Ethical review of research protocols: experience of a research ethics committee

Considerations of sex and gender dimensions by research ethics committees: a scoping review

Despite a growing consensus on the importance of integrating sex and gender in health research, research across disciplines continues to be conducted and reported without a gender focus. Research ethics committees (RECs) can play a particularly powerful role in identifying the gender gaps at an early stage of the development of research protocols. Their role is missing in the dialogue related to improving gender awareness and analysis in health research. A scoping review was conducted to examine the extent to which RECs discuss and consider the inclusion and analysis of sex and gender in health research and to examine the literature regarding the gender balance of RECs. The limited literature around gender and research ethics reveals the power and potential of RECs to ensure that gender dimensions are thoughtfully included in health research, and sheds light on the gaps that exist. These include an under-representation of women on RECs, a lack of awareness of the importance of gender-related aspects in health research and a paucity of gender-related training to RECs. Guidelines such as the Sex and Gender Equity in Research guidelines are required for RECs to strengthen the ways in which health research is gendered from conception of a research protocol to its publication.

The Multidimensional Nature of Research Ethics: Letters Issued by a French Research Ethics Committee Included Similar Proportions of Ethical and Scientific Queries

Debate is ongoing concerning the activities and functioning of Research Ethics Committees (REC), especially a possible science-or-ethics dichotomy in research ethics review. We retrospectively analyzed 145 letters issued by a French REC over 18 months. All queries were classified in three levels: qualification (definition of the problem), category (aggregation of broader topics) and finally fields (ethical, scientific, or administrative). Overall, 971 queries were identified, of which 407 (42%), 379 (39%), and 135 (14%) were deemed ethical, scientific, and administrative queries, respectively. The most frequent concern was about participants' information. The main influencing factor was the profession of the reporting readers-scientific queries were more frequently raised by a methodologist, whereas ethical queries were more frequently raised by an ethicist. These results indicate that research ethics review is a multidimensional task that should be considered a collaborative effort.

Fundamentos bioéticos que utilizan los comités de ética para la evaluación de investigaciones en seres humanos, en Antioquia

Los comités de ética de investigación (CEI) son grupos de carácter interdisciplinar encargados de la evaluación de proyectos de investigación en los cuales participan seres humanos directa o indirectamente. Los CEI tienen diferentes funciones, procedimientos y fundamentos, tanto nacionales como internacionales, bajo los cuales se rigen para llevar a cabo su función. El objetivo del proyecto es describir los fundamentos bioéticos que tienen en cuenta los CEI al momento de establecer los criterios de evaluación de un proyecto de investigación, para ello, se realizó una entrevista semiestructurada (encuesta) a un integrante o al CEI en pleno. Los resultados obtenidos muestran una diferencia en la aplicación de los fundamentos, que en algunos casos depende de si el CEI está o no certificado. Se encontró que los CEI no usan los mismos fundamentos porque los desconocen, no les aplican o lo hacen parcialmente. Se concluye que todos los CEI aplican la Resolución 008430 de 1993 para la evaluación, sin embargo, son flexibles en su aplicación porque esta no abarca la diversidad y complejidad de las investigaciones actuales, por lo que es urgente su actualización.

What are the most common reasons for return of ethics submissions? An audit of an Australian health service ethics committee

One of the key criticisms of the ethical review process is the time taken to decision, and associated resource use. A key source of delay is that most submissions are required to respond to at least one request for further information or clarification from the Human Research Ethics Committee (HREC). This study audited the request letters of a single Australian public health HREC using content analysis. Twenty-four submissions were analysed, including 355 individual request elements. Most submissions received a single request letter. There was a mean number of 14.2 (SD = 5.5) elements per letter for the first request and a mean of 2.1 (SD = 1.2) for subsequent requests. Administrative errors were the most common source of request for further information, occurring in all submissions. The second most common theme was the content of the Participant Information and Consent Form, occurring in 79% of submissions. Other common themes, present in over 50% of submissions, concerned: data collection and study procedures; general ethical considerations; recruitment and consent; site, setting or patient pool; research design and methodology; and data management and security. In terms of the general purpose of the HREC comments, 44% were direct corrections or specific requests for changes, 42% were asking for more information or clarification of existing information, and 14% were the HREC expressing concerns about an element of the study, without directly suggesting a change. Overall, the study provides some evidence to show that the quality of the submission (ensuring correct attachments, up to date documents, clear information etc.) could account for a significant proportion of the burden and delay associated with ethical review.

Insights into the perception that research ethics committees are a barrier to research with seriously ill children: A study of committee minutes and correspondence with researchers studying seriously ill children

BACKGROUND

Research ethics committees are commonly perceived as a 'barrier' to research involving seriously ill children. Researchers studying seriously ill children often feel that committees view their applications more harshly compared to applications for research with other populations. Whether or not this is the case in practice is unknown.

AIM

The aim of this study was to explore committees' concerns, expectations and decisions for research applications involving seriously ill children submitted for review in the United Kingdom.

DESIGN

Content analysis of committee meeting minutes, decision letters and researcher response letters.

SETTING/PARTICIPANTS

Chief investigators for National Institute of Health Research portfolio studies involving seriously ill children were contacted for permission to review their study documents.

RESULTS

Of the 77 applications included in this study, 57 received requests for revisions at first review. Committee expectations and concerns commonly related to participant information sheets, methodology, consent, recruitment or formatting. Changes were made to 53 of these studies, all of which were subsequently approved.

CONCLUSION

Our findings suggest that committees review applications for research involving seriously ill children with the same scrutiny as applications for research with other populations. Yet, the perception that committees act as a barrier to this type of research persists. We suggest that this perception remains due to other factors including, but not limited to, the high levels of formatting or administrative revisions requested by committees or additional study requirements needed for research involving children, such as multiple versions of consent forms or participant information sheets.

Research Ethics Committees’ Oversight of Biomedical Research in South Africa: A Thematic Analysis of Ethical Issues Raised During Ethics Review of Non-Expedited Protocols

In South Africa, biomedical research cannot commence until it has been reviewed and approved by a local research ethics committee (REC). There remains a dearth of empirical data on the nature and frequency of ethical issues raised by such committees. This study sought to identify ethical concerns typically raised by two South African RECs. Meeting minutes for 180 protocols reviewed between 2009 and 2014 were coded and analyzed using a preexisting framework. Results showed that the most frequent queries involved informed consent, respect for participants, and scientific validity. Interestingly, administrative issues (non-ethical) such as missing researchers’ CVs and financial contracts emerged more frequently than ethical questions such as favorable risk/benefit ratio and fair participant selection. Although not generalizable to all RECs, our data provide insights into two South African RECs’ review concerns. More education and awareness of the actual ethical issues typically raised by such committees might help improve review outcomes and relationships between researchers and RECs.

Consent requirements for research with human tissue: Swiss ethics committee members disagree

BACKGROUND

In Switzerland, research with identifiable human tissue samples, and/or its accompanying data, must be approved by a research ethics committee (REC) before it can be allowed to take place. However, as the demand for such tissue has rapidly increased in recent years, and biobanks have been created to meet these needs, committees have had to deal with a growing number of such demands. Detailed instructions for evaluating every kind of tissue request are scarce. Committees charged with evaluating research protocols therefore sometimes face uncertainty in their decision-making.

METHODS

We examine how a pool of Swiss REC members deal with a number of cases involving human tissue, in order to determine the standards they adhere to, and their understanding and implementation of existing laws and guidelines.

RESULTS

There is considerable divergence in the approaches and decisions of Swiss REC members regarding human tissue sample requests, particularly concerning the issue of informed consent. Despite recent trends towards less strict consent requirements for biosample research, many of our respondents continue to employ demanding standards for researchers. The question of informed consent, and the circumstances in which it is required, continues to result in differences of opinion.

CONCLUSIONS

While room for local and cultural interpretation is essential to the workings of an REC, misunderstanding of existing guidelines, or an absence of regulation in sensitive areas, will only lead to suboptimal functioning of the REC itself. Our data suggests that there is uncertainty and disagreement on the question of consent for human tissue sample, which existing laws and guidelines may not fully clarify. Methods to address these uncertainties should be implemented in order to ensure efficient and harmonious review of research protocols.

Decisions by Finnish Medical Research Ethics Committees: A Nationwide Study of Process and Outcomes

Review by research ethics committees (RECs) is the key in medical research regulation. Data from meeting notes and project summaries were abstracted from all projects submitted in 2002 (n = 1,004) and 2007 (n = 1,045) to the official medical RECs in Finland. Data from consecutive submissions were combined per project. When comparing RECs, logistic regression was used to adjust for application characteristics. The number of projects handled varied notably by REC. In the first handling, 85% of applications in 2002 and 77% in 2007 were approved, while 13% and 20% were tabled. For 61% of the projects, the review time was <30 days, 16% had >89 days, and 6% had 6 months or longer. The variation by REC in approval rates, number of handlings, or long review times was not explained by project characteristics. In the last handling, 94% of the projects in both years were approved or concluded not to need a statement from that REC. The most common reason for tabling or not approving an application was patient autonomy, usually centered on the patient leaflet. The next most common reasons were requests for further information and dissatisfaction with the scientific aspects of the project. The reasons classified as "ethics" in the narrow sense were rare. The REC focus was to assure that researchers follow the various rules on medical research and to improve the quality of research and project documents. REC considerations could be divided into decisions based on ethics and recommendations covering other aspects.

Shortcomings of protocols of drug trials in relation to sponsorship as identified by Research Ethics Committees: analysis of comments raised during ethical review

BACKGROUND

Submission of study protocols to research ethics committees (RECs) constitutes one of the earliest stages at which planned trials are documented in detail. Previous studies have investigated the amendments requested from researchers by RECs, but the type of issues raised during REC review have not been compared by sponsor type. The objective of this study was to identify recurring shortcomings in protocols of drug trials based on REC comments and to assess whether these were more common among industry-sponsored or non-industry trials.

METHODS

Retrospective analysis of 226 protocols of drug trials approved in 2010-2011 by three RECs affiliated to academic medical centres in The Netherlands. For each protocol, information on sponsorship, number of participating centres, participating countries, study phase, registration status of the study drug, and type and number of subjects was retrieved. REC comments were extracted from decision letters sent to investigators after review and were classified using a predefined checklist that was based on legislation and guidelines on clinical drug research and previous literature.

RESULTS

Most protocols received comments regarding participant information and consent forms (n = 182, 80.5%), methodology and statistical analyses (n = 160, 70.8%), and supporting documentation, including trial agreements and certificates of insurance (n = 154, 68.1%). Of the submitted protocols, 122 (54.0%) were non-industry and 104 (46.0%) were industry-sponsored trials. Non-industry trials more often received comments on subject selection (n = 44, 36.1%) than industry-sponsored trials (n = 18, 17.3%; RR, 1.58; 95% CI, 1.01 to 2.47), and on methodology and statistical analyses (n = 95, 77.9% versus n = 65, 62.5%, respectively; RR, 1.18; 95% CI, 1.01 to 1.37). Non-industry trials less often received comments on supporting documentation (n = 72, 59.0%) than industry-sponsored trials (n = 82, 78.8%; RR, 0.83; 95% CI, 0.72 to 0.95).

CONCLUSIONS

RECs identified important ethical and methodological shortcomings in protocols of both industry-sponsored and non-industry drug trials. Investigators, especially of non-industry trials, should better prepare their research protocols in order to facilitate the ethical review process.