An effective multisource informed consent procedure for research and clinical practice: an observational study of patient understanding and awareness of their roles as research stakeholders in a cancer biobank

BackgroundEfforts to improve patients’ understanding of their own medical treatments or research in which they are involved are progressing, especially with regard to informed consent procedures. We aimed to design a multisource informed consent procedure that is easily adaptable to both clinical and research applications, and to evaluate its effectiveness in terms of understanding and awareness, even in less educated patients.MethodsWe designed a multisource informed consent procedure for patients’ enrolment in a Cancer Institute Biobank (CRO-Biobank). From October 2009 to July 2011, a total of 550 cancer patients admitted to the Centro di Riferimento Oncologico IRCCS Aviano, who agreed to contribute to its biobank, were consecutively enrolled. Participants were asked to answer a self-administered questionnaire aim at exploring their understanding of biobanks and their needs for information on this topic, before and after study participation. Chi-square tests were performed on the questionnaire answers, according to gender or education.ResultsOf the 430 patients who returned the questionnaire, only 36.5% knew what a biobank was before participating in the study. Patients with less formal education were less informed by some sources (the Internet, newspapers, magazines, and our Institute). The final assessment test, taken after the multisource informed consent procedure, showed more than 95% correct answers. The information received was judged to be very or fairly understandable in almost all cases. More than 95% of patients were aware of participating in a biobank project, and gave helping cancer research (67.5%), moral obligation, and supporting cancer care as main reasons for their involvement.ConclusionsOur multisource informed consent information system allowed a high rate of understanding and awareness of study participation, even among less-educated participants, and could be an effective and easy-to-apply model for others to consider to contribute to a well-informed decision making process in several fields, from clinical practice to research.Further studies are needed to explore the effects on the study comprehension by each source of information, and by other sources suggested by participants in the questionnaire.

[1]  A. Casebeer,et al.  Public participation in regional health policy: a theoretical framework. , 2005, Health policy.

[2]  Catherine A McCarty,et al.  Study newsletters, community and ethics advisory boards, and focus group discussions provide ongoing feedback for a large biobank , 2011, American journal of medical genetics. Part A.

[3]  P. Maguire,et al.  Improving communication with cancer patients. , 1999, European journal of cancer.

[4]  Christiane,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2004, Journal international de bioethique = International journal of bioethics.

[5]  M. Hansson,et al.  Building on relationships of trust in biobank research , 2005, Journal of Medical Ethics.

[6]  S. McCormick,et al.  Public Involvement in Breast Cancer Research: An Analysis and Model for Future Research , 2004, International journal of health services : planning, administration, evaluation.

[7]  G. Laurie Evidence of support for biobanking practices , 2008, BMJ : British Medical Journal.

[8]  L. Nisticò,et al.  Research understanding, attitude and awareness towards biobanking: a survey among Italian twin participants to a genetic epidemiological study , 2009, BMC medical ethics.

[9]  Kathy Hudson,et al.  Subjects matter: a survey of public opinions about a large genetic cohort study , 2008, Genetics in Medicine.

[10]  H. G. van der Poel,et al.  A trial of consent procedures for future research with clinically derived biological samples , 2009, British Journal of Cancer.

[11]  Joanna Goven Assessing genetic testing: who are the "lay experts"? , 2008, Health policy.

[12]  S. Patterson,et al.  The value of banked samples for oncology drug discovery and development. , 2011, Journal of the National Cancer Institute. Monographs.

[13]  F. Perrone,et al.  Informed versus randomised consent to clinical trials , 1995, The Lancet.

[14]  K. Muto,et al.  Awareness and motivation of Japanese donors of blood for research. , 1999, American journal of public health.

[15]  C. Tempfer,et al.  Consumer participation and organizational development in health care: a systematic review , 2011, Wiener klinische Wochenschrift.

[16]  J. Meningaud,et al.  Bio-libraries and DNA storage: assessment of patient perception of information. , 2001, Medicine and law.

[17]  Matthew E Falagas,et al.  Informed consent: how much and what do patients understand? , 2009, American journal of surgery.

[18]  Martin Lupton,et al.  Informed consent: can a patient ever be fully informed? , 2005, Current opinion in obstetrics & gynecology.

[19]  N. N. Available World medical association declaration of Helsinki , 2000, Chinese Journal of Integrative Medicine.

[20]  Joan Scott,et al.  Public opinion about the importance of privacy in biobank research. , 2009, American journal of human genetics.

[21]  Karen M Kaphingst,et al.  Views of female breast cancer patients who donated biologic samples regarding storage and use of samples for genetic research , 2006, Clinical genetics.

[22]  E F Cook,et al.  Quality of informed consent: a new measure of understanding among research subjects. , 2001, Journal of the National Cancer Institute.

[23]  C. Lidz The therapeutic misconception and our models of competency and informed consent. , 2006, Behavioral sciences & the law.

[24]  J. V. van Delden,et al.  Inclusion of Residual Tissue in Biobanks: Opt-In or Opt-Out? , 2012, PLoS biology.

[25]  Phyllis N Butow,et al.  Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology (DAS‐O) to identify shared decision making during treatment consultations , 2011, Health expectations : an international journal of public participation in health care and health policy.

[26]  J. Mancini,et al.  Consent for biobanking: assessing the understanding and views of cancer patients. , 2011, Journal of the National Cancer Institute.

[27]  J. Broerse,et al.  Patient involvement in a scientific advisory process: setting the research agenda for medical products. , 2012, Health policy.

[28]  J. Mancini,et al.  Contributing to research via biobanks: what it means to cancer patients , 2014, Health expectations : an international journal of public participation in health care and health policy.

[29]  James Flory,et al.  Interventions to improve research participants' understanding in informed consent for research: a systematic review. , 2004, JAMA.

[30]  L. Ursin Biobank research and the right to privacy , 2008, Theoretical medicine and bioethics.

[31]  B. Hadaschik,et al.  Two decades' experience with a prospective biobank for urologic oncology: research, clinical care, and the patients' view. , 2013, Urologic oncology.

[32]  P. Riegman,et al.  Biobanking residual tissues , 2011, Human Genetics.

[33]  G. Geller,et al.  Public perspectives on informed consent for biobanking. , 2009, American journal of public health.

[34]  G. Annas Globalized clinical trials and informed consent. , 2009, The New England journal of medicine.

[35]  Domján Andrea,et al.  World Medical Association Declaration of Helsinki (WMA) - Ethical principles for medical research involving human subjects , 2014 .

[36]  N. Aaronson,et al.  Opt-out plus, the patients’ choice: preferences of cancer patients concerning information and consent regimen for future research with biological samples archived in the context of treatment , 2008, Journal of Clinical Pathology.

[37]  K. Hodgkinson,et al.  Personal privacy, public benefits, and biobanks: a conjoint analysis of policy priorities and public perceptions , 2011, Genetics in Medicine.

[38]  J. Holland,et al.  Informed consent for investigational chemotherapy: patients' and physicians' perceptions. , 1984, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[39]  S. Eckstein Ethical principles for medical research involving human subjects. , 2001, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[40]  M. Gagnon,et al.  Introducing patients' and the public's perspectives to health technology assessment: A systematic review of international experiences , 2011, International Journal of Technology Assessment in Health Care.