Is it ethical for doctors to ask their own patients for research consent?

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  1. Little Rain

    Great to hear about updated models of “integrated” ethical consent protocols.
    And thank you for providing examples of the current model of “informed” consent.
    It’s encouraging to hear of developments being enacted not only in the name of
    technological or technical evolution, but rather to perhaps sometimes take
    what appears a necessary slower step which is more humane and of greater value
    in terms of a greater social integrity.

  2. Aurelia Cotta

    While I appreciate that it is considered faster and easier, I think that getting consent from your own regular doctor is always fraught with coercion. I prefer to have a third party do it, and if they trained enough med students or nurses who are already there on shifts, they could still use 3rd parties without having the Family doctor involved. The other issue is that research files must be kept separate from regular medical files, for multiple reasons that none of you have addressed here from security or data, to the often very different standards in lab research.
    And if you want more people to come out to your studies, then PAY them more. I spent 2 days doing testing for one study, because the interviewers were terrible. (Newbies) Only $100. That’s not even minimum wage, never mind parking, gas etc
    Patients will show up for studies when they are treated with respect, and I can’t tell you how many people I’ve met who heard they were getting nothing, or just $20 so they never show up.

    • Todd Lee

      I think the context of the question is most important to the ethics and feasibility of this approach. I see this as a major step forward for questions where the treating doctor knows they should do A or B but honestly does not know which is better. Currently, they do A because it is the option they have always done in the past. But they acknowledge B could be better and currently the evidence isn’t really helpful in informing them. If you were in the hospital next week and another doctor was working, he/she may have chosen B because that’s that they usually do but they acknowledge A may be correct. The science cannot tell which is best. Your receipt of A or B is essentially a chance decision based on who is the treating physician at the moment and what their usual practice was. This is the perfect opportunity for an integrated consent trial which allows for both reasonable treatments to be compared properly such that all future patients will receive A or B based on what is actually better rather than the chance encounter.

      In general these studies probably shouldn’t require any real additional testing or significant additional visits outside of usual care and the data collected should be limited to that which is highly pertinent to properly answering the question.

      Right now we spend millions of dollars practicing medicine with incomplete information about a surprising number of decisions. The success rate for research funding for clinical trials is below 20% in Canada. This is one step forward to answering questions quickly, ethically, and with a minimal cost to the system and benefit to all future patients. If done right.

  3. Kelli Norton

    Just had a short discussion on the topic of doctors presenting research to their own patients (not consenting but introducing) and the ethics surrounding this. I’ve often wondered if this could be construed as coercive. I was told research shows 85% of patients prefer to have research presented to them by their own docs (I have not confirmed these stats just stating what I was told). In my opinion, who presents the research, the atmosphere in which research is presented (at point of care or some other point), and whether consent is obtained via traditional means (use of informed consent document with signature lines) or via this integrated model (verbal consent obtained by doctor & documented elsewhere), should be determined case by case (based on, among other things, level of risk). I don’t think a one-size-fits-all approach to research recruitment exists. I think research recruitment should be adaptive in general. I also think we should consider moving towards (audio) recorded consent. There may be some downsides to this but I believe the pros might outweigh the cons.

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