2011;38:417-22. DOI: https://doi.org/10.1188/11.ONF.417-422

Joffe S, Cook EF, Cleary PD, Clark JW, Weeks JC. Quality of informed consent: a new measure of understanding among research subjects. J Natl Cancer Inst. 2001;93:139-47. DOI: https://doi.org/10.1093/jnci/93.2.139

Sreenivasan G. Does informed consent to research require comprehension? Lancet. 2003;362:2016-8. DOI: https://doi.org/10.1016/S0140-6736(03)15025-8

Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for translation and cultural adaptation. Value Health. 2005;8:94-104. DOI: https://doi.org/10.1111/j.1524-4733.2005.04054.x

Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155-63. DOI: https://doi.org/10.1016/j.jcm.2016.02.012

Terwee CB, Bot SD, Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34-42. DOI: https://doi.org/10.1016/j.jclinepi.2006.03.012

Atal S, Dunne F. Assessment of the understanding of informed consent including participants’ experiences, and generation of a supplemental consent decision aid for gestational diabetes mellitus (GDM) research. HRB Open Res. 2018;1:12. DOI: https://doi.org/10.12688/hrbopenres.12811.1

Cotrim H, Granja C, Carvalho AS, Cotrim C, Martins R. Children’s understanding of informed assents in research studies. Healthcare. 2021;9:871. DOI: https://doi.org/10.3390/healthcare9070871

Gupta UC. Informed consent in clinical research: revisiting few concepts and areas. Perspectives Clin Res. 2013;4:26-32. DOI: https://doi.org/10.4103/2229-3485.106373

Nishimura A, Carey J, Erwin PJ, Tilburt JC, Hassan Murad H, McCormick JB, et al. Improving understanding in the research informed consent process: a systematic review of 54 interventions tested in randomized control trials. BMC Med Ethics. 2013;14:28. DOI: https://doi.org/10.1186/1472-6939-14-28

Flory J, Emanuel E. Interventions to improve research participants’ understanding in informed consent for research: a systematic review. JAMA. 2004;292:13. DOI: https://doi.org/10.1001/jama.292.13.1593

Ittenbach RF, Gaynor JW, Dorich JM, Burnham NB, Huang G, Harvey MT, et al. uConsent: addressing the gap in measuring understanding of informed consent in clinical research. Clin Transl Sci. 2023;16:2530-42. DOI: https://doi.org/10.1111/cts.13645

Direção-Geral da Saúde. Programa Nacional para as Doenças Cérebro-Cardiovasculares. 2017. [cited 2023 May 24]. Available from: https://www.chlc. min-saude.pt/wp-content/uploads/sites/3/2017/10/DGS_PNDCCV_VF.pdf.

Published

2024-07-19

How to Cite

1.
L. Ferreira P, Barradas A, Ribeiro I. Quality of Informed Consent in Phase III Clinical Trials in Portugal: The Participants’ Perspective. Acta Med Port [Internet]. 2024 Jul. 19 [cited 2024 Aug. 31];:601-8. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/20570

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