Krishnamurti Tamar, Argo Nichole
Departments of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania(TK, NA)
Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania(NA)
Med Decis Making. 2016 Aug;36(6):726-40. doi: 10.1177/0272989X16636844. Epub 2016 Mar 10.
Traditional informed consent documents tend to be too lengthy and technical to facilitate proper patient engagement. Patient-centered, short informed consent content could be equally informative, while minimizing patient burden and producing greater patient engagement. This study aimed to develop and evaluate patient-centered, patient-designed paper and video informed consent formats.
Two studies were conducted. In study 1, 118 self-identifying asthma patients recruited from a national, online pool completed survey tasks from their personal computers. Participants in study 1 were randomly assigned to examine sections of a standard informed consent document for an asthma trial and to select information they deemed critical to their decision making. In study 2, a sample of 83 self-identifying asthma patients completed experimental tasks in a university laboratory. Participants in study 2 were randomly assigned to a full informed consent document; a shortened, patient-designed informed consent document created from study 1; or a video with content matched to the shortened paper form.
Study 1 yielded a more readable, concise version of a standard informed consent document (5 v. 17 pages). This shortened, patient-designed form closely met normative criteria for good clinical practice. In study 2, participants who viewed either the shortened paper consent or video reported greater engagement than those viewing the standard paper consent, without lowered performance on any other decision-relevant variables (i.e., comprehension, judged risk/benefit, feelings of trust). The video consent format did not cause increased enrollment.
Results suggest that providing concise informed consent content, systematically developed from patients' self-reported information needs, may be more effective at engaging and informing clinical trial participants than the traditional consent approach, without detriment to trial comprehension, risk assessment, or enrollment.
传统的知情同意文件往往过于冗长和专业,不利于患者充分参与。以患者为中心的简短知情同意内容同样能提供丰富信息,同时减轻患者负担并提高患者参与度。本研究旨在开发和评估以患者为中心、由患者设计的纸质和视频知情同意格式。
进行了两项研究。在研究1中,从全国在线数据库招募的118名自认为患有哮喘的患者通过个人电脑完成调查任务。研究1的参与者被随机分配去查看一份哮喘试验标准知情同意文件的各个部分,并选择他们认为对自己决策至关重要的信息。在研究2中,83名自认为患有哮喘的患者样本在大学实验室完成实验任务。研究2的参与者被随机分配到一份完整的知情同意文件;一份根据研究1创建的缩短的、由患者设计的知情同意文件;或一个内容与缩短的纸质形式相匹配的视频。
研究1产生了一份更易读、更简洁的标准知情同意文件版本(5页对17页)。这份缩短的、由患者设计的表格紧密符合良好临床实践的规范标准。在研究2中,查看缩短的纸质同意书或视频的参与者比查看标准纸质同意书的参与者报告的参与度更高,且在任何其他与决策相关的变量(即理解、判断的风险/益处、信任感受)上表现未降低。视频同意格式并未导致入组人数增加。
结果表明,根据患者自我报告的信息需求系统开发的简洁知情同意内容,在吸引和告知临床试验参与者方面可能比传统同意方法更有效,且不会损害试验理解、风险评估或入组情况。