Skip to main content
Top
Published in: Trials 1/2022

Open Access 01-12-2022 | COVID-19 | Methodology

E-Consent—a guide to maintain recruitment in clinical trials during the COVID-19 pandemic

Authors: Ricardo Almeida-Magana, Hanna Maroof, Jack Grierson, Rosie Clow, Eoin Dinneen, Tarek Al-Hammouri, Nicola Muirhead, Chris Brew-Graves, John Kelly, Greg Shaw

Published in: Trials | Issue 1/2022

Login to get access

Abstract

Background

The COVID-19 pandemic has posed daunting challenges when conducting clinical research. Adopting new technologies such as remote electronic consent (e-Consent) can help overcome them. However, guidelines for e-Consent implementation in ongoing clinical trials are currently lacking. The NeuroSAFE PROOF trial is a randomized clinical trial evaluating the role of frozen section analysis during RARP for prostate cancer. In response to the COVID-19 crisis, recruitment was halted, and a remote e-Consent solution was designed. The aim of this paper is to describe the process of implementation, impact on recruitment rate, and patients’ experience using e-Consent.

Methods

A substantial amendment of the protocol granted the creation of a remote e-Consent framework based on the REDCap environment, following the structure and content of the already approved paper consent form. Although e-Consent obviated the need for in-person meeting, there was nonetheless counselling sessions performed interactively online. This new pathway offered continuous support to patients through remote consultations. The whole process was judged to be compliant with regulatory requirements before implementation.

Results

Before the first recruitment suspension, NeuroSAFE PROOF was recruiting an average of 9 patients per month. After e-Consent implementation, 63 new patients (4/month) have been enrolled despite a second lockdown, none of whom would have been recruited using the old methods given restrictions on face-to-face consultations. Patients have given positive feedback on the use of the platform. Limited troubleshooting has been required after implementation.

Conclusion

Remote e-Consent-based recruitment was critical for the continuation of the NeuroSAFE PROOF trial during the COVID-19 pandemic. The described pathway complies with ethical and regulatory guidelines for informed consent, while minimizing face-to-face interactions that increase the risk of COVID-19 transmission. This guide will help researchers integrate e-Consent to ongoing or planned clinical trials while uncertainty about the course of the pandemic continues.

Trial registration

NeuroSAFE PROOF trial NCT03317990. Registered on 23 October 2017. Regional Ethics Committee reference 17/LO/1978.
Literature
2.
go back to reference Wyatt D, Faulkner-Gurstein R, Cowan H, Wolfe CDA. Impacts of COVID-19 on clinical research in the UK: a multi-method qualitative case study. Plos One. 2021;16(8):e0256871.CrossRef Wyatt D, Faulkner-Gurstein R, Cowan H, Wolfe CDA. Impacts of COVID-19 on clinical research in the UK: a multi-method qualitative case study. Plos One. 2021;16(8):e0256871.CrossRef
3.
go back to reference Asaad M, Habibullah NK, Butler CE. The Impact of COVID-19 on Clinical Trials. Ann Surg. 2020;272(3):e222–e3.CrossRef Asaad M, Habibullah NK, Butler CE. The Impact of COVID-19 on Clinical Trials. Ann Surg. 2020;272(3):e222–e3.CrossRef
6.
go back to reference Nathe JM, Krakow EF. The challenges of informed consent in high-stakes, randomized oncology trials: a systematic review. MDM Policy Prac. 2019;4(1):238146831984032.CrossRef Nathe JM, Krakow EF. The challenges of informed consent in high-stakes, randomized oncology trials: a systematic review. MDM Policy Prac. 2019;4(1):238146831984032.CrossRef
7.
go back to reference Welch BM, Marshall E, Qanungo S, Aziz A, Laken M, Lenert L, et al. Teleconsent: a novel approach to obtain informed consent for research. Contemp Clin Trials Commun. 2016;3:74–9.CrossRef Welch BM, Marshall E, Qanungo S, Aziz A, Laken M, Lenert L, et al. Teleconsent: a novel approach to obtain informed consent for research. Contemp Clin Trials Commun. 2016;3:74–9.CrossRef
9.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRef Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRef
10.
go back to reference Lawrence CE, Dunkel L, Mcever M, Israel T, Taylor R, Chiriboga G, et al. A REDCap-based model for electronic consent (eConsent): moving toward a more personalized consent. J Clin Transl Sci. 2020;4(4):345–53.CrossRef Lawrence CE, Dunkel L, Mcever M, Israel T, Taylor R, Chiriboga G, et al. A REDCap-based model for electronic consent (eConsent): moving toward a more personalized consent. J Clin Transl Sci. 2020;4(4):345–53.CrossRef
11.
go back to reference Lunt H, Connor S, Skinner H, Brogden G. Electronic informed consent: the need to redesign the consent process for the digital age. Intern Med J. 2019;49(7):923–9.CrossRef Lunt H, Connor S, Skinner H, Brogden G. Electronic informed consent: the need to redesign the consent process for the digital age. Intern Med J. 2019;49(7):923–9.CrossRef
13.
go back to reference Grady C, Cummings SR, Rowbotham MC, Mcconnell MV, Ashley EA, Kang G. Informed consent. N Engl J Med. 2017;376(9):856–67.CrossRef Grady C, Cummings SR, Rowbotham MC, Mcconnell MV, Ashley EA, Kang G. Informed consent. N Engl J Med. 2017;376(9):856–67.CrossRef
14.
go back to reference Upadhaya S, Yu JX, Oliva C, Hooton M, Hodge J, Hubbard-Lucey VM. Impact of COVID-19 on oncology clinical trials. Nat Rev Drug Discov. 2020;19(6):376–7.CrossRef Upadhaya S, Yu JX, Oliva C, Hooton M, Hodge J, Hubbard-Lucey VM. Impact of COVID-19 on oncology clinical trials. Nat Rev Drug Discov. 2020;19(6):376–7.CrossRef
15.
go back to reference Marcum M, Kurtzweil N, Vollmer C, Schmid L, Vollmer A, Kastl A, et al. COVID-19 pandemic and impact on cancer clinical trials: an academic medical center perspective. Cancer Med. 2020;9(17):6141–6.CrossRef Marcum M, Kurtzweil N, Vollmer C, Schmid L, Vollmer A, Kastl A, et al. COVID-19 pandemic and impact on cancer clinical trials: an academic medical center perspective. Cancer Med. 2020;9(17):6141–6.CrossRef
16.
go back to reference Orkin AM, Gill PJ, Ghersi D, Campbell L, Sugarman J, Emsley R, et al. Guidelines for reporting trial protocols and completed trials modified due to the COVID-19 pandemic and other extenuating circumstances. JAMA. 2021;326(3):257.CrossRef Orkin AM, Gill PJ, Ghersi D, Campbell L, Sugarman J, Emsley R, et al. Guidelines for reporting trial protocols and completed trials modified due to the COVID-19 pandemic and other extenuating circumstances. JAMA. 2021;326(3):257.CrossRef
17.
go back to reference Burki TK. Cuts in cancer research funding due to COVID-19. Lancet Oncol. 2021;22(1):e6.CrossRef Burki TK. Cuts in cancer research funding due to COVID-19. Lancet Oncol. 2021;22(1):e6.CrossRef
18.
go back to reference Wilson J, Heinsch M, Betts D, Booth D, Kay-Lambkin F. Barriers and facilitators to the use of e-health by older adults: a scoping review. BMC Public Health. 2021;21(1):1556. Wilson J, Heinsch M, Betts D, Booth D, Kay-Lambkin F. Barriers and facilitators to the use of e-health by older adults: a scoping review. BMC Public Health. 2021;21(1):1556.
19.
go back to reference Haussen DC, Doppelheuer S, Schindler K, Grossberg JA, Bouslama M, Schultz M, et al. Utilization of a smartphone platform for electronic informed consent in acute stroke trials. Stroke. 2017;48(11):3156–60.CrossRef Haussen DC, Doppelheuer S, Schindler K, Grossberg JA, Bouslama M, Schultz M, et al. Utilization of a smartphone platform for electronic informed consent in acute stroke trials. Stroke. 2017;48(11):3156–60.CrossRef
20.
go back to reference Haussen DC, Craft L, Doppelheuer S, Rodrigues GM, Al-Bayati AR, Ravindran K, et al. Legal authorized representative experience with smartphone-based electronic informed consent in an acute stroke trial. J NeuroInterv Surg. 2020;12(5):483.CrossRef Haussen DC, Craft L, Doppelheuer S, Rodrigues GM, Al-Bayati AR, Ravindran K, et al. Legal authorized representative experience with smartphone-based electronic informed consent in an acute stroke trial. J NeuroInterv Surg. 2020;12(5):483.CrossRef
21.
go back to reference Meyerowitz EA, Richterman A, Gandhi RT, Sax PE. Transmission of SARS-CoV-2: a review of viral, host, and environmental factors. Ann Intern Med. 2021;174(1):69–79.CrossRef Meyerowitz EA, Richterman A, Gandhi RT, Sax PE. Transmission of SARS-CoV-2: a review of viral, host, and environmental factors. Ann Intern Med. 2021;174(1):69–79.CrossRef
22.
go back to reference Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020;323(16):1610.CrossRef Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020;323(16):1610.CrossRef
23.
go back to reference De Sutter E, Borry P, Geerts D, Huys I. Personalized and long-term electronic informed consent in clinical research: stakeholder views. BMC Med Ethics. 2021;22(1):108. De Sutter E, Borry P, Geerts D, Huys I. Personalized and long-term electronic informed consent in clinical research: stakeholder views. BMC Med Ethics. 2021;22(1):108.
24.
go back to reference Sanderson IC, Obeid JS, Madathil KC, Gerken K, Fryar K, Rugg D, et al. Managing clinical research permissions electronically: a novel approach to enhancing recruitment and managing consents. Clin Trials. 2013;10(4):604–11.CrossRef Sanderson IC, Obeid JS, Madathil KC, Gerken K, Fryar K, Rugg D, et al. Managing clinical research permissions electronically: a novel approach to enhancing recruitment and managing consents. Clin Trials. 2013;10(4):604–11.CrossRef
25.
go back to reference Naeim A, Dry S, Elashoff D, Xie Z, Petruse A, Magyar C, et al. Electronic video consent to power precision health research: a pilot cohort study. JMIR Form Res. 2021;5(9):e29123.CrossRef Naeim A, Dry S, Elashoff D, Xie Z, Petruse A, Magyar C, et al. Electronic video consent to power precision health research: a pilot cohort study. JMIR Form Res. 2021;5(9):e29123.CrossRef
26.
go back to reference Heinze O, Birkle M, Köster L, Bergh B. Architecture of a consent management suite and integration into IHE-based regional health information networks. BMC Med Inform Decis Mak. 2011;11(1):58.CrossRef Heinze O, Birkle M, Köster L, Bergh B. Architecture of a consent management suite and integration into IHE-based regional health information networks. BMC Med Inform Decis Mak. 2011;11(1):58.CrossRef
27.
go back to reference Harle CA, Golembiewski EH, Rahmanian KP, Krieger JL, Hagmajer D, Mainous AG, et al. Patient preferences toward an interactive e-consent application for research using electronic health records. J Am Med Inform Assoc. 2018;25(3):360–8.CrossRef Harle CA, Golembiewski EH, Rahmanian KP, Krieger JL, Hagmajer D, Mainous AG, et al. Patient preferences toward an interactive e-consent application for research using electronic health records. J Am Med Inform Assoc. 2018;25(3):360–8.CrossRef
28.
go back to reference Simon CM, Schartz HA, Rosenthal GE, Eisenstein EL, Klein DW. Perspectives on electronic informed consent from patients underrepresented in research in the United States: a focus group study. J Empir Res Hum Res Ethics. 2018;13(4):338–48.CrossRef Simon CM, Schartz HA, Rosenthal GE, Eisenstein EL, Klein DW. Perspectives on electronic informed consent from patients underrepresented in research in the United States: a focus group study. J Empir Res Hum Res Ethics. 2018;13(4):338–48.CrossRef
Metadata
Title
E-Consent—a guide to maintain recruitment in clinical trials during the COVID-19 pandemic
Authors
Ricardo Almeida-Magana
Hanna Maroof
Jack Grierson
Rosie Clow
Eoin Dinneen
Tarek Al-Hammouri
Nicola Muirhead
Chris Brew-Graves
John Kelly
Greg Shaw
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
COVID-19
Published in
Trials / Issue 1/2022
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-022-06333-6

Other articles of this Issue 1/2022

Trials 1/2022 Go to the issue