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      GCP compliance and readability of informed consent forms from an emerging hub for clinical trials

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          Abstract

          Background:

          The rapid expansion of trials in emerging regions has raised valid concerns about research subject protection, particularly related to informed consent. The purpose of this study is to assess informed consent form (ICF) compliance with Good Clinical Practice (GCP) guidelines and the readability easeof the ICFs in Abu Dhabi, a potential destination for clinical trials in the UAE.

          Materials and Methods:

          A multicenter retrospective cross-sectional analysis of 140 ICFs from industry sponsored and non-sponsored studies was conducted by comparing against a local standard ICF. Flesch-Kincaid Reading Scale was used to assess the readability ease of the forms.

          Results:

          Non-sponsored studies had significantly lower overall GCP compliance of 55.8% when compared to 79.5% for industry sponsored studies. Only 33% of sponsored and 16% of non-sponsored studies included basic information on the participants' rights and responsibilities. Flesch-Kincaid Reading ease score for the informed consent forms from industry sponsored studies was significantly higher 48.9 ± 4.8 as compared to 38.5 ± 8.0 for non-sponsored studies, though both were more complex than recommended. Reading Grade Level score was also higher than expected, but scores for the ICFs from the industry sponsored studies were 9.7 ± 0.7, significantly lower as compared to 12.2 ± 1.3 for non-sponsored studies.

          Conclusion:

          In spite of the undisputed benefits of conducting research in emerging markets readability, comprehension issues and the lack of basic essential information call for improvements in the ICFs to protect the rights of future research subjects enrolled in clinical trials in the UAE.

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          Most cited references26

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          Ethics and clinical research.

          H BEECHER (1966)
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            Readability standards for informed-consent forms as compared with actual readability.

            Institutional review boards (IRBs) are charged with safeguarding potential research subjects with limited literacy but may have an inadvertent role in promulgating unreadable consent forms. We hypothesized that text provided by IRBs in informed-consent forms falls short of the IRBs' own readability standards and that readability is influenced by the level of research activity, local literacy rates, and federal oversight. To test these hypotheses, we conducted a cross-sectional study linking data from several public-use sources. A total of 114 Web sites of U.S. medical schools were surveyed for IRB readability standards and informed-consent-form templates. Actual readability was measured with the Flesch-Kincaid scale, which assigns a score on the basis of the minimal grade level required to read and understand English text (range, 0 to 12). Data on the level of research activity, local literacy rates, and federal oversight were obtained from organizational Web sites. The average readability score for text provided by IRBs was 10.6 (95 percent confidence interval, 10.3 to 10.8) on the Flesch-Kincaid scale. Specific readability standards, found on 61 Web sites (54 percent), ranged from a 5th-grade reading level to a 10th-grade reading level. The mean Flesch-Kincaid scores for the readability of sample text provided by IRBs exceeded the stated standard by 2.8 grade levels (95 percent confidence interval, 2.4 to 3.2; P<0.001). Readability was not associated with either the level of research funding (P=0.89) or local rates of literacy (P=0.92). However, the 52 schools that had been made subject to oversight by the Office for Human Research Protections (46 percent) had lower Flesch-Kincaid scores than the other schools (10.2 vs. 10.9, P=0.005). IRBs commonly provide text for informed-consent forms that falls short of their own readability standards. Federal oversight is associated with better readability. Copyright 2003 Massachusetts Medical Society
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              Informed consent: how much and what do patients understand?

              We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research. We conducted a systematic search of PubMed (1961-2006) to identify relevant articles. We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research. Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.
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                Author and article information

                Journal
                Perspect Clin Res
                Perspect Clin Res
                PCR
                Perspectives in Clinical Research
                Medknow Publications & Media Pvt Ltd (India )
                2229-3485
                2229-5488
                Apr-Jun 2015
                : 6
                : 2
                : 104-108
                Affiliations
                [1] Department of Academic Affairs, Tawam Hospital, Johns Hopkins Medicine International, Al Ain, United Arab Emirates
                Author notes
                Address for correspondence: Dr. Satish Chandra, Director Clinical Research, Tawam Hospital, Box 15258, Al Ain, UAE. E-mail: schandra@ 123456tawamhospital.ae
                Article
                PCR-6-104
                10.4103/2229-3485.154012
                4394576
                25878956
                5a882769-f6e2-4357-b851-02f46c1ddd1f
                Copyright: © Perspectives in Clinical Research

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Medicine
                clinical trials,gcp,informed consent,readability
                Medicine
                clinical trials, gcp, informed consent, readability

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