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Mrisho M, Essack Z. Understanding Constraints and Enablers of Turnaround Time for Ethics Review: The Case of Institutional Review Boards in Tanzania. J Empir Res Hum Res Ethics 2021; 16:514-524. [PMID: 34180729 PMCID: PMC8530844 DOI: 10.1177/15562646211026855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Independent ethics review of research is required prior to the implementation of all health research involving human participants. However, ethics review processes are challenged by protracted turnaround times, which may negatively impact the implementation of socially valuable research. Previous research has documented delays in ethics review in developed and developing countries. This study aimed to determine the extent of variability in turnaround times for protocol review among different institutional review boards (IRBs) within Tanzania. Methods. This descriptive cross-sectional study employed a mixed-method approach, with qualitative and quantitative components. Seven IRBs were purposively sampled from the 15 accredited IRBs operational in Tanzania during the study period, April 2017-April 2018. Quantitative data were analysed using STATA software and qualitative data were analysed thematically. Results. The median time for review across all IRBs was 32 days, with a range of 1-396 days. Qualitative results identified five key themes related to turnaround time from interviews with participants. These included: (1) procedures for receiving and distribution of protocols, (2) number of reviewers assigned to protocols, (3) duration of reviewing protocols, (4) reasons for delayed feedback, and (5) training of research ethics committee members. Conclusion. The study showed that the median days for ethical approval in Tanzania was 32 days. We observed from this study that electronic submission systems facilitated faster turnaround times. Failure to adhere to the submission checklists and guidelines was a major obstacle to the turnaround time.
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Affiliation(s)
- Mwifadhi Mrisho
- Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania
- University of KwaZulu-Natal, School of Applied Human Sciences, Psychology. Private Bag X01, Scottsville 3209, Pietermaritzburg, South Africa
| | - Zaynab Essack
- University of KwaZulu-Natal, School of Applied Human Sciences, Psychology. Private Bag X01, Scottsville 3209, Pietermaritzburg, South Africa
- Centre for Community-Based Research, Human and Social Capabilities Division, Human Sciences Research Council, South Africa
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Scott AM, Kolstoe S, Ploem MCC, Hammatt Z, Glasziou P. Exempting low-risk health and medical research from ethics reviews: comparing Australia, the United Kingdom, the United States and the Netherlands. Health Res Policy Syst 2020; 18:11. [PMID: 31992320 PMCID: PMC6986069 DOI: 10.1186/s12961-019-0520-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disproportionate regulation of health and medical research contributes to research waste. Better understanding of exemptions of research from ethics review in different jurisdictions may help to guide modification of review processes and reduce research waste. Our aim was to identify examples of low-risk human health and medical research exempt from ethics reviews in Australia, the United Kingdom, the United States and the Netherlands. METHODS We examined documents providing national guidance on research ethics in each country, including those authored by the National Health and Medical Research Council (Australia), National Health Service (United Kingdom), the Office for Human Research Protections (United States) and the Central Committee on Research Involving Humans (the Netherlands). Examples and types of research projects exempt from ethics reviews were identified, and similar examples and types were grouped together. RESULTS Nine categories of research were exempt from ethics reviews across the four countries; these were existing data or specimen, questionnaire or survey, interview, post-marketing study, evaluation of public benefit or service programme, randomised controlled trials, research with staff in their professional role, audit and service evaluation, and other exemptions. Existing non-identifiable data and specimens were exempt in all countries. Four categories - evaluation of public benefit or service programme, randomised controlled trials, research with staff in their professional role, and audit and service evaluation - were exempted by one country each. The remaining categories were exempted by two or three countries. CONCLUSIONS Examples and types of research exempt from research ethics reviews varied considerably. Given the considerable costs and burdens on researchers and ethics committees, it would be worthwhile to develop and provide clearer guidance on exemptions, illustrated with examples, with transparent underpinning rationales.
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Affiliation(s)
- Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
| | | | | | - Zoë Hammatt
- Z Consulting LLC, Denver, USA.,John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD, 4226, Australia
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Linden JA, Schneider JI, Cotter A, Drexel S, Frosch E, Martin ND, Canavan C, Holtman M, Mitchell PM, Feldman JA. Variability in Institutional Board Review for a Multisite Assessment of Resident Professionalism. J Empir Res Hum Res Ethics 2019; 14:117-125. [DOI: 10.1177/1556264619831895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Residents serve as both trainees and employees and can be considered potentially vulnerable research participants. This can lead to variation in the institutional review board (IRB) review. We studied sites participating in the Assessment of Professional Behaviors Study sponsored by the National Board of Medical Examiners (2009-2011). Of the 19 sites, all but one were university affiliated. IRB review varied; 2/19 did not submit to a local IRB, 4/17 (23%) were exempt, 11/17 (65%) were expedited, and 2/17 (12%) required full Board review; 12/17 (71%) required written informed consent. The interval from submission to approval was 1 to 2 months (8/17); the range was 1 to 7 months. Although most stated there were no major barriers to approval, the most common concern was resident coercion and loss of confidentiality. Local IRB review of this educational research study varied.
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Affiliation(s)
- Judith A. Linden
- Boston Medical Center, MA, USA
- Boston University School of Medicine, MA, USA
| | | | - Andrea Cotter
- Boston Medical Center, MA, USA
- Boston University School of Medicine, MA, USA
| | - Sabrina Drexel
- Boston Medical Center, MA, USA
- Boston University School of Medicine, MA, USA
| | - Emily Frosch
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - James A. Feldman
- Boston Medical Center, MA, USA
- Boston University School of Medicine, MA, USA
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Petrova M, Barclay S. Research approvals iceberg: how a 'low-key' study in England needed 89 professionals to approve it and how we can do better. BMC Med Ethics 2019; 20:7. [PMID: 30678668 PMCID: PMC6346542 DOI: 10.1186/s12910-018-0339-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The red tape and delays around research ethics and governance approvals frequently frustrate researchers yet, as the lesser of two evils, are largely accepted as unavoidable. Here we quantify aspects of the research ethics and governance approvals for one interview- and questionnaire-based study conducted in England which used the National Health Service (NHS) procedures and the electronic Integrated Research Application System (IRAS). We demonstrate the enormous impact of existing approvals processes on costs of studies, including opportunity costs to focus on the substantive research, and suggest directions for radical system change. MAIN TEXT We have recorded 491 exchanges with 89 individuals involved in research ethics and governance approvals, generating 193 pages of email text excluding attachments. These are conservative estimates (e.g. only records of the research associate were used). The exchanges were conducted outside IRAS, expected to be the platform where all necessary documents are provided and questions addressed. Importantly, the figures exclude the actual work of preparing the ethics documentation (such as the ethics application, information sheets and consent forms). We propose six areas of work to enable system change: 1. Support the development of a broad range of customised research ethics and governance templates to complement generic, typically clinical trials orientated, ones; 2. Develop more sophisticated and flexible frameworks for study classification; 3. Link with associated processes for assessment, feedback, monitoring and reporting, such as ones involving funders and patient and public involvement groups; 4. Invest in a new generation IT infrastructure; 5. Enhance system capacity through increasing online reviewer participation and training; and 6. Encourage researchers to quantify the approvals processes for their studies. CONCLUSION Ethics and governance approvals are burdensome for historical reasons and not because of the nature of the task. There are many opportunities to improve their efficiency and analytic depth in an age of innovation, increased connectivity and distributed working. If we continue to work under current systems, we are perpetuating, paradoxically, an unethical system of research approvals by virtue of its wastefulness and impoverished ethical debate.
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Affiliation(s)
- Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
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Shoenbill K, Song Y, Cobb NL, Drezner MK, Mendonca EA. IRB Process Improvements: A Machine Learning Analysis. J Clin Transl Sci 2017; 1:176-183. [PMID: 29082031 PMCID: PMC5647673 DOI: 10.1017/cts.2016.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Clinical research involving humans is critically important, but it is a lengthy and expensive process. Most studies require institutional review board (IRB) approval. Our objective is to identify predictors of delays or accelerations in the IRB review process and apply this knowledge to inform process change in an effort to improve IRB efficiency, transparency, consistency and communication. METHODS We analyzed timelines of protocol submissions to determine protocol or IRB characteristics associated with different processing times. Our evaluation included single variable analysis to identify significant predictors of IRB processing time and machine learning methods to predict processing times through the IRB review system. Based on initial identified predictors, changes to IRB workflow and staffing procedures were instituted and we repeated our analysis. RESULTS Our analysis identified several predictors of delays in the IRB review process including type of IRB review to be conducted, whether a protocol falls under Veteran's Administration purview and specific staff in charge of a protocol's review. CONCLUSIONS We have identified several predictors of delays in IRB protocol review processing times using statistical and machine learning methods. Application of this knowledge to process improvement efforts in two IRBs has led to increased efficiency in protocol review. The workflow and system enhancements that are being made support our four-part goal of improving IRB efficiency, consistency, transparency, and communication.
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Affiliation(s)
- Kimberly Shoenbill
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Yiqiang Song
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Nichelle L. Cobb
- Human Subjects, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Marc K. Drezner
- Institute for Clinical and Translational Research, University of Wisconsin–Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
| | - Eneida A. Mendonca
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Institute for Clinical and Translational Research, University of Wisconsin–Madison, Madison, WI, USA
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
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Huser V, Cimino JJ. Impending Challenges for the Use of Big Data. Int J Radiat Oncol Biol Phys 2015; 95:890-894. [PMID: 26797535 DOI: 10.1016/j.ijrobp.2015.10.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Vojtech Huser
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland.
| | - James J Cimino
- Informatics Institute, University of Alabama at Birmingham, Birmingham, Alabama
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