1
|
Winograd RP, Coffey B, Woolfolk C, Wood CA, Ilavarasan V, Liss D, Jain S, Stringfellow E. To Prescribe or Not to Prescribe?: Barriers and Motivators for Progressing Along Each Stage of the Buprenorphine Training and Prescribing Path. J Behav Health Serv Res 2023; 50:165-180. [PMID: 35060002 DOI: 10.1007/s11414-021-09783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
This study aimed to identify the strongest barriers and motivators associated with each step toward buprenorphine prescribing (1. obtaining a waiver, 2. beginning to prescribe, and 3. prescribing to more people) among a sample of Missouri-based medical professionals (N = 130). Item weights (number of endorsements times mean rank of the item's importance) were calculated based on their responses. Across groups, lack of access to psychosocial support services, need for higher levels of care, and clinical complexity were strong barriers. Among non-prescribers (n = 57, 46.3%), administrative burden, potential of becoming an addiction clinic, and concern about misuse and diversion were most heavily weighted. Among prescribers (n = 66, 53.7%), patients' inability to afford medications was a barrier across phases. Prominent motivators among all groups were the effectiveness of buprenorphine, improvement in other health outcomes, and a personal interest in treating addiction. Only prescribers reported the presence of institutional support and mentors as significant motivators.
Collapse
Affiliation(s)
- Rachel P Winograd
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA.
| | - Bridget Coffey
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Candice Woolfolk
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Claire A Wood
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - Vinith Ilavarasan
- St. Louis - Missouri Institute of Mental Health, University of Missouri, 43 Benton Court, St. Louis, MO, 63121, USA
| | - David Liss
- Department of Emergency Medicine, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Subodh Jain
- Spectrum Health, Division of Psychiatry and Behavioral Medicine, 2750 E Beltline NE, Grand Rapids, MI, 49525, USA
| | - Erin Stringfellow
- Massachusetts General Hospital Institute for Technology Assessment & Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Swartzell KL, Fulton JS, Crowder SJ. State-level Medicaid 1915(c) home and community-based services waiver support for caregivers. Nurs Outlook 2022; 70:749-757. [PMID: 35933177 DOI: 10.1016/j.outlook.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Informal caregivers encounter emotional distress, worsening personal health, and financial strain. The Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver programs provide an array of services including support for caregivers. PURPOSE This policy analysis examined Medicaid waiver services offered to persons 65 and older among the 50 states and District of Columbia (DC). METHODS Data were obtained from Medicaid waiver applications for adults age 65 and older available at Medicaid.gov. Data elements included number of waiver programs and services for supporting caregivers. Descriptive statistics were applied. FINDINGS Forty-three states including DC (84%) offered a Medicaid waiver for older adults; seven states (14%) offer two waiver programs; eight states (16%) had no Medicaid waiver. Payment to a relative or legal guardian caregiver was the most common service offered in 39 (76%) states. Other services included in-home respite care and adult day health care (35 states; 67%), out-of-home respite care (32 states; 63%), skilled nursing (28 states; 55%), paid spousal caregivers (18 states; 35%), caregiver training (15 states; 29%), and adult day care for socialization (7 states, 14%). DISCUSSION This study identifies wide variability in caregiver support across state-based Medicaid waivers. Future research should evaluate effectiveness of the waiver programs in supporting caregivers and inform evidence-based policy advocacy for supporting caregivers.
Collapse
|
3
|
Andraka-Christou B, Gordon AJ, Spetz J, Totaram R, Golan M, Randall-Kosich O, Harrison J, Calder S, Kertesz SG, Stein BD. Beyond state scope of practice laws for advanced practitioners: Additional supervision requirements for buprenorphine prescribing. J Subst Abuse Treat 2022; 138:108715. [PMID: 35067400 PMCID: PMC9167216 DOI: 10.1016/j.jsat.2021.108715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/11/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Buprenorphine is a life-saving medication for people with opioid use disorder (OUD). U.S. federal law allows advanced practice clinicians (APCs), such as nurse practitioners (NPs) and physician assistants (PAs), to obtain a federal waiver to prescribe buprenorphine in office-based practices. However, states regulate APCs' scope of practice (SOP) variously, including requirements for physician supervision. States may also have laws entirely banning NP/PA buprenorphine prescribing or requiring that supervising physicians have a federal waiver to prescribe buprenorphine. We sought to identify prevalence of state laws other than SOP laws that either 1) prohibit NP/PA buprenorphine prescribing entirely, or 2) require supervision by a federally waivered physician. METHODS We searched for state statutes and regulations in all 50 states and Washington D.C. regulating prescribing of buprenorphine for OUD by APCs during summer 2021. We excluded general scope of practice laws, laws only applicable to Medicaid-funded clinicians, laws not applicable to substance use disorder (SUD) treatment, and laws only applicable to NPs/PAs serving licensed SUD treatment facilities. We then conducted content analysis. RESULTS One state prohibits all APCs from prescribing buprenorphine for OUD, even though the state's general SOP laws permit APC buprenorphine prescribing. Five states require PA supervision by a federally waivered physician. Three states require NP supervision by a federally waivered physician. CONCLUSIONS Aside from general scope of practice laws, several states have created laws explicitly regulating buprenorphine prescribing by APCs outside of licensed state SUD facilities.
Collapse
Affiliation(s)
- Barbara Andraka-Christou
- School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States of America; Department of Internal Medicine, University of Central Florida, Orlando, FL, United States of America.
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States of America; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America; Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, United States of America
| | - Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States of America
| | - Rachel Totaram
- School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States of America
| | - Matthew Golan
- School of Law, Emory University, Atlanta, GA, United States of America
| | - Olivia Randall-Kosich
- School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | | | - Spencer Calder
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States of America; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America; Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, United States of America
| | - Stefan G Kertesz
- Birmingham, Alabama VA Health Care System, Birmingham, AL, United States of America; Division of Preventive Medicine, University of Alabama, Birmingham, AL, United States of America
| | | |
Collapse
|
4
|
Miller LH, Parks J, Yowell R. The Impact of COVID-19 on Financing of Psychiatric Services. Psychiatr Clin North Am 2022; 45:161-77. [PMID: 35219436 DOI: 10.1016/j.psc.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The onset of the COVID-19 pandemic in early 2020 had a significant impact on the delivery of behavioral health services, with significant short-term and long-range consequences. Intertwined with the delivery of services has been the financial ramifications of the pandemic. The rapid response by governmental agencies to shore up financial support for clinical services, and the swift shift to virtual care provided relief for a broad array of practice settings; however, it did not mitigate the full impact of the pandemic. Effective state, national, and international leadership, communication, and coordination are critical to improve the global response to any pandemic.
Collapse
|
5
|
Abdul Baki MN, Alhaj Hussein M. The impact of article processing charge waiver on conducting research in low-income countries. Confl Health 2021; 15:75. [PMID: 34654449 PMCID: PMC8518252 DOI: 10.1186/s13031-021-00413-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022] Open
Abstract
Health sciences research is a major tool in exchanging publications and knowledge between the various countries of the world. Researchers in developing countries barely have any financial funding from governmental or educational institutes to support their research. In low-income countries such as Syria, With less than 30$ per month and almost no financial support, Syrian residency doctors are fighting to push the scientific research reality of this ongoing crisis country forward and without a doubt, APC waiver plays a crucial role in this continuing mission.
Collapse
|
6
|
Abstract
An informed consent is a vital component of health care and forms an important component of any research study. Informed consent is the process where a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. A proper consent is imperative to ensure safety of the patients. However, obtaining a consent in the hospital settings has become a matter of concern in the times of this coronavirus-19 (COVID-19) pandemic. This brief review describes the additional complexities added to the consent for research and the various modifications needed in view of this pandemic. The current consent proformas need to be modified and individualised to the patient ensuring patient safety during research in the ongoing pandemic. We need to become more familiar with the technology and electronic tools as the acceptable alternative tools of communication in the current scenario. There is a need to incorporate a separate covid consent with due consideration to deferred consent, pre-emptive consent or waiver of a consent.
Collapse
Affiliation(s)
- Heena Garg
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Puneet Khanna
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
7
|
Gu GL, Duan FX, Zhang Z, Wei XM, Cui L, Zhang B. Must pilots permanently quit flying career after treatment for colorectal cancer? - Medical waiver for Air Force pilots with colorectal cancer: Three case reports. World J Clin Cases 2020; 8:790-797. [PMID: 32149062 PMCID: PMC7052549 DOI: 10.12998/wjcc.v8.i4.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/09/2019] [Accepted: 12/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) could seriously threaten the physical and mental health of pilots. Shall they end their flying after treatment of CRC? With this study, we investigated the possibility of a gradual medical waiver for such pilots to fly aircrafts again after treatment of CRC.
CASE SUMMARY We analyzed the medical waiver and clinical data of 3 pilots with CRC, who had accepted the treatment at the Department of General Surgery, Air Force Medical Center (formerly, Air Force General Hospital) between 2013 and 2018. All 3 cases underwent a series of comprehensive treatment courses, including radical resection of CRC, sequential radiotherapy, and chemotherapy. The follow-up results were satisfactory. After passing through the high-risk period of recurrence and metastasis of CRC, they all were given a medical waiver for flying again. Medical observation showed that their flying operations were safe.
CONCLUSION The CRC treatment shall follow the guidelines for diagnosis and treatment and should simultaneously protect the combating capabilities of pilots as much as possible. It is safe for pilots with CRC, who are continuously monitored under medical observation after passing through the high-risk period of recurrence and metastasis, to undertake military flight missions again.
Collapse
Affiliation(s)
- Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, PLA, Beijing 100142, China
| | - Fu-Xiao Duan
- Department of General Surgery, the General Hospital of Northern Theater Command PLA, Shenyang 110016, Liaoning Province, China
| | - Zhi Zhang
- Department of General Surgery, Air Force Medical Center, PLA, Beijing 100142, China
| | - Xue-Ming Wei
- Department of General Surgery, Air Force Medical Center, PLA, Beijing 100142, China
| | - Li Cui
- Department of Aviation Diseases, Air Force Medical Center, PLA, Beijing 100142, China
| | - Bo Zhang
- Department of Medical Research, Air Force Medical Center, PLA, Beijing 100142, China
| |
Collapse
|
8
|
Marino R, Perrone J, Nelson LS, Wiegand TJ, Schwarz ES, Wax PM, Stolbach AI. ACMT Position Statement: Remove the Waiver Requirement for Prescribing Buprenorphine for Opioid Use Disorder. J Med Toxicol 2019; 15:307-309. [PMID: 31414402 DOI: 10.1007/s13181-019-00728-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ryan Marino
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | | | | | - Evan S Schwarz
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Paul M Wax
- University of Texas Southwestern, Dallas, TX, USA
| | | |
Collapse
|
9
|
Doig CJ, Page SA, McKee JL, Moore EE, Abu-Zidan FM, Carroll R, Marshall JC, Faris PD, Tolonen M, Catena F, Cocolini F, Sartelli M, Ansaloni L, Minor SF, Peirera BM, Diaz JJ, Kirkpatrick AW. Ethical considerations in conducting surgical research in severe complicated intra-abdominal sepsis. World J Emerg Surg 2019; 14:39. [PMID: 31404221 PMCID: PMC6683332 DOI: 10.1186/s13017-019-0259-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background Severe complicated intra-abdominal sepsis (SCIAS) has high mortality, thought due in part to progressive bio-mediator generation, systemic inflammation, and multiple organ failure. Treatment includes early antibiotics and operative source control. At surgery, open abdomen management with negative-peritoneal-pressure therapy (NPPT) has been hypothesized to mitigate MOF and death, although clinical equipoise for this operative approach exists. The Closed or Open after Laparotomy (COOL) study (https://clinicaltrials.gov/ct2/show/NCT03163095) will prospectively randomize eligible patients intra-operatively to formal abdominal closure or OA with NPTT. We review the ethical basis for conducting research in SCIAS. Main body Research in critically ill incapacitated patients is important to advance care. Conducting research among SCIAS is complicated due to the severity of illness including delirium, need for emergent interventions, diagnostic criteria confirmed only at laparotomy, and obtundation from anaesthesia. In other circumstances involving critically ill patients, clinical experts have worked closely with ethicists to apply principles that balance the rights of patients whilst simultaneously permitting inclusion in research. In Canada, the Tri-Council Policy Statement-2 (TCPS-2) describes six criteria that permit study enrollment and randomization in such situations: (a) serious threat to the prospective participant requires immediate intervention; (b) either no standard efficacious care exists or the research offers realistic possibility of direct benefit; (c) risks are not greater than that involved in standard care or are clearly justified by prospect for direct benefits; (d) prospective participant is unconscious or lacks capacity to understand the complexities of the research; (e) third-party authorization cannot be secured in sufficient time; and (f) no relevant prior directives are known to exist that preclude participation. TCPS-2 criteria are in principle not dissimilar to other (inter)national criteria. The COOL study will use waiver of consent to initiate enrollment and randomization, followed by surrogate or proxy consent, and finally delayed informed consent in subjects that survive and regain capacity. Conclusions A delayed consent mechanism is a practical and ethical solution to challenges in research in SCIAS. The ultimate goal of consent is to balance respect for patient participants and to permit participation in new trials with a reasonable opportunity for improved outcome and minimal risk of harm.
Collapse
Affiliation(s)
- Christopher J Doig
- 1Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Stacey A Page
- 2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jessica L McKee
- 3Regional Trauma Services, Foothills Medical Centre, Calgary, Canada
| | | | - Fikri M Abu-Zidan
- 7Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | - Rosemary Carroll
- 8Surgical Services John Hunter Hospital, Newcastle, NSW Australia
| | - John C Marshall
- 6Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Peter D Faris
- 5Research Facilitation Analytics (DIMR), University of Calgary, Calgary, Alberta Canada
| | - Matti Tolonen
- 9Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Fausto Catena
- 10Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Federico Cocolini
- 11General, Emergency and Trauma Surgery dept, Bufalini Hospital, Cesena, Italy
| | | | - Luca Ansaloni
- 13Unit of General and Emergency Surgery, Bufalini Hospital of Cesena, Cesena, Italy
| | - Sam F Minor
- 14Department of Critical Care and Department of Surgery, NSHA- Queen Elizabeth II Health Sciences Centre, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9 Canada
| | - Bruno M Peirera
- 15Division of Trauma Surgery, University of Campinas, Campinas, SP Brazil
| | - Jose J Diaz
- 16Department of Surgery, Acute Care Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School on Medicine, Baltimore, MD USA
| | - Andrew W Kirkpatrick
- 17Department of Critical Care Medicine, University of Calgary, Calgary, Alberta Canada.,18Department of Surgery, University of Calgary, Calgary, Alberta Canada.,19EG23 Foothills Medical Centre, Calgary, Alberta T2N 2 T9 Canada
| | | |
Collapse
|
10
|
Dal-Ré R, Avendaño-Solà C, de Boer A, James SK, Rosendaal FR, Stephens R, Ioannidis JPA. A limited number of medicines pragmatic trials had potential for waived informed consent following the 2016 CIOMS ethical guidelines. J Clin Epidemiol 2019; 114:60-71. [PMID: 31212001 DOI: 10.1016/j.jclinepi.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES European regulations do not allow modification or waiver of informed consent for medicines randomized controlled trials (RCTs) where the three 2016 Council for International Organizations of Medical Sciences (CIOMS) provisions are met (consent would be impractical or unfeasible, yet the trial would have high social value and pose no or minimal risk to participants). We aimed to identify whether any such trials of medicines were being conducted in Europe. STUDY DESIGN AND SETTING This is a survey of all phase 4 "ongoing" RCTs on the EU clinical trial register between July 1, 2016 and June 30, 2018, to identify those with potentially high levels of pragmatism. Trials that were excluded were as follows: those conducted on rare diseases; conducted on healthy volunteers (except those assessing vaccines); masked (single-, double-blind) trials; single-center trials; those where one could expect to lead patients to prefer one intervention over the other; and miscellaneous reasons. The degree of pragmatism of the RCTs was self-assessed by trials' investigators by means of the PRECIS-2 tool. Investigators of those trials considered to be highly pragmatic assessed the fulfillment of the three CIOMS provisions. Seven patients assessed the social value of the RCTs. Finally, 33 members of 11 research ethics committees (RECs) assessed the social value of the trials and whether they posed no more than minimal risk to participants. Investigators, patients, and REC members assessed the fulfillment of the CIOMS provisions as "yes," "not sure" or "no." RESULTS Of the 638 phase 4 trials, 420 were RCTs, and 21 of these (5%) were candidates to be pragmatic. Investigators of 15 of these 21 RCTs self-assessed their trial's degree of pragmatism: 14 were highly pragmatic. Of these 14, eight fulfilled the three CIOMS provisions. Assessments by patients and RECs were inconsistent for several trials. CONCLUSIONS We found few low-risk participant-level pragmatic RCTs that could be suitable for modified or waived participants' informed consent. European regulators should consider amending the current regulation and encouraging the conduct of such trials.
Collapse
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Avda Reyes Católicos 2, E-28040 Madrid, Spain.
| | - Cristina Avendaño-Solà
- Clinical Pharmacology Service, Puerta de Hierro University Hospital, Manuel de Falla 1, E-28222 Majadahonda, Madrid, Spain
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, PO Box 80082, 3508TB Utrecht, the Netherlands
| | - Stephan K James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Dag Hammarskölds väg 14B, SE-752 37 Uppsala, Sweden
| | - Frits R Rosendaal
- Department of Clinical Epidemiology C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Richard Stephens
- National Cancer Research Institute's Consumer Forum, National Cancer Research Institute, Angel Building 407, St John Street, EC1V 4AD, London, UK
| | - John P A Ioannidis
- Departments of Medicine, Health Research and Policy, Biomedical Data Science and Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA 94305, USA
| |
Collapse
|
11
|
Abstract
Waivers of informed consent for research participation are permitted in the United States under the Common Rule, the Health Insurance Portability and Accountability Act regulations, and the US Food and Drug Administration's Exception from Informed Consent rule for emergency research. We assess the novel question regarding what legal right researchers have to carry out research procedures on or about another person, be it experimental medical intervention, psychological or social manipulation, or invasion of privacy, without the permission of their subjects. Our analysis frames waivers of consent as a species of presumed consent, and we address the underlying empirical question of whether it is reasonable to believe that subjects from whom no consent is sought would in fact agree, if asked. A scoping review of what is known about participation and refusal rates in United States-based research suggests that a large minority, on average, do not agree to take part in research. Refusal rates vary widely. This suggests that, while researchers may assert the social utility of their studies are high enough to justify waivers, there is reason to suspect that many who would be enrolled under a waiver of consent would not want to be enrolled. We conclude that waivers should be rare and that institutional review boards and researchers must explicitly address study acceptability in the community at large and the target population of their proposed research.
Collapse
Affiliation(s)
- Francis X Baker
- 1 Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jon F Merz
- 1 Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
12
|
Borkosky B, Smith DM. The risks and benefits of disclosing psychotherapy records to the legal system: What psychologists and patients need to know for informed consent. Int J Law Psychiatry 2015; 42-43:19-30. [PMID: 26434998 DOI: 10.1016/j.ijlp.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
When psychologists release patient records to the legal system, the typical practice is to obtain the patient's signature on a consent form, but rarely is a formal informed-consent obtained from the patient. Although psychologists are legally and ethically required to obtain informed consent for all services (including disclosure of records), there are a number of barriers to obtaining truly informed consent. Furthermore, compared to disclosures to nonlegal third parties, there are significantly greater risks when records are disclosed to the legal system. For these reasons, true informed consent should be obtained from the patient when records are disclosed to the legal system. A model for informed consent is proposed. This procedure should include a description of risks and benefits of disclosing or refusing to disclose by the psychotherapist, an opportunity to ask questions, and indication by the patient of a freely made choice. Both psychotherapist and patient share decision making responsibilities in our suggested model. The patient should be informed about potential harm to the therapeutic relationship, if applicable. Several recommendations for practice are described, including appropriate communications with attorneys and the legal system. A sample form, for use by psychotherapists, is included.
Collapse
Affiliation(s)
| | - Deirdre M Smith
- University of Maine School of Law, 246 Deering Avenue, Portland, ME 04102, United States.
| |
Collapse
|