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Published in: Trials 1/2014

Open Access 01-12-2014 | Research

Patient information leaflets (PILs) for UK randomised controlled trials: a feasibility study exploring whether they contain information to support decision making about trial participation

Authors: Katie Gillies, Wan Huang, Zoë Skea, Jamie Brehaut, Seonaidh Cotton

Published in: Trials | Issue 1/2014

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Abstract

Background

Informed consent is regarded as a cornerstone of ethical healthcare research and is a requirement for most clinical research studies. Guidelines suggest that prospective randomised controlled trial (RCT) participants should understand a basic amount of key information about the RCTs they are being asked to enrol in in order to provide valid informed consent. This information is usually provided to potential participants in a patient information leaflet (PIL). There is evidence that some trial participants fail to understand key components of trial processes or rationale. As such, the existing approach to information provision for potential RCT participants may not be optimal. Decision aids have been used for a variety of treatment and screening decisions to improve knowledge, but focus more on overall decision quality, and may be helpful to those making decisions about participating in an RCT. We investigated the feasibility of using a tool to identify which items recommended for good quality decision making are present in UK PILs.

Methods

PILs were sampled from UK registered Clinical Trials Unit websites across a range of clinical areas. The evaluation tool, which is based on standards for supporting decision making, was applied to 20 PILs. Two researchers independently rated each PIL using the tool. In addition, word count and readability were assessed.

Results

PILs scored poorly on the evaluation tool with the majority of leaflets scoring less than 50%. Specifically, presenting probabilities, clarifying and expressing values and structured guidance in deliberation and communication sub-sections scored consistently poorly. Tool score was associated with word count (r = 0.802, P <0.01); there was no association between score and readability (r = -0.372, P = 0.106).

Conclusions

The tool was feasible to use to evaluate PILs for UK RCTs. PILs did not meet current standards of information to support good quality decision making. Writers of information leaflets could use the evaluation tool as a framework during PIL development to help ensure that items are included which promote and support more informed decisions about trial participation. Further research is required to evaluate the inclusion of such information.
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Literature
2.
go back to reference Beauchamp TL, Childress JF: Principles of Biomedical Ethics. 1994, Oxford: Oxford University Press Beauchamp TL, Childress JF: Principles of Biomedical Ethics. 1994, Oxford: Oxford University Press
3.
go back to reference International Conference on Harmonisation (ICH): Step 4 version. ICH Harmonised Tripartite Guideline: Guideline for Good Clinical Practice E6(R1). 1996, Geneva: ICH International Conference on Harmonisation (ICH): Step 4 version. ICH Harmonised Tripartite Guideline: Guideline for Good Clinical Practice E6(R1). 1996, Geneva: ICH
4.
go back to reference National Research Ethics Service (NRES): Information Sheet and Consent Forms: Guidance for Researchers and Reviewers. 2009, London: National Health Service, National Patient Safety Agency National Research Ethics Service (NRES): Information Sheet and Consent Forms: Guidance for Researchers and Reviewers. 2009, London: National Health Service, National Patient Safety Agency
5.
go back to reference Wade J, Donovan JL, Lane JA, Neal DE, Hamdy FC: It's not just what you say, it's also how you say it: opening the 'black box' of informed consent appointments in randomised controlled trials. Soc Sci Med. 2009, 68: 2018-2028. 10.1016/j.socscimed.2009.02.023.CrossRefPubMed Wade J, Donovan JL, Lane JA, Neal DE, Hamdy FC: It's not just what you say, it's also how you say it: opening the 'black box' of informed consent appointments in randomised controlled trials. Soc Sci Med. 2009, 68: 2018-2028. 10.1016/j.socscimed.2009.02.023.CrossRefPubMed
6.
go back to reference Antoniou EE, Draper H, Reed K, Buris A, Southwood TR, Zeegers MP: An empirical study on the preferred size of the participant information sheet in research. J Med Ethics. 2011, 37: 557-562. 10.1136/jme.2010.041871.CrossRefPubMed Antoniou EE, Draper H, Reed K, Buris A, Southwood TR, Zeegers MP: An empirical study on the preferred size of the participant information sheet in research. J Med Ethics. 2011, 37: 557-562. 10.1136/jme.2010.041871.CrossRefPubMed
7.
go back to reference Brown RF, Shuk E, Butow P, Edgerson S, Tattersall MH, Ostroff JS: Identifying patient information needs about cancer clinical trials using a Question Prompt List. Patient Educ Couns. 2011, 84: 69-77. 10.1016/j.pec.2010.07.005.CrossRefPubMed Brown RF, Shuk E, Butow P, Edgerson S, Tattersall MH, Ostroff JS: Identifying patient information needs about cancer clinical trials using a Question Prompt List. Patient Educ Couns. 2011, 84: 69-77. 10.1016/j.pec.2010.07.005.CrossRefPubMed
8.
go back to reference Flory J, Emanuel E: Interventions to improve research participants' understanding in informed consent for research: a systematic review. JAMA. 2000, 6 (292): 1593-1601. Flory J, Emanuel E: Interventions to improve research participants' understanding in informed consent for research: a systematic review. JAMA. 2000, 6 (292): 1593-1601.
9.
go back to reference Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, Cothart IR, Ross S, Shepherd SM, Russell D: Factors that limit the quality, number and progress of randomised controlled trials. Health Technol Assess. 1999, 3: 1-143.PubMed Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, Cothart IR, Ross S, Shepherd SM, Russell D: Factors that limit the quality, number and progress of randomised controlled trials. Health Technol Assess. 1999, 3: 1-143.PubMed
10.
go back to reference Sand K, Loge JH, Berger O, Gronberg BH, Kaasa S: Lung cancer patients’ perceptions of informed consent documents. Patient Educ Couns. 2008, 73: 313-317. 10.1016/j.pec.2008.06.011.CrossRefPubMed Sand K, Loge JH, Berger O, Gronberg BH, Kaasa S: Lung cancer patients’ perceptions of informed consent documents. Patient Educ Couns. 2008, 73: 313-317. 10.1016/j.pec.2008.06.011.CrossRefPubMed
11.
go back to reference Canvin K, Jacoby A: Duty, desire or indifference? A qualitative study of patient decisions about recruitment to an epilepsy treatment trial. Trials. 2006, 7: 32-10.1186/1745-6215-7-32.CrossRefPubMedPubMedCentral Canvin K, Jacoby A: Duty, desire or indifference? A qualitative study of patient decisions about recruitment to an epilepsy treatment trial. Trials. 2006, 7: 32-10.1186/1745-6215-7-32.CrossRefPubMedPubMedCentral
12.
go back to reference Estey A, Musseau A, Keehn L: Patient’s understanding of health information: a multihospital comparison. Patient Educ Couns. 1994, 24: 73-78. 10.1016/0738-3991(94)90027-2.CrossRefPubMed Estey A, Musseau A, Keehn L: Patient’s understanding of health information: a multihospital comparison. Patient Educ Couns. 1994, 24: 73-78. 10.1016/0738-3991(94)90027-2.CrossRefPubMed
13.
go back to reference Griffin JM, Struve JK, Collins D, Liu D, Nelson DB, Bloomfield HE: Long term clinical trials: how much information do participants retain from the informed consent process?. Contemp Clin Trials. 2006, 27: 441-448. 10.1016/j.cct.2006.04.006.CrossRefPubMed Griffin JM, Struve JK, Collins D, Liu D, Nelson DB, Bloomfield HE: Long term clinical trials: how much information do participants retain from the informed consent process?. Contemp Clin Trials. 2006, 27: 441-448. 10.1016/j.cct.2006.04.006.CrossRefPubMed
14.
go back to reference Itoh K, Sasaki Y, Fujii H, Ohtsu T, Wakita H, Igarashi T, Abe K: Patients in phase I trials of anti-cancer agents in Japan: motivation, comprehension and expectations. Br J Cancer. 1997, 76: 107-113. 10.1038/bjc.1997.344.CrossRefPubMedPubMedCentral Itoh K, Sasaki Y, Fujii H, Ohtsu T, Wakita H, Igarashi T, Abe K: Patients in phase I trials of anti-cancer agents in Japan: motivation, comprehension and expectations. Br J Cancer. 1997, 76: 107-113. 10.1038/bjc.1997.344.CrossRefPubMedPubMedCentral
15.
go back to reference Kruse AY, Kjaergard LL, Krogsgaard K, Gluud C, Mortensen EL, Gottschau A, Bjerg AM: A randomised trial assessing the impact of written information on outpatients’ knowledge about attitude toward randomised clinical trials. The INFO trial group. Control Clin Trials. 2000, 21: 223-240. 10.1016/S0197-2456(00)00048-9.CrossRefPubMed Kruse AY, Kjaergard LL, Krogsgaard K, Gluud C, Mortensen EL, Gottschau A, Bjerg AM: A randomised trial assessing the impact of written information on outpatients’ knowledge about attitude toward randomised clinical trials. The INFO trial group. Control Clin Trials. 2000, 21: 223-240. 10.1016/S0197-2456(00)00048-9.CrossRefPubMed
16.
go back to reference Murphy DA, O’Keefe ZH, Kaufman AH: Improving comprehension and recall of information for an HIV vaccine trial among women at risk for HIV: reading level simplification and inclusion of pictures to illustrate key concepts. AIDS Educ Prev. 1999, 11: 389-399.PubMed Murphy DA, O’Keefe ZH, Kaufman AH: Improving comprehension and recall of information for an HIV vaccine trial among women at risk for HIV: reading level simplification and inclusion of pictures to illustrate key concepts. AIDS Educ Prev. 1999, 11: 389-399.PubMed
17.
go back to reference Coyne CA, Xu R, Raich P, Plomer K, Dignan M, Wenzel L, Fairclough D, Habermann T, Schnell L, Quella S, Cella D, Eastern Cooperative Oncology Group: Randomised, controlled trial of an easy-to-read informed consent statement for clinical trial participation: a study of the Eastern Cooperative Oncology Group. J Clin Oncol. 2003, 21: 836-842. 10.1200/JCO.2003.07.022.CrossRefPubMed Coyne CA, Xu R, Raich P, Plomer K, Dignan M, Wenzel L, Fairclough D, Habermann T, Schnell L, Quella S, Cella D, Eastern Cooperative Oncology Group: Randomised, controlled trial of an easy-to-read informed consent statement for clinical trial participation: a study of the Eastern Cooperative Oncology Group. J Clin Oncol. 2003, 21: 836-842. 10.1200/JCO.2003.07.022.CrossRefPubMed
18.
go back to reference Wray RJ, Stryker JE, Winer E, Demetri G, Emmons KM: Do cancer patients fully understand clinical trial participation? A pilot study to assess informed consent and patient expectations. J Cancer Educ. 2007, 22: 21-24. 10.1007/BF03174370.CrossRefPubMed Wray RJ, Stryker JE, Winer E, Demetri G, Emmons KM: Do cancer patients fully understand clinical trial participation? A pilot study to assess informed consent and patient expectations. J Cancer Educ. 2007, 22: 21-24. 10.1007/BF03174370.CrossRefPubMed
19.
go back to reference Ives NJ, Troop M, Waters A, Davies S, Higgs S, Esterbrook PJ: Does an HIV clinical trial information booklet improve patient knowledge and understanding of HIV clinical trials?. HIV Med. 2001, 2: 241-249. 10.1046/j.1464-2662.2001.00084.x.CrossRefPubMed Ives NJ, Troop M, Waters A, Davies S, Higgs S, Esterbrook PJ: Does an HIV clinical trial information booklet improve patient knowledge and understanding of HIV clinical trials?. HIV Med. 2001, 2: 241-249. 10.1046/j.1464-2662.2001.00084.x.CrossRefPubMed
20.
go back to reference Bjorn E, Rossel P, Holm S: Can the written information to research subjects be improved? An empirical study. J Med Ethics. 1999, 25: 263-267. 10.1136/jme.25.3.263.CrossRefPubMedPubMedCentral Bjorn E, Rossel P, Holm S: Can the written information to research subjects be improved? An empirical study. J Med Ethics. 1999, 25: 263-267. 10.1136/jme.25.3.263.CrossRefPubMedPubMedCentral
21.
go back to reference Guarino P, Lamping DL, Elbourne D, Carpenter J, Peduzzi P: A brief measure of perceived understanding of informed consent in a clinical trial was validated. J Clin Epidemiol. 2006, 59: 608-614. 10.1016/j.jclinepi.2005.11.009.CrossRefPubMed Guarino P, Lamping DL, Elbourne D, Carpenter J, Peduzzi P: A brief measure of perceived understanding of informed consent in a clinical trial was validated. J Clin Epidemiol. 2006, 59: 608-614. 10.1016/j.jclinepi.2005.11.009.CrossRefPubMed
22.
go back to reference Ryan RE, Prictor MJ, McLuaghlin KJ, Hill SJ: Audio-visual presentation of information for informed consent for participation in clinical trial. Cochrane Database Syt Rev. 2008, 23: CD003717- Ryan RE, Prictor MJ, McLuaghlin KJ, Hill SJ: Audio-visual presentation of information for informed consent for participation in clinical trial. Cochrane Database Syt Rev. 2008, 23: CD003717-
23.
go back to reference Dunn LB, Lindamer LA, Palmer BW, Schneiderman LJ, Jeste DV: Enhancing comprehension of consent for research in older patients with psychosis: a randomised study of novel consent procedure. Am J Psychiatry. 2001, 158: 1911-1913. 10.1176/appi.ajp.158.11.1911.CrossRefPubMed Dunn LB, Lindamer LA, Palmer BW, Schneiderman LJ, Jeste DV: Enhancing comprehension of consent for research in older patients with psychosis: a randomised study of novel consent procedure. Am J Psychiatry. 2001, 158: 1911-1913. 10.1176/appi.ajp.158.11.1911.CrossRefPubMed
24.
go back to reference Knapp P, Raynor DK, Silcock J, Parkinson B: Can user-testing of a clinical trial information sheet make it fit-for-purpose? – a randomised controlled trial. BMC Med. 2011, 9: 89-10.1186/1741-7015-9-89.CrossRefPubMedPubMedCentral Knapp P, Raynor DK, Silcock J, Parkinson B: Can user-testing of a clinical trial information sheet make it fit-for-purpose? – a randomised controlled trial. BMC Med. 2011, 9: 89-10.1186/1741-7015-9-89.CrossRefPubMedPubMedCentral
25.
go back to reference Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Homes Rovner M, Llewellyn Thomas H, Lyddiatt A, Legare F, Thomson R: Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011, 10: CD001431-PubMed Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Homes Rovner M, Llewellyn Thomas H, Lyddiatt A, Legare F, Thomson R: Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011, 10: CD001431-PubMed
26.
go back to reference Abhyankar P: Decision making about cancer treatment and clinical trial participation. PhD thesis. 2008, Leeds: University of Leeds Abhyankar P: Decision making about cancer treatment and clinical trial participation. PhD thesis. 2008, Leeds: University of Leeds
27.
go back to reference McCann S, Campbell MK, Entwistle VE: Reasons for participating in randomised controlled trials: conditional altruism and considerations for self. Trials. 2010, 11: 31-10.1186/1745-6215-11-31.CrossRefPubMedPubMedCentral McCann S, Campbell MK, Entwistle VE: Reasons for participating in randomised controlled trials: conditional altruism and considerations for self. Trials. 2010, 11: 31-10.1186/1745-6215-11-31.CrossRefPubMedPubMedCentral
28.
go back to reference Juraskova I, Butow P, Lopez A, Secombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF: Improving informed consent: a pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS). Health Expect. 2008, 11: 252-262. 10.1111/j.1369-7625.2008.00498.x.CrossRefPubMed Juraskova I, Butow P, Lopez A, Secombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF: Improving informed consent: a pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS). Health Expect. 2008, 11: 252-262. 10.1111/j.1369-7625.2008.00498.x.CrossRefPubMed
29.
go back to reference Sundaresan P, Turner S, Kneebone A, Pearse M, Butow P: Evaluating the utility of a patient decision aid for potential participants of a prostate cancer trial (RAVES-ROG 08.03). Radiother Oncol. 2011, 101 (3): 521-524. 10.1016/j.radonc.2011.07.016.CrossRefPubMed Sundaresan P, Turner S, Kneebone A, Pearse M, Butow P: Evaluating the utility of a patient decision aid for potential participants of a prostate cancer trial (RAVES-ROG 08.03). Radiother Oncol. 2011, 101 (3): 521-524. 10.1016/j.radonc.2011.07.016.CrossRefPubMed
30.
go back to reference Abhyankar P, Bekker HL, Summers BA, Velikova G: Why values elicitation techniques enable people to make informed decisions about cancer trial participation. Health Expect. 2011, 14: 20-32.CrossRefPubMed Abhyankar P, Bekker HL, Summers BA, Velikova G: Why values elicitation techniques enable people to make informed decisions about cancer trial participation. Health Expect. 2011, 14: 20-32.CrossRefPubMed
31.
go back to reference Brehaut JC, Lott A, Fergusson DA, Shojania KG, Kimmelman J, Saginur R: Can patient decision aids help people make good decisions about participating in clinical trials? A study protocol. Implement Sci. 2008, 23: 38-CrossRef Brehaut JC, Lott A, Fergusson DA, Shojania KG, Kimmelman J, Saginur R: Can patient decision aids help people make good decisions about participating in clinical trials? A study protocol. Implement Sci. 2008, 23: 38-CrossRef
32.
go back to reference Gillies K, Entwistle V: Supporting positive experiences and sustained participation in clinical trials: looking beyond information provision. J Med Ethics. 2012, 38 (12): 751-756. 10.1136/medethics-2011-100059.CrossRefPubMed Gillies K, Entwistle V: Supporting positive experiences and sustained participation in clinical trials: looking beyond information provision. J Med Ethics. 2012, 38 (12): 751-756. 10.1136/medethics-2011-100059.CrossRefPubMed
33.
go back to reference Elwyn G, O'Connor A, Stacey D, Volk R, Edwards A, Coulter A, Thomson R, Barrat A, Barry M, Bernstein S, Butow P, Clarke A, Entwistle V, Feldman-Stewart D, Holmes-Rovner M, Llewellyn-Thomas H, Moujmid N, Mulley A, Ruland C, Sepucha K, Sykes A, Whelan T: International Patient Decision Aid Standards (IPDAS) Collaboration. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006, 333: 417-10.1136/bmj.38926.629329.AE.CrossRefPubMedPubMedCentral Elwyn G, O'Connor A, Stacey D, Volk R, Edwards A, Coulter A, Thomson R, Barrat A, Barry M, Bernstein S, Butow P, Clarke A, Entwistle V, Feldman-Stewart D, Holmes-Rovner M, Llewellyn-Thomas H, Moujmid N, Mulley A, Ruland C, Sepucha K, Sykes A, Whelan T: International Patient Decision Aid Standards (IPDAS) Collaboration. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006, 333: 417-10.1136/bmj.38926.629329.AE.CrossRefPubMedPubMedCentral
34.
go back to reference Brehaut JC, Carroll K, Elwyn G, Saginur R, Kimmelman J, Shojania K, Syrowatka A, Nguyen T, Hoe E, Fergusson D: Informed consent documents do not encourage good-quality decision making. J Clin Epidemiol. 2012, 65: 708-724. 10.1016/j.jclinepi.2012.01.004.CrossRefPubMed Brehaut JC, Carroll K, Elwyn G, Saginur R, Kimmelman J, Shojania K, Syrowatka A, Nguyen T, Hoe E, Fergusson D: Informed consent documents do not encourage good-quality decision making. J Clin Epidemiol. 2012, 65: 708-724. 10.1016/j.jclinepi.2012.01.004.CrossRefPubMed
35.
go back to reference Tait AR, Voepel-Lewis T, Zikmund-Fisher BJ, Fagerlin A: The effect of format on parents’ understanding of the risks and benefits of clinical research: a comparison between text, tables and graphics. J Health Commun. 2010, 15: 487-501. 10.1080/10810730.2010.492560.CrossRefPubMedPubMedCentral Tait AR, Voepel-Lewis T, Zikmund-Fisher BJ, Fagerlin A: The effect of format on parents’ understanding of the risks and benefits of clinical research: a comparison between text, tables and graphics. J Health Commun. 2010, 15: 487-501. 10.1080/10810730.2010.492560.CrossRefPubMedPubMedCentral
36.
go back to reference The European Parliament and the Council of the European Union: Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001. OJEC. 2001, 121: 34-44. The European Parliament and the Council of the European Union: Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001. OJEC. 2001, 121: 34-44.
38.
go back to reference Boulos MN: British internet-derived patient information on diabetes mellitus: is it readable?. Diabetes Technol Ther. 2005, 7 (3): 528-535. 10.1089/dia.2005.7.528.CrossRefPubMed Boulos MN: British internet-derived patient information on diabetes mellitus: is it readable?. Diabetes Technol Ther. 2005, 7 (3): 528-535. 10.1089/dia.2005.7.528.CrossRefPubMed
39.
go back to reference Beardsley E, Jefford M, Mileshkin L: Longer consent forms for clinical trials compromise patient understanding: so why are they lengthening?. J Clin Oncol. 2007, 25: e13-e14. 10.1200/JCO.2006.10.3341.CrossRefPubMed Beardsley E, Jefford M, Mileshkin L: Longer consent forms for clinical trials compromise patient understanding: so why are they lengthening?. J Clin Oncol. 2007, 25: e13-e14. 10.1200/JCO.2006.10.3341.CrossRefPubMed
Metadata
Title
Patient information leaflets (PILs) for UK randomised controlled trials: a feasibility study exploring whether they contain information to support decision making about trial participation
Authors
Katie Gillies
Wan Huang
Zoë Skea
Jamie Brehaut
Seonaidh Cotton
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Trials / Issue 1/2014
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-15-62

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