Limkakeng Alexander T, de Oliveira Lucas Lentini Herling, Moreira Tais, Phadtare Amruta, Garcia Rodrigues Clarissa, Hocker Michael B, McKinney Ross, Voils Corrine I, Pietrobon Ricardo
Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA.
Department of Surgery, Duke University, Durham, North Carolina, USA.
J Med Ethics. 2014 Jun;40(6):401-8. doi: 10.1136/medethics-2012-101147. Epub 2013 May 11.
Emergency departments are challenging research settings, where truly informed consent can be difficult to obtain. A deeper understanding of emergency medical patients' opinions about research is needed. We conducted a systematic review and meta-summary of quantitative and qualitative studies on which values, attitudes, or beliefs of emergent medical research participants influence research participation. We included studies of adults that investigated opinions toward emergency medicine research participation. We excluded studies focused on the association between demographics or consent document features and participation and those focused on non-emergency research. In August 2011, we searched the following databases: MEDLINE, EMBASE, Google Scholar, Scirus, PsycINFO, AgeLine and Global Health. Titles, abstracts and then full manuscripts were independently evaluated by two reviewers. Disagreements were resolved by consensus and adjudicated by a third author. Studies were evaluated for bias using standardised scores. We report themes associated with participation or refusal. Our initial search produced over 1800 articles. A total of 44 articles were extracted for full-manuscript analysis, and 14 were retained based on our eligibility criteria. Among factors favouring participation, altruism and personal health benefit had the highest frequency. Mistrust of researchers, feeling like a 'guinea pig' and risk were leading factors favouring refusal. Many studies noted limitations of informed consent processes in emergent conditions. We conclude that highlighting the benefits to the participant and society, mitigating risk and increasing public trust may increase research participation in emergency medical research. New methods for conducting informed consent in such studies are needed.
急诊科是具有挑战性的研究环境，在这种环境中很难获得真正意义上的知情同意。需要更深入地了解急诊患者对研究的看法。我们对关于急诊医学研究参与者的哪些价值观、态度或信念会影响研究参与的定量和定性研究进行了系统综述和元总结。我们纳入了针对成年人的研究，这些研究调查了对急诊医学研究参与的看法。我们排除了关注人口统计学或同意文件特征与参与之间的关联的研究，以及关注非急诊研究的那些研究。2011年8月，我们检索了以下数据库：医学文献数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、谷歌学术、Scirus、心理学文摘数据库（PsycINFO）、老龄线数据库（AgeLine）和全球健康数据库。两名评审员独立评估标题、摘要，然后是全文。分歧通过协商一致解决，并由第三位作者裁决。使用标准化分数评估研究的偏倚。我们报告与参与或拒绝相关的主题。我们最初的搜索产生了1800多篇文章。总共提取了44篇文章进行全文分析，根据我们的纳入标准保留了14篇。在有利于参与的因素中，利他主义和个人健康益处出现的频率最高。对研究人员的不信任、感觉像“小白鼠”以及风险是导致拒绝的主要因素。许多研究指出了急诊情况下知情同意过程的局限性。我们得出结论，强调对参与者和社会的益处、降低风险以及增强公众信任可能会增加急诊医学研究的参与度。在此类研究中需要新的知情同意方法。
