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Solorzano-Barrera C, Rodriguez-Patarroyo M, Tórres-Quintero A, Guzman-Tordecilla DN, Franco-Rodriguez AN, Maniar V, Shrestha P, Vecino-Ortiz AI, Pariyo GW, Gibson DG, Ali J. Recruiting hard-to-reach populations via respondent driven sampling for mobile phone surveys in Colombia: a qualitative study. Glob Health Action 2024; 17:2297886. [PMID: 38205794 PMCID: PMC10786427 DOI: 10.1080/16549716.2023.2297886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Uptake of mobile phone surveys (MPS) is increasing in many low- and middle-income countries, particularly within the context of data collection on non-communicable diseases (NCDs) behavioural risk factors. One barrier to collecting representative data through MPS is capturing data from older participants.Respondent driven sampling (RDS) consists of chain-referral strategies where existing study subjects recruit follow-up participants purposively based on predefined eligibility criteria. Adapting RDS strategies to MPS efforts could, theoretically, yield higher rates of participation for that age group. OBJECTIVE To investigate factors that influence the perceived acceptability of a RDS recruitment method for MPS involving people over 45 years of age living in Colombia. METHODS An MPS recruitment strategy deploying RDS techniques was piloted to increase participation of older populations. We conducted a qualitative study that drew from surveys with open and closed-ended items, semi-structured interviews for feedback, and focus group discussions to explore perceptions of the strategy and barriers to its application amongst MPS participants. RESULTS The strategy's success is affected by factors such as cultural adaptation, institutional credibility and public trust, data protection, and challenges with mobile phone technology. These factors are relevant to individuals' willingness to facilitate RDS efforts targeting hard-to-reach people. Recruitment strategies are valuable in part because hard-to-reach populations are often most accessible through their contacts within their social network who can serve as trust liaisons and drive engagement. CONCLUSIONS These findings may inform future studies where similar interventions are being considered to improve access to mobile phone-based data collection amongst hard-to-reach groups.
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Affiliation(s)
| | | | | | - Deivis Nicolas Guzman-Tordecilla
- Institute of Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Vidhi Maniar
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrés I Vecino-Ortiz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - George W Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dustin G Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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2
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Wedell E, Bettergarcia JN, Thomson BR, Shrewsbury AM. Age Moderates the Association of Community Connectedness and Psychological Distress Among LGBTQ+ Youth and Adults. JOURNAL OF HOMOSEXUALITY 2024; 71:722-740. [PMID: 36228152 DOI: 10.1080/00918369.2022.2132573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
High levels of psychological distress present a major public health issue among LGBTQ+ youth and adults; however, research has repeatedly identified community connectedness as an important protective factor for mental health in LGBTQ+ populations. The aim of the present study was to examine whether age moderates the association of community connectedness on psychological distress in a community sample of LGBTQ+ people. In the present exploratory study, we analyzed secondary cross-sectional data from a sample of LGBTQ+ youth and adults (n = 292) in a semi-rural community in the Western United States. Participants completed a measure of community connectedness, the K6, and the PHQ-4. The results of two moderation models showed that the negative association of community connectedness on psychological distress was strongest among youth, weaker among young adults, and nonsignificant among older middle-aged adults and older adults. These results provide further evidence for the potential buffering role of community connectedness on psychological distress for LGBTQ+ youth and young adults.
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Affiliation(s)
- Emma Wedell
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Jay N Bettergarcia
- Department of Psychology and Child Development, California Polytechnic State University, San Luis Obispo, California, USA
| | - Bonnie Rose Thomson
- Department of Psychology, State University of New York, Brockport, New York, USA
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Terao M, Mittal N, Roth M, Saha A, Super L, Reichek J. Utilization of Teleconsent for Adolescent and Young Adult Cancer Clinical Trials, a Report from the Children's Oncology Group. J Adolesc Young Adult Oncol 2024; 13:132-137. [PMID: 37540127 PMCID: PMC10877395 DOI: 10.1089/jayao.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Purpose: Adolescents and young adults (AYAs, ages 15-39 years) are underrepresented in oncology clinical trials. Reasons for this include accessibility of the trial and whether the trial is presented to AYAs. The coronavirus disease 2019 (COVID-19) pandemic not only amplified these enrollment challenges but also presented opportunities for improving the enrollment process through virtual methods such as electronic informed consent and teleconsent. While AYAs are well positioned to take advantage of these opportunities, the extent to which institutions utilize remote enrollment processes is unclear. The goal of this study was to identify the utilization of and barriers to using teleconsent for AYA oncology clinical trials. Methods: The Children's Oncology Group (COG) AYA Responsible Investigator (RI) Network Teleconsent Working Group sought to understand teleconsent utilization both before and during the pandemic. The working group developed an online survey distributed via email to COG AYA RI Network members (n = 197). Results: The survey received 49 responses (25%) from 40 different institutions. Before the pandemic, 13% of respondents reported that their institution allowed study enrollment via teleconsent. After the pandemic, 23% reported using teleconsent for clinical trial enrollment and 38% reported changes in institutional Review Board policies and procedures allowing teleconsent. Respondents reported that the greatest benefit of teleconsent was patient convenience and the greatest barrier was institutional restrictions on teleconsent utilization. Respondents reported that sharing institutional guidelines would be the most helpful intervention to improve teleconsent adoption. Conclusion: Teleconsent is a promising but underutilized approach. Institutions should work together to address common challenges to accessibility and acceptance of clinical trials by AYA cancer patients.
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Affiliation(s)
- Michael Terao
- Office of Student Learning and Academic Advising, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Nupur Mittal
- Department of Pediatrics, Rush University Medical Center, Chicago, Chicago, USA
| | - Michael Roth
- Department of Pediatrics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Aniket Saha
- Department of Pediatrics, Prisma Health Upstate Children's Hospital, Greenville, South Carolina, USA
| | - Leanne Super
- Department of Pediatrics, Children's Cancer Centre, Monash Children's Hospital and Royal Children's Hospital, Melbourne, Australia
| | - Jennifer Reichek
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Corneli A, Starling S, Choi Y, Vosylius J, Madre L, Mackinnon A, Tenaerts P. Participant comprehension and acceptability of enhanced versus text-only electronic informed consent: an innovative qualitative pilot study. Pilot Feasibility Stud 2024; 10:10. [PMID: 38233932 DOI: 10.1186/s40814-023-01432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The use of electronic informed consent (eIC) in decentralized trials offers a pragmatic approach to enrolling participants across multiple geographic areas. METHODS Using a randomized, cross-over study design, we conducted a qualitative descriptive evaluation of two eIC approaches-text-only eIC and enhanced eIC-in a mock hypertension Phase III clinical trial. We assessed participant comprehension and acceptability (usability, satisfaction, and eIC preference). RESULTS A total of 24 individuals with hypertension participated in the study: 12 reviewed the text-only eIC first, followed by the enhanced eIC, and 12 reviewed the enhanced eIC first, followed by the text-only eIC. The study population was diverse in gender, age, race, and geographic location. We found no descriptive differences in participant comprehension and satisfaction between the two eIC approaches. However, more participants preferred the enhanced eIC, and participants indicated that the digital elements were personable and made them feel more informed, engaged, comfortable, and prepared to participate in clinical research. CONCLUSIONS Our findings suggest that enhancing the eIC process with digital elements may have beneficial outcomes among potential participants beyond comprehension and satisfaction.
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Affiliation(s)
- Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Summer Starling
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Yujung Choi
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
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Zhang TR. Ethics of 'Counting Me In': framing the implications of direct-to-patient genomics research. JOURNAL OF MEDICAL ETHICS 2023; 50:45-49. [PMID: 37130755 DOI: 10.1136/jme-2022-108741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
Count Me In (CMI) was launched in 2015 as a patient-driven research initiative aimed at accelerating the study of cancer genomics through direct participant engagement, electronic consent and open-access data sharing. It is an example of a large-scale direct-to-patient (DTP) research project which has since enrolled thousands of individuals. Within the broad scope of 'citizen science', DTP genomics research is defined here as a specific form of 'top-down' research endeavour developed and overseen by institutions within the traditional human subjects research context; in novel ways, it engages and recruits patients with defined diseases, consents them for medical information and biospecimens sharing, and stores and disseminates genomic information. Importantly, these projects simultaneously aim to empower participants in the research process while increasing sample size, particularly in rare disease states. Using CMI as a case study, this paper discusses how DTP genomics research raises new questions in the context of traditional human subjects research ethics, including issues surrounding participant selection, remote consent, privacy and return of results. It aims to demonstrate how current research ethics frameworks may be insufficient in this context, and that institutions, institutional review boards and investigators should be aware of these gaps and their role in ensuring the conduct of ethical, novel forms of research together with participants. Ultimately, a broader question is raised of whether the rhetoric of participatory genomics research advocates for an ethic of personal and social duty for contributing to the advancement of generalisable knowledge about health and disease.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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6
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Haring LV, Hall JT, Janssen A, Johannes JM, Verhoeff AP, Ujcic-Voortman JK. Developing a digital informed consent app: opportunities and challenges of a new format to inform and obtain consent in public health research. BMC Med Ethics 2023; 24:97. [PMID: 37941000 PMCID: PMC10634039 DOI: 10.1186/s12910-023-00974-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Informed consent procedures for large population-based cohort studies should be comprehensive and easy-to-use. This is particularly challenging when participants from different socio-economic groups and multicultural ethnic backgrounds are involved. Recently, more and more studies have tried to use multimedia in informed consent procedures. We describe the development and testing of a digital informed consent app and elaborate on whether this may contribute to a comprehensive and practical procedure to obtain informed consent for public health research. METHODS In a sample of parents with young children, we used a mixed method approach to study the user experience of an informed consent app and evaluate whether it can be used to adequately inform people and register their consent. Through semi-structured interviews we investigated participants' experiences with and opinions about the app, with a special focus on comprehensibility of the content and the usability of the app. Information retention questions were asked to evaluate to what extent participants could recall key aspects of the provided study information. RESULTS The 30 participants in this study used the app between 4 and 15 min to give their consent. Overall, they found the app well-designed, informative and easy to use. To learn more about the study for which informed consent is asked, most of the participants chose to watch the animated film, which was generally found to convey information in a clear manner. The identification process was met with mixed reactions, with some feeling it as a secure way to give consent, while for others it contradicted their view of using data anonymously. Information retention questions showed that while all participants remembered various aspects of the study, fewer than half answered all four questions satisfactorily. CONCLUSION Our study shows that a well-designed informed consent app can be an effective tool to inform eligible participants and to record consents. Still, some issues remain, including trust barriers towards the identification procedure and lack of information retention in some participants. When implementing consent procedures that incorporate digital formats, it may be beneficial to also invest in a complementary face-to-face recruitment approach.
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Affiliation(s)
- Luuk V Haring
- Department of Healthy Living, GGD Amsterdam, Amsterdam, the Netherlands.
- Sarphati Amsterdam: Research for Healthy Living, Amsterdam, the Netherlands.
| | - Joy T Hall
- Department of Healthy Living, GGD Amsterdam, Amsterdam, the Netherlands
- Sarphati Amsterdam: Research for Healthy Living, Amsterdam, the Netherlands
| | - Anton Janssen
- Department of Healthy Living, GGD Amsterdam, Amsterdam, the Netherlands
- Sarphati Amsterdam: Research for Healthy Living, Amsterdam, the Netherlands
| | - J Marleen Johannes
- Department of Youth Health Care, GGD Amsterdam, Amsterdam, the Netherlands
- Sarphati Amsterdam: Research for Healthy Living, Amsterdam, the Netherlands
| | - Arnoud P Verhoeff
- Department of Healthy Living, GGD Amsterdam, Amsterdam, the Netherlands
- Sarphati Amsterdam: Research for Healthy Living, Amsterdam, the Netherlands
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Joanne K Ujcic-Voortman
- Department of Healthy Living, GGD Amsterdam, Amsterdam, the Netherlands
- Sarphati Amsterdam: Research for Healthy Living, Amsterdam, the Netherlands
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Cohen E, Byrom B, Becher A, Jörntén-Karlsson M, Mackenzie AK. Comparative Effectiveness of eConsent: Systematic Review. J Med Internet Res 2023; 25:e43883. [PMID: 37656499 PMCID: PMC10504628 DOI: 10.2196/43883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Providing informed consent means agreeing to participate in a clinical trial and having understood what is involved. Flawed informed consent processes, including missing dates and signatures, are common regulatory audit findings. Electronic consent (eConsent) uses digital technologies to enable the consenting process. It aims to improve participant comprehension and engagement with study information and to address data quality concerns. OBJECTIVE This systematic literature review aimed to assess the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, and study enrollment and retention rates, as well as the effects of eConsent on the time patients took to perform the consenting process ("cycle time") and on-site workload in comparison with traditional paper-based consenting. METHODS The systematic review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Ovid Embase and Ovid MEDLINE were systematically searched for publications reporting original, comparative data on the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, enrollment and retention rates, cycle time, and site workload. The methodological validity of the studies that compared outcomes for comprehension, acceptability, and usability across paper consent and eConsent was assessed. Study methodologies were categorized as having "high" validity if comprehensive assessments were performed using established instruments. RESULTS Overall, 37 publications describing 35 studies (13,281 participants) were included. All studies comparing eConsenting and paper-based consenting for comprehension (20/35, 57% of the studies; 10 with "high" validity), acceptability (8/35, 23% of the studies; 1 with "high" validity), and usability (5/35, 14% of the studies; 1 with "high" validity) reported significantly better results with eConsent, better results but without significance testing, or no significant differences in overall results. None of the studies reported better results with paper than with eConsent. Among the "high" validity studies, 6 studies on comprehension reported significantly better understanding of at least some concepts, the study on acceptability reported statistically significant higher satisfaction scores, and the study on usability reported statistically significant higher usability scores with eConsent than with paper (P<.05 for all). Cycle times were increased with eConsent, potentially reflecting greater patient engagement with the content. Data on enrollment and retention were limited. Comparative data from site staff and other study researchers indicated the potential for reduced workload and lower administrative burden with eConsent. CONCLUSIONS This systematic review showed that compared with patients using paper-based consenting, patients using eConsent had a better understanding of the clinical trial information, showed greater engagement with content, and rated the consenting process as more acceptable and usable. eConsent solutions thus have the potential to enhance understanding, acceptability, and usability of the consenting process while inherently being able to address data quality concerns, including those related to flawed consenting processes.
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Affiliation(s)
| | | | - Anja Becher
- Oxford PharmaGenesis, Oxford, United Kingdom
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8
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Fahey MC, Dahne J, Chen BK, Smith TT, Wahlquist AE, Carpenter MJ. "And then I found $5": Optimizing recruitment efficiency in remote clinical trials. J Clin Transl Sci 2023; 7:e102. [PMID: 37250999 PMCID: PMC10225265 DOI: 10.1017/cts.2023.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction As clinical trials adopt remote methodologies, there is need to optimize efficiency of remote enrollment. Within a remote clinical trial, we aim to (1) assess if sociodemographic factors differ among those consenting via mail vs. technology-based procedures (e-consent), (2) determine if, among those consenting via mail, a small unconditional monetary reward ($5) increases likelihood of subsequent enrollment, (3) economically evaluate additional cost per additional participant enrolled with $5 reward. Methods In the parent nationwide randomized clinical trial of adult smokers (N = 638), participants could enroll via mail or e-consent. Logistic regression models assessed relationships between sociodemographics and enrollment via mail (vs e-consent). Mailed consent packets were randomized (1:4) to include $5 unconditional reward or not, and logistic regression modeling examined impact of reward on subsequent enrollment, allowing for a randomized study within a study. Incremental cost-effectiveness ratio analysis estimated additional cost per additional participant enrolled with $5 incentive. Results Older age, less education, lower income, and female sex predicted enrolling via mail vs e-consent (p < .05's). In adjusted model, older age (AOR = 1.02, p = .016) and less education (AOR = 2.23, p < .001) remained predictive of mail enrollment. The $5 incentive (vs none) increased enrollment rate by 9% (AOR = 1.64, p = .007), with estimated cost of additional $59 per additional participant enrolled. Conclusions As e-consent methods become more common, they have potential to reach many individuals but with perhaps diminished inclusion across all sociodemographic groups. Provision of an unconditional monetary incentive is possibly a cost-effective mechanism to increase recruitment efficiency for studies employing mail-based consenting procedures.
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Affiliation(s)
- Margaret C. Fahey
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Brian K. Chen
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Tracy T. Smith
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amy E. Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
| | - Mathew J. Carpenter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Buckley MT, O'Shea MR, Kundu S, Lipitz-Snyderman A, Kuperman G, Shah S, Iasonos A, Houston C, Terzulli SL, Lengfellner JM, Sabbatini P. Digitalizing the Clinical Research Informed Consent Process: Assessing the Participant Experience in Comparison With Traditional Paper-Based Methods. JCO Oncol Pract 2023; 19:e355-e364. [PMID: 36534933 PMCID: PMC10022878 DOI: 10.1200/op.22.00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/14/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Consent processes are critical for clinical care and research and may benefit from incorporating digital strategies. We compared an electronic informed consent (eIC) option to paper consent across four outcomes: (1) technology burden, (2) protocol comprehension, (3) participant agency (ability to self-advocate), and (4) completion of required document fields. METHODS We assessed participant experience with eIC processes compared with traditional paper-based consenting using surveys and compared completeness of required fields, over 3 years (2019-2021). Participants who consented to a clinical trial at a large academic cancer center via paper or eIC were invited to either pre-COVID-19 pandemic survey 1 (technology burden) or intrapandemic survey 2 (comprehension and agency). Consent document completeness was assessed via electronic health records. RESULTS On survey 1, 83% of participants (n = 777) indicated eIC was easy or very easy to use; discomfort with technology overall was not correlated with discomfort using eIC. For survey 2, eIC (n = 262) and paper consenters (n = 193) had similar comprehension scores. All participants responded favorably to at least five of six agency statements; however, eIC generated a higher proportion of positive free-text comments (P < .05), with themes such as thoroughness of the discussion and consenter professionalism. eIC use yielded no completeness errors across 235 consents versus 6.4% for paper (P < .001). CONCLUSION Our findings suggest that eIC when compared with paper (1) did not increase technology burden, (2) supported comparable comprehension, (3) upheld key elements of participant agency, and (4) increased completion of mandatory consent fields. The results support a broader call for organizations to offer eIC for clinical research discussions to enhance the overall participant experience and increase the completeness of the consent process.
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Affiliation(s)
| | | | | | | | | | - Suken Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Paul Sabbatini
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Eysenbach G, Hagens S, Kemp J, Roble H, Carter-Langford A, Shen N. Patient Perspectives and Preferences for Consent in the Digital Health Context: State-of-the-art Literature Review. J Med Internet Res 2023; 25:e42507. [PMID: 36763409 PMCID: PMC9960046 DOI: 10.2196/42507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The increasing integration of digital health tools into care may result in a greater flow of personal health information (PHI) between patients and providers. Although privacy legislation governs how entities may collect, use, or share PHI, such legislation has not kept pace with digital health innovations, resulting in a lack of guidance on implementing meaningful consent. Understanding patient perspectives when implementing meaningful consent is critical to ensure that it meets their needs. Consent for research in the context of digital health is limited. OBJECTIVE This state-of-the-art review aimed to understand the current state of research as it relates to patient perspectives on digital health consent. Its objectives were to explore what is known about the patient perspective and experience with digital health consent and provide recommendations on designing and implementing digital health consent based on the findings. METHODS A structured literature search was developed and deployed in 4 electronic databases-MEDLINE, IEEE Xplore, Scopus, and Web of Science-for articles published after January 2010. The initial literature search was conducted in March 2021 and updated in March 2022. Articles were eligible for inclusion if they discussed electronic consent or consent, focused on the patient perspective or preference, and were related to digital health or digital PHI. Data were extracted using an extraction template and analyzed using qualitative content analysis. RESULTS In total, 75 articles were included for analysis. Most studies were published within the last 5 years (58/75, 77%) and conducted in a clinical care context (33/75, 44%) and in the United States (48/75, 64%). Most studies aimed to understand participants' willingness to share PHI (25/75, 33%) and participants' perceived usability and comprehension of an electronic consent notice (25/75, 33%). More than half (40/75, 53%) of the studies did not describe the type of consent model used. The broad open consent model was the most explored (11/75, 15%). Of the 75 studies, 68 (91%) found that participants were willing to provide consent; however, their consent behaviors and preferences were context-dependent. Common patient consent requirements included clear and digestible information detailing who can access PHI, for what purpose their PHI will be used, and how privacy will be ensured. CONCLUSIONS There is growing interest in understanding the patient perspective on digital health consent in the context of providing clinical care. There is evidence suggesting that many patients are willing to consent for various purposes, especially when there is greater transparency on how the PHI is used and oversight mechanisms are in place. Providing this transparency is critical for fostering trust in digital health tools and the innovative uses of data to optimize health and system outcomes.
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Affiliation(s)
| | | | - Jessica Kemp
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Heba Roble
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Nelson Shen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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11
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LeCroy MN, Potter LN, Bandeen-Roche K, Bianco ME, Cappola AR, Carter EB, Dayan PS, Eckstrom E, Edwards DF, Farabi SS, Fisher SD, Giordano J, Hanson HA, Jenkins E, Juhn Y, Kaskel F, Stake CE, Reeds DN, Schleiss MR, Wafford QE, McColley SA. Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic. J Clin Transl Sci 2022; 7:e38. [PMID: 36845306 PMCID: PMC9947617 DOI: 10.1017/cts.2022.510] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the "Lifespan and Life Course Research: integrating strategies" "Un-Meeting" to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.
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Affiliation(s)
- Madison N. LeCroy
- Department of Pediatrics, Division of Academic General Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lindsey N. Potter
- Center for Health Outcomes and Population Equity (HOPE), Department of Population Health Sciences, Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD, USA
| | - Monica E. Bianco
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ebony B. Carter
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University, School of Medicine, St. Louis, MO, USA
| | - Peter S. Dayan
- Department of Emergency Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Eckstrom
- Department of Medicine, Division of General Internal Medicine & Geriatrics, Oregon Clinical & Translational Research Institute, Oregon Health & Science University, Portland, OR, USA
| | - Dorothy F. Edwards
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research and Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Health Sciences Learning Center, Madison, WI, USA
| | - Sarah S. Farabi
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Sheehan D. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Judy Giordano
- University of Rochester Medical Center, Rochester, NY, USA
| | - Heidi A. Hanson
- Department of Surgery and Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Emerald Jenkins
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Young Juhn
- Precision Population Science Lab and Artificial Intelligence Program, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Frederick Kaskel
- Department of Pediatrics, Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Bronx, NY, USA
| | - Christine E. Stake
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Dominic N. Reeds
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO, USA
| | - Mark R. Schleiss
- Department of Pediatrics, Division of Infectious Diseases, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Q. Eileen Wafford
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susanna A. McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Tamuhla T, Tiffin N, Allie T. An e-consent framework for tiered informed consent for human genomic research in the global south, implemented as a REDCap template. BMC Med Ethics 2022; 23:119. [PMID: 36434585 PMCID: PMC9694827 DOI: 10.1186/s12910-022-00860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
Research involving human participants requires their consent, and it is common practice to capture consent information on paper and store those hard copies, presenting issues such as long-term storage requirements, inefficient retrieval of consent forms for reference or future use, and the potential for transcription errors when transcribing captured informed consent. There have been calls to move to electronic capture of the consent provided by research participants (e-consent) as a way of addressing these issues. A tiered framework for e-consent was designed using the freely available features in the inbuilt REDCap e-consent module. We implemented 'branching logic', 'wet signature' and 'auto-archiver' features to the main informed consent and withdrawal of consent documents. The branching logic feature streamlines the consent process by making follow-up information available depending on participant response, the 'wet signature' feature enables a timestamped electronic signature to be appended to the e-consent documents and the 'auto-archiver' allows for PDF copies of the e-consent documents to be stored in the database. When designing the content layout, we provided example participant information text which can be modified as required. Emphasis was placed on the flow of information to optimise participant understanding and this was achieved by merging the consent and participant information into one document where the consent questions were asked immediately after the corresponding participant information. In addition, we have provided example text for a generic human genomic research study, which can be easily edited and modified according to specific requirements. Building informed consent protocols and forms without prior experience can be daunting, so we have provided researchers with a REDCap template that can be directly incorporated into REDCap databases. It prompts researchers about the types of consent they can request for genomics studies and assists them with suggestions for the language they might use for participant information and consent questions. The use of this tiered e-consent module can ensure the accurate and efficient electronic capture and storage of the consents given by participants in a format that can be easily queried and can thus facilitate ethical and effective onward sharing of data and samples whilst upholding individual participant preferences.
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Affiliation(s)
- Tsaone Tamuhla
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nicki Tiffin
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.
| | - Taryn Allie
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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13
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Yusof MYPM, Teo CH, Ng CJ. Electronic informed consent criteria for research ethics review: a scoping review. BMC Med Ethics 2022; 23:117. [DOI: 10.1186/s12910-022-00849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The research shows a growing trend in using an electronic platform to supplement or replace traditional paper-based informed consent processes. Instead of the traditionally written informed consent document, electronic informed consent (eConsent) may be used to assess the research subject’s comprehension of the information presented. By doing so, respect for persons as one of the research ethical principles can be upheld. Furthermore, these electronic methods may reduce potential airborne infection exposures, particularly during the pandemic, thereby adhering to the beneficence and nonmaleficence principle. This scoping review aims to identify the ethics related criteria that have been included in electronic informed consent processes and to synthesize and map these criteria to research ethics principles, in order to identify the gaps, if any, in current electronic informed consent processes.
Methods
The search was performed based on internet search and three main databases: PubMed, SCOPUS and EBSCO. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation guideline was used to report this work.
Results
Of 34 studies that met the inclusion criteria, 242 essential original constructs were collated, and 7 concepts were derived. Digital content showed the highest percentage of collated original constructs (27%, n = 65) followed by accessibility (24%, n = 56), comprehension engagement (18%, n = 43), autonomy (14%, n = 34), confidentiality (11%, n = 25), language (5%, n = 13), and parental consent (1%, n = 2). Twenty-five new items were synthesized for eConsent criteria which may provide guidance for ethical review of research involving eConsent.
Conclusion
The current study adds significant value to the corpus of knowledge in research ethics by providing ethical criteria on electronic informed consent based on evidence-based data. The new synthesized items in the criteria can be readily used as an initial guide by the IRB/REC members during a review process on electronic informed consent and useful to the future preparation of a checklist.
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14
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Nyholm Gaarskjær A, Crookshanks Duroux M, Hogreffe R. Participant comprehension and perspectives regarding the convenience, security, and satisfaction with teleconsent compared to in-person consent: A parallel-group pilot study among Danish citizens. Contemp Clin Trials Commun 2022; 28:100927. [PMID: 35669485 PMCID: PMC9163420 DOI: 10.1016/j.conctc.2022.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/09/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Teleconsent via video conferencing enables decentralized trials with remote consent and has the additional benefit of allowing a real-time reaction to potential misunderstandings. However, participant acceptance of and satisfaction with teleconsent versus in-person consent processes are unknown. Methods We conducted a parallel-group pilot study to evaluate participant comprehension and perspectives regarding the convenience, security, and satisfaction with teleconsent compared to in-person consent among Danish citizens for a hypothetical research study. Results There were no statistically significant differences in perceptions of security or satisfaction between teleconsent and in-person consent arms. However, participants viewed teleconsent as more convenient than in-person consent, as no transportation was needed and the process was less time-consuming. Recruitment was also faster in the teleconsent arm, and more people dropped out of the in-person arm, citing difficulties with transportation and time. Conclusion Decentralized clinical trials have been demonstrated to increase recruitment and enrollment rates, improve trial efficiency, and decrease dropout rates and trial delays. We add to this literature by suggesting that patients perceive teleconsent as similar to in-person consent, suggesting this is a feasible and acceptable substitution for in-person consent in multisite, decentralized trials. Future work should include patient perspectives from a larger, more diverse group of participants.
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Affiliation(s)
- Anne Nyholm Gaarskjær
- Molecular Pharmacology, Department of Health Science and Technology (HST), Faculty of Medicine, Aalborg University, Denmark
| | - Meg Crookshanks Duroux
- Molecular Pharmacology, Department of Health Science and Technology (HST), Faculty of Medicine, Aalborg University, Denmark
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15
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De Micco F, Fineschi V, Banfi G, Frati P, Oliva A, Travaini GV, Picozzi M, Curcio G, Pecchia L, Petitti T, Alloni R, Rosati E, De Benedictis A, Tambone V. From COVID-19 Pandemic to Patient Safety: A New “Spring” for Telemedicine or a Boomerang Effect? Front Med (Lausanne) 2022; 9:901788. [PMID: 35783642 PMCID: PMC9240206 DOI: 10.3389/fmed.2022.901788] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022] Open
Abstract
During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.
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Affiliation(s)
- Francesco De Micco
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
- *Correspondence: Vittorio Fineschi
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mario Picozzi
- Department of Biotechnology and Science of Life, Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Tommasangelo Petitti
- Hygiene, Public Health and Statistics, Campus Bio-Medico University of Rome, Rome, Italy
- Department of Medical Affairs, Fondazione Don Carlo Gnocchi Onlus, Rome, Italy
| | - Rossana Alloni
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Enrico Rosati
- Casa di Cura “Auxologico Roma–Buon Pastore”, Rome, Italy
| | - Anna De Benedictis
- Nursing Science Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittoradolfo Tambone
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
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16
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Peay HL, Gwaltney AY, Moultrie R, Cope H, Boyea BL, Porter KA, Duparc M, Alexander AA, Biesecker BB, Isiaq A, Check J, Gehtland L, Bailey DB, King NMP. Education and Consent for Population-Based DNA Screening: A Mixed-Methods Evaluation of the Early Check Newborn Screening Pilot Study. Front Genet 2022; 13:891592. [PMID: 35646095 PMCID: PMC9133477 DOI: 10.3389/fgene.2022.891592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
A challenge in implementing population-based DNA screening is providing sufficient information, that is, understandable and acceptable, and that supports informed decision making. Early Check is an expanded newborn screening study offered to mothers/guardians whose infants have standard newborn screening in North Carolina. We developed electronic education and consent to meet the objectives of feasibility, acceptability, trustworthiness, and supporting informed decisions. We used two methods to evaluate Early Check among mothers of participating infants who received normal results: an online survey and interviews conducted via telephone. Survey and interview domains included motivations for enrollment, acceptability of materials and processes, attitudes toward screening, knowledge recall, and trust. Quantitative analyses included descriptive statistics and assessment of factors associated with knowledge recall and trust. Qualitative data were coded, and an inductive approach was used to identify themes across interviews. Survey respondents (n = 1,823) rated the following as the most important reasons for enrolling their infants: finding out if the baby has the conditions screened (43.0%), and that no additional blood samples were required (20.1%). Interview respondents (n = 24) reported the value of early knowledge, early intervention, and ease of participation as motivators. Survey respondents rated the study information as having high utility for decision making (mean 4.7 to 4.8 out of 5) and 98.2% agreed that they had sufficient information. Knowledge recall was relatively high (71.8–92.5% correct), as was trust in Early Check information (96.2% strongly agree/agree). Attitudes about Early Check screening were positive (mean 0.1 to 0.6 on a scale of 0–4, with lower scores indicating more positive attitudes) and participants did not regret participation (e.g., 98.6% strongly agreed/agreed Early Check was the right decision). Interview respondents further reported positive attitudes about Early Check materials and processes. Early Check provides a model for education and consent in large-scale DNA screening. We found evidence of high acceptability, trustworthiness and knowledge recall, and positive attitudes among respondents. Population-targeted programs need to uphold practices that result in accessible information for those from diverse backgrounds. Additional research on those who do not select screening, although ethically and practically challenging, is important to inform population-based DNA screening practices.
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Affiliation(s)
- Holly L Peay
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Angela You Gwaltney
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Rebecca Moultrie
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Heidi Cope
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Beth Lincoln- Boyea
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Katherine Ackerman Porter
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Martin Duparc
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Amir A Alexander
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Barbara B Biesecker
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Aminah Isiaq
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Lisa Gehtland
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Donald B Bailey
- Genomics, Bioinformatics, and Translational Research Center, RTI International, Research Triangle Park, NC, Unites States
| | - Nancy M P King
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
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17
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Almeida-Magana R, Maroof H, Grierson J, Clow R, Dinneen E, Al-Hammouri T, Muirhead N, Brew-Graves C, Kelly J, Shaw G. E-Consent-a guide to maintain recruitment in clinical trials during the COVID-19 pandemic. Trials 2022; 23:388. [PMID: 35550639 PMCID: PMC9096749 DOI: 10.1186/s13063-022-06333-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/23/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has posed daunting challenges when conducting clinical research. Adopting new technologies such as remote electronic consent (e-Consent) can help overcome them. However, guidelines for e-Consent implementation in ongoing clinical trials are currently lacking. The NeuroSAFE PROOF trial is a randomized clinical trial evaluating the role of frozen section analysis during RARP for prostate cancer. In response to the COVID-19 crisis, recruitment was halted, and a remote e-Consent solution was designed. The aim of this paper is to describe the process of implementation, impact on recruitment rate, and patients' experience using e-Consent. METHODS A substantial amendment of the protocol granted the creation of a remote e-Consent framework based on the REDCap environment, following the structure and content of the already approved paper consent form. Although e-Consent obviated the need for in-person meeting, there was nonetheless counselling sessions performed interactively online. This new pathway offered continuous support to patients through remote consultations. The whole process was judged to be compliant with regulatory requirements before implementation. RESULTS Before the first recruitment suspension, NeuroSAFE PROOF was recruiting an average of 9 patients per month. After e-Consent implementation, 63 new patients (4/month) have been enrolled despite a second lockdown, none of whom would have been recruited using the old methods given restrictions on face-to-face consultations. Patients have given positive feedback on the use of the platform. Limited troubleshooting has been required after implementation. CONCLUSION Remote e-Consent-based recruitment was critical for the continuation of the NeuroSAFE PROOF trial during the COVID-19 pandemic. The described pathway complies with ethical and regulatory guidelines for informed consent, while minimizing face-to-face interactions that increase the risk of COVID-19 transmission. This guide will help researchers integrate e-Consent to ongoing or planned clinical trials while uncertainty about the course of the pandemic continues. TRIAL REGISTRATION NeuroSAFE PROOF trial NCT03317990 . Registered on 23 October 2017. Regional Ethics Committee reference 17/LO/1978.
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Affiliation(s)
- Ricardo Almeida-Magana
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK.
| | - Hanna Maroof
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jack Grierson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Rosie Clow
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Eoin Dinneen
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Tarek Al-Hammouri
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Nicola Muirhead
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - Chris Brew-Graves
- NCITA Clinical Trials Unit, Division of Medicine, University College London, Charles Bell House, 2nd Floor, 43-45 Foley Street, London, W1W 7TY, UK
| | - John Kelly
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 3rd Floor, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Greg Shaw
- Department of Urology, Westmoreland Street Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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18
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Albright AE, Cui R, Allen RS. Pet Ownership and Mental and Physical Health in Older White and Black Males and Females. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095655. [PMID: 35565050 PMCID: PMC9103503 DOI: 10.3390/ijerph19095655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/22/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023]
Abstract
Pet ownership literature remains mixed regarding associations with mental and physical health outcomes among older adults. The present study investigates the relationship between pet ownership and depression, health, and physical activity in an older adult sample balanced by sex (male/female), race (White/Black), and urban/rural status. Participants were adults aged 65+ recruited between 1999 and 2001 in the University of Alabama at Birmingham Study of Aging. Participants completed the Geriatric Depression Scale, a single-item self-reported health measure, and a physical activity questionnaire. Dog owners reported better subjective health and were more likely to walk for exercise as compared to non-pet owners. Cat owners did not differ from non-pet owners in terms of self-reported health or walking. White participants were more likely than Black participants to report ownership of a pet. No relationships were found between pet ownership and symptoms of depression. Findings were not influenced by sex, race, or geographical location. Dog ownership may be associated with positive physical health behaviors and subjective health perceptions. Additional research focused on mechanisms and cognitive impact is needed. Although there may be physical health benefits of dog ownership, adopting a pet should not be viewed as a simplistic solution to alleviating depression in older adults.
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Affiliation(s)
- Amy E. Albright
- Department of Veterans Affairs, VA Maine Health Care System, Augusta, ME 04240, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35401, USA;
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL 35487, USA
- Correspondence:
| | - Ruifeng Cui
- Department of Veterans Affairs, VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Health Care System, Pittsburgh, PA 15240, USA;
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Rebecca S. Allen
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35401, USA;
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL 35487, USA
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Simon CM, Wang K, Shinkunas LA, Stein DT, Meissner P, Smith M, Pentz R, Klein DW. Communicating With Diverse Patients About Participating in a Biobank: A Randomized Multisite Study Comparing Electronic and Face-to-Face Informed Consent Processes. J Empir Res Hum Res Ethics 2022; 17:144-166. [PMID: 34410195 PMCID: PMC8712348 DOI: 10.1177/15562646211038819] [Citation(s) in RCA: 2] [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
Some individuals' understanding of informed consent (IC) information may improve with electronic delivery, but others may benefit from face-to-face (F2F). This randomized, multisite study explores how individuals from diverse backgrounds understand electronic IC documents versus F2F, their confidence in understanding, and enrollment in research. A total of 501 patients at two U.S. biobanks with diverse populations participated. There were no overall differences between electronic and F2F understanding, but F2F predicted higher confidence in understanding and enrollment. Ethnicity and a higher educational level predicted higher understanding and confidence. Study findings suggest that electronic consent may lead to better understanding for non-Hispanic patients of higher socioeconomic status. F2F processes may lead to better understanding and higher enrollment of patients from Hispanic and lower socioeconomic levels. Researchers should carefully consider how they implement electronic IC processes and whether to maintain an F2F process to better address the needs and limitations of some populations.
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Affiliation(s)
| | - Kai Wang
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | | - Rebecca Pentz
- School of Medicine, Emory University, Atlanta, GA, USA
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20
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Hu Z, Ouyang C, Hahne J, Khoshnood K, Zhang J, Liu X, Wu Y, Wang X. Knowledge and Attitudes of Research Participants in China Toward Electronic Informed Consent in Clinical Trials: A Cross Sectional Study. J Empir Res Hum Res Ethics 2022; 17:362-372. [PMID: 35088620 DOI: 10.1177/15562646221075884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to investigate the knowledge and attitudes of participants and potential participants in clinical trials toward electronic informed consent. We conducted a survey-based cross-sectional study in Hunan Province, China in March 2021. A total of 547 respondents were included in this study. All questions in an 8-item survey section assessing participants' knowledge of electronic informed consent received correct answers from at least 70% of participants. In terms of attitude scores, most participants (86.3%) believed that electronic informed consent is more convenient than the paper-based version, and more than half (51.2%) believed that electronic informed consent could completely replace the paper-based version. Responses indicated that common concerns about electronic informed consent were its security and confidentiality, legal benefits, and implications for rights protection.
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Affiliation(s)
- Zhanqing Hu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
| | - Chenxi Ouyang
- School of Pharmacy, 118393Hunan University of Chinese Medicine, Changsha, 410208, Hunan, PR China
| | - Jessica Hahne
- Yale School of Public Health, 50296Yale University, 60 College Street, New Haven, CT 06520, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, 50296Yale University, 60 College Street, New Haven, CT 06520, USA
| | - Jinqiang Zhang
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
| | - Xiyu Liu
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
- Clinical Research Center, 504354The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
| | - Ying Wu
- School of Public Administration, Central South University, Changsha 410075, Hunan, PR China
| | - Xiaomin Wang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
- Clinical Research Center, 504354The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan, PR China
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21
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Lajonchere C, Naeim A, Dry S, Wenger N, Elashoff D, Vangala S, Petruse A, Ariannejad M, Magyar C, Johansen L, Werre G, Kroloff M, Geschwind D. An Integrated, Scalable, Electronic Video Consent Process to Power Precision Health Research: Large, Population-Based, Cohort Implementation and Scalability Study. J Med Internet Res 2021; 23:e31121. [PMID: 34889741 PMCID: PMC8701720 DOI: 10.2196/31121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/23/2021] [Accepted: 09/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obtaining explicit consent from patients to use their remnant biological samples and deidentified clinical data for research is essential for advancing precision medicine. OBJECTIVE We aimed to describe the operational implementation and scalability of an electronic universal consent process that was used to power an institutional precision health biobank across a large academic health system. METHODS The University of California, Los Angeles, implemented the use of innovative electronic consent videos as the primary recruitment tool for precision health research. The consent videos targeted patients aged ≥18 years across ambulatory clinical laboratories, perioperative settings, and hospital settings. Each of these major areas had slightly different workflows and patient populations. Sociodemographic information, comorbidity data, health utilization data (ambulatory visits, emergency room visits, and hospital admissions), and consent decision data were collected. RESULTS The consenting approach proved scalable across 22 clinical sites (hospital and ambulatory settings). Over 40,000 participants completed the consent process at a rate of 800 to 1000 patients per week over a 2-year time period. Participants were representative of the adult University of California, Los Angeles, Health population. The opt-in rates in the perioperative (16,500/22,519, 73.3%) and ambulatory clinics (2308/3390, 68.1%) were higher than those in clinical laboratories (7506/14,235, 52.7%; P<.001). Patients with higher medical acuity were more likely to opt in. The multivariate analyses showed that African American (odds ratio [OR] 0.53, 95% CI 0.49-0.58; P<.001), Asian (OR 0.72, 95% CI 0.68-0.77; P<.001), and multiple-race populations (OR 0.73, 95% CI 0.69-0.77; P<.001) were less likely to participate than White individuals. CONCLUSIONS This is one of the few large-scale, electronic video-based consent implementation programs that reports a 65.5% (26,314/40,144) average overall opt-in rate across a large academic health system. This rate is higher than those previously reported for email (3.6%) and electronic biobank (50%) informed consent rates. This study demonstrates a scalable recruitment approach for population health research.
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Affiliation(s)
- Clara Lajonchere
- Institute for Precision Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Arash Naeim
- Center for SMART Health, Institute for Precision Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Sarah Dry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Neil Wenger
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Sitaram Vangala
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Antonia Petruse
- Embedded Clinical Research and Innovation Unit, Clinical and Translational Science Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Maryam Ariannejad
- Institute for Precision Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Clara Magyar
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Liliana Johansen
- Embedded Clinical Research and Innovation Unit, Clinical and Translational Science Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Gabriela Werre
- Embedded Clinical Research and Innovation Unit, Clinical and Translational Science Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Maxwell Kroloff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Daniel Geschwind
- Institute for Precision Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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22
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Perni S, Hong K, Hong TS, Nipp RD. Toward a Science of Personalized Informed Consent in Cancer Clinical Trials. JCO Oncol Pract 2021; 17:655-661. [PMID: 33974444 DOI: 10.1200/op.20.00975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Subha Perni
- Harvard Radiation Oncology Program, Massachusetts General Hospital and Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA.,Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Kessely Hong
- Harvard Kennedy School, Harvard University, Boston, MA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
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23
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Rodriguez-Patarroyo M, Torres-Quintero A, Vecino-Ortiz AI, Hallez K, Franco-Rodriguez AN, Rueda Barrera EA, Puerto S, Gibson DG, Labrique A, Pariyo GW, Ali J. Informed Consent for Mobile Phone Health Surveys in Colombia: A Qualitative Study. J Empir Res Hum Res Ethics 2021; 16:24-34. [PMID: 32975157 PMCID: PMC8132005 DOI: 10.1177/1556264620958606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Public health surveys deployed through automated mobile phone calls raise a set of ethical challenges, including succinctly communicating information necessary to obtain respondent informed consent. This study aimed to capture the perspectives of key stakeholders, both experts and community members, on consent processes and preferences for participation in automated mobile phone surveys (MPS) of non-communicable disease risk factors in Colombia. We conducted semi-structured interviews with ethics and digital health experts and focus group discussions with community representatives. There was meaningful disagreement within both groups regarding the necessity of consent, when the purpose of a survey is to contribute to the formulation of public policies. Respondents who favored consent emphasized that consent communications ought to promote understanding and voluntariness, and implicitly suggested that information disclosure conform to a reasonable person standard. Given the automated and unsolicited nature of the phone calls and concerns regarding fraud, trust building was emphasized as important, especially for national MPS deployment. Community sensitization campaigns that provide relevant contextual information (such as the name of the administering institution) were thought to support trust-building. Additional ways to achieve the goals of consent while building trust in automated MPS for disease surveillance should be evaluated in order to inform ethical and effective practice.
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Affiliation(s)
| | | | - Andres I. Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristina Hallez
- Center for Effective Global Action, University of California, Berkeley, CA, USA
| | | | | | - Stephanie Puerto
- Institute of Public Health, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Dustin G. Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - George W. Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
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24
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Rosa C, Marsch LA, Winstanley EL, Brunner M, Campbell ANC. Using digital technologies in clinical trials: Current and future applications. Contemp Clin Trials 2020; 100:106219. [PMID: 33212293 DOI: 10.1016/j.cct.2020.106219] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/05/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
In 2015, we provided an overview of the use of digital technologies in clinical trials, both as a methodological tool and as a mechanism to deliver interventions. At that time, there was limited guidance and limited use of digital technologies in clinical research. However, since then smartphones have become ubiquitous and digital health technologies have exploded. This paper provides an update to our earlier publication and an overview of how technology has been used in the past five years in clinical trials, providing examples with varying levels of technological integration and across different health conditions. Digital technology integration ranges from the incorporation of artificial intelligence in diagnostic devices to the use of real-world data (e.g., electronic health records) for study recruitment. Clinical trials can now be conducted entirely virtually, eliminating the need for in-person interaction. Much of the published research demonstrates how digital approaches can improve the design and implementation of clinical trials. While challenges remain, progress over the last five years is encouraging, and barriers can be overcome with careful planning.
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Affiliation(s)
- Carmen Rosa
- National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, USA.
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA.
| | - Erin L Winstanley
- West Virginia University, School of Medicine and Rockefeller Neuroscience Institute, Department of Behavioral Medicine and Psychiatry, Morgantown, West Virginia, USA; West Virginia University, School of Medicine, Department of Neuroscience Morgantown, West Virginia, USA.
| | - Meg Brunner
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA.
| | - Aimee N C Campbell
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA.
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25
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Skelton E, Drey N, Rutherford M, Ayers S, Malamateniou C. Electronic consenting for conducting research remotely: A review of current practice and key recommendations for using e-consenting. Int J Med Inform 2020; 143:104271. [PMID: 32979650 PMCID: PMC7487205 DOI: 10.1016/j.ijmedinf.2020.104271] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/20/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Electronic approaches are becoming more widely used to obtain informed consent for research participation. Electronic consent (e-consent) provides an accessible and versatile approach to the consenting process, which can be enhanced with audio-visual and interactive features to improve participant engagement and comprehension of study procedures. Best practice guidance underpinned by ethical principles is required to ensure effective implementation of e-consent for use in research. AIM To identify the key considerations for successful and ethical implementation of e-consent in the recruitment of participants to research projects which are conducted remotely. METHODS Electronic database searches of CINAHL, Medline, Embase, DARE, HTA, PubMed, the Cochrane Library, Scopus, Web of Science, NHS Evidence, and hand-searches of reference lists were performed. Primary research studies of adult (≥ 18 years old) research participants using e-consent, published in English language, peer-reviewed journals between 2010-2020 were eligible for inclusion. RESULTS Of the initial 665 identified studies, 18 met the inclusion criteria: 6 cohort studies, 5 qualitative studies, 4 randomised control trials, 2 mixed-methods studies and one case-control study. Critical appraisal of included studies using Critical Appraisal Skills Program (CASP) tools suggested a low to moderate risk of bias in most studies (n = 15). Key practice recommendations for researchers using e-consent were identified around five primary themes: 1) accessibility and user-friendliness of e-consent, 2) user engagement and comprehension, 3) customisability to participant preferences and demographics, 4) data security and 5) impact on research teams. CONCLUSION E-consenting approaches are generally well received by participants, with most studies reporting user-friendly interfaces and sufficient participant comprehension of consenting documentation. IMPLICATIONS FOR PRACTICE E-consent may facilitate remotely-conducted research by offering a feasible and robust alternative to face-to-face consenting approaches, however paper-based options should still be offered, based on participant preference. Customising e-consenting platforms may improve accessibility for individuals with specific needs, and increase engagement with study information. Research teams must offer prospective participants opportunities to discuss study information in real-time.
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Affiliation(s)
- Emily Skelton
- Division of Radiography and Midwifery, City, University of London, UK; Department of Perinatal Imaging and Health, King's College London, UK.
| | | | - Mary Rutherford
- Department of Perinatal Imaging and Health, King's College London, UK
| | - Susan Ayers
- Division of Radiography and Midwifery, City, University of London, UK
| | - Christina Malamateniou
- Division of Radiography and Midwifery, City, University of London, UK; Department of Perinatal Imaging and Health, King's College London, UK
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26
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Pung J, Rienhoff O. Key components and IT assistance of participant management in clinical research: a scoping review. JAMIA Open 2020; 3:449-458. [PMID: 33215078 PMCID: PMC7660951 DOI: 10.1093/jamiaopen/ooaa041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 01/05/2023] Open
Abstract
Objectives Managing participants and their data are fundamental for the success of a clinical trial. Our review identifies and describes processes that deal with management of trial participants and highlights information technology (IT) assistance for clinical research in the context of participant management. Methods A scoping literature review design, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, was used to identify literature on trial participant-related proceedings, work procedures, or workflows, and assisting electronic systems. Results The literature search identified 1329 articles of which 111 were included for analysis. Participant-related procedures were categorized into 4 major trial processes: recruitment, obtaining informed consent, managing identities, and managing administrative data. Our results demonstrated that management of trial participants is considered in nearly every step of clinical trials, and that IT was successfully introduced to all participant-related areas of a clinical trial to facilitate processes. Discussion There is no precise definition of participant management, so a broad search strategy was necessary, resulting in a high number of articles that had to be excluded. Nevertheless, this review provides a comprehensive overview of participant management-related components, which was lacking so far. The review contributes to a better understanding of how computer-assisted management of participants in clinical trials is possible.
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Affiliation(s)
- Johannes Pung
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Otto Rienhoff
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
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27
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De Sutter E, Zaçe D, Boccia S, Di Pietro ML, Geerts D, Borry P, Huys I. Implementation of Electronic Informed Consent in Biomedical Research and Stakeholders' Perspectives: Systematic Review. J Med Internet Res 2020; 22:e19129. [PMID: 33030440 PMCID: PMC7582148 DOI: 10.2196/19129] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023] Open
Abstract
Background Informed consent is one of the key elements in biomedical research. The introduction of electronic informed consent can be a way to overcome many challenges related to paper-based informed consent; however, its novel opportunities remain largely unfulfilled due to several barriers. Objective We aimed to provide an overview of the ethical, legal, regulatory, and user interface perspectives of multiple stakeholder groups in order to assist responsible implementation of electronic informed consent in biomedical research. Methods We conducted a systematic literature search using Web of Science (Core collection), PubMed, EMBASE, ACM Digital Library, and PsycARTICLES. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for reporting this work. We included empirical full-text studies focusing on the concept of electronic informed consent in biomedical research covering the ethical, legal, regulatory, and user interface domains. Studies written in English and published from January 2010 onward were selected. We explored perspectives of different stakeholder groups, in particular researchers, research participants, health authorities, and ethics committees. We critically appraised literature included in the systematic review using the Newcastle-Ottawa scale for cohort and cross-sectional studies, Critical Appraisal Skills Programme for qualitative studies, Mixed Methods Appraisal Tool for mixed methods studies, and Jadad tool for randomized controlled trials. Results A total of 40 studies met our inclusion criteria. Overall, the studies were heterogeneous in the type of study design, population, intervention, research context, and the tools used. Most of the studies’ populations were research participants (ie, patients and healthy volunteers). The majority of studies addressed barriers to achieving adequate understanding when using electronic informed consent. Concerns shared by multiple stakeholder groups were related to the security and legal validity of an electronic informed consent platform and usability for specific groups of research participants. Conclusions Electronic informed consent has the potential to improve the informed consent process in biomedical research compared to the current paper-based consent. The ethical, legal, regulatory, and user interface perspectives outlined in this review might serve to enhance the future implementation of electronic informed consent. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020158979; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158979
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Drieda Zaçe
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Maria Luisa Di Pietro
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - David Geerts
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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28
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Campbell LM, Paolillo EW, Bryan R, Marquie-Beck J, Moore DJ, Nebeker C, Moore RC. Informing Informed Consent for HIV Research. J Empir Res Hum Res Ethics 2020; 15:235-243. [PMID: 32560591 DOI: 10.1177/1556264620933766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
"Respect for Persons" is an ethical principle demonstrated through the informed consent process. Participants at a large HIV research center were surveyed to identify important aspects of the consent process. Persons with and without HIV (n = 103) completed a short pre/post questionnaire with both open-ended and forced choice response options. Qualitative analysis resulted in eleven themes about the most important consent elements which did not differ by HIV serostatus. Overall, participants rated the informed consent content and presentation by research staff as "extremely informative" and found the consent information to be "extremely consistent" with their study experience. Study results support the value of an interactive process and can be used to inform the design of a standardized, digital consent process.
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Affiliation(s)
- Laura M Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Emily W Paolillo
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Robert Bryan
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - David J Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA.,Center for Wireless and Population Health Systems, Qualcomm Institute, University of California San Diego, La Jolla, CA, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Abstract
The risks posed to patients with cancer by the current COVID-19 pandemic demand rapid structural changes in healthcare delivery, with many positive changes likely to continue long term. An immediate critical reassessment of trial methodology based on clinical and scientific priorities is essential to ensure the resilience of clinical cancer research and optimize patient-centered care.
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30
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Haussen DC, Craft L, Doppelheuer S, Rodrigues GM, Al-Bayati AR, Ravindran K, Schultz M, Sutherly L, Schindler KM, Frankel MR, Nogueira RG. Legal authorized representative experience with smartphone-based electronic informed consent in an acute stroke trial. J Neurointerv Surg 2019; 12:483-485. [PMID: 31530653 DOI: 10.1136/neurintsurg-2019-015283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The pilot use of a smartphone platform for electronic informed consent (e-Consent) in large vessel occlusion acute stroke (LVOS) trials has recently been reported. The degree of satisfaction from Legal Authorized Representatives (LARs) with regard to this process remains to be established. METHODS A single-center study evaluating the experience of LARs with the use of e-Consent in a LVOS randomized trial of an investigational drug administered within 12 hours of last known normal was carried out. A structured survey was used to evaluate the experience of the LARs with the e-consenting process. RESULTS From February to November 2018, 60 consecutive patients were e-Consented. Of these, 53 LARs completed the survey. The median (IQR) age of the patients was 63 (53-70) years, baseline/discharge National Institutes of Health Stroke Scale score was 17 (12-20)/3(1-12), and 45% were independent at discharge. The survey was applied in person in 43% of cases and via telephone in 57%. Median LAR age was 48 (39-59) years, 64% were female, and a multi-ethnic composition was observed. Forty percent of LARs had less than tertiary level of education (high-school or less). Regarding the e-Consent, 98% of LARs reported to be 'clear' and 83% felt 'very comfortable' in signing. The overall experience was 'excellent/good' in 91%. Despite the positive general impression regarding the use of e-Consent, 12 LARs (22%) would have preferred paper consent. Multivariable regression indicated that lower educational status (tertiary education or less: OR 5.09, 95% CI 1.02 to 25.48; p=0.04) and lower baseline ASPECTS score (OR 0.63, 95% CI 0.41 to 0.96; p=0.03) were independently associated with preference for paper consent. CONCLUSIONS e-Consent was overall very well perceived by LARs in a randomized clinical trial of LVOS. A minority of proxies, who were more commonly less formally educated, would have preferred paper consenting.
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Affiliation(s)
- Diogo C Haussen
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Leah Craft
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Shannon Doppelheuer
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Gabriel Martins Rodrigues
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Alhamza R Al-Bayati
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Krishnan Ravindran
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Meagan Schultz
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Loretta Sutherly
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Kiva M Schindler
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Michael R Frankel
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
| | - Raul G Nogueira
- Neurology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center -Grady Memorial Hospital, Atlanta, Florida, USA
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31
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Abstract
Individuals approached to participate in human subjects research, irrespective of age, must be completely apprised of the study, and researchers must ensure that the information is understood to the fullest extent possible, prior to decision making. However, evolving regulatory and institutional requirements have led to permission/assent/consent (PAC) forms that are unnecessarily complex, serving only to exacerbate the challenges associated with communicating this important information to prospective participants. At greatest risk are children and other individuals with low literacy, limited English proficiency, and diminished mental capacity, populations all too often neglected in clinical research. This paper examines various strategies that have been evaluated to facilitate informed PAC, drawing on experiences across a broad array of populations whose needs overlap with those of children. These strategies range from simplifying PAC forms for readability and creating multimedia PAC delivery tools to actively engaging participants on their understanding of PAC elements by leveraging testing, rewards, and third-party communications. Notably, the findings from strategies that have been explored in more than one setting are uniformly mixed with respect to their ability to improve comprehension, underscoring the challenges that persist in designing, implementing, and objectively examining strategies intended to facilitate informed PAC. However, these studies do serve to highlight efforts that may reduce anxiety around, and increase the satisfaction of participants with, the PAC process. Ultimately, accommodating a diverse participant pool will require the consideration, and continual refinement, of various PAC strategies along with the engagement of team members who are intimately familiar with these populations.
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Affiliation(s)
- Susan M Abdel-Rahman
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy, 2401 Gillham Rd., POB 2.M02.47, Kansas City, MO, 64108, USA. .,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
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32
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Mwaka E, Nakigudde J, Ali J, Ochieng J, Hallez K, Tweheyo R, Labrique A, Gibson DG, Rutebemberwa E, Pariyo G. Consent for mobile phone surveys of non-communicable disease risk factors in low-resource settings: an exploratory qualitative study in Uganda. Mhealth 2019; 5:26. [PMID: 31559271 PMCID: PMC6737387 DOI: 10.21037/mhealth.2019.07.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/19/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lack of data for timely decision-making around the prevention and control of non-communicable diseases (NCDs) presents special challenges for policy makers, especially in resource-limited settings. New data collection methods, including pre-recorded Interactive Voice Response (IVR) phone surveys, are being developed to support rapid compilation of population-level disease risk factor information in such settings. We aimed to identify information that could be used to optimize consent approaches for future mobile phone surveys (MPS) employed in Uganda and, possibly, similar contexts. METHODS We conducted an in-depth qualitative study with key stakeholders in Uganda about consent approaches, and potential challenges, for pre-recorded IVR NCD risk factor surveys. Semi-structured interviews were conducted with 14 key informants. A contextualized thematic approach was used to interpret the results supported by representative quotes. RESULTS Several potential challenges in designing consent approaches for MPS were identified, including low literacy and the lack of appropriate ways of assessing comprehension and documenting consent. Communication with potential respondents prior to the MPS and providing options for callbacks were suggested as possible strategies for improving comprehension within the consent process. "Opt-in" forms of authorization were preferred over "opt-out". There was particular concern about data security and confidentiality and how matters relating to this would be communicated to MPS respondents. CONCLUSIONS These local insights provide important information to support optimization of consent for MPS, whose use is increasing globally to advance public health surveillance and research in constructive ways.
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Affiliation(s)
- Erisa Mwaka
- Makerere University of College Health Sciences, Kampala, Uganda
| | - Janet Nakigudde
- Makerere University of College Health Sciences, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, USA
| | - Joseph Ochieng
- Makerere University of College Health Sciences, Kampala, Uganda
| | | | - Raymond Tweheyo
- Makerere University of College Health Sciences, Kampala, Uganda
| | - Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - George Pariyo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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