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Proposals to Conduct Randomized Controlled Trials Without Informed Consent: a Narrative Review.

TitleProposals to Conduct Randomized Controlled Trials Without Informed Consent: a Narrative Review.
Publication TypeJournal Article
Year of Publication2016
AuthorsFlory JH, Mushlin AI, Goodman ZI
JournalJ Gen Intern Med
Volume31
Issue12
Pagination1511-1518
Date Published2016 Dec
ISSN1525-1497
KeywordsHumans, Informed Consent, Patient Selection, Randomized Controlled Trials as Topic, Research Design
Abstract

BACKGROUND: Individual informed consent from all participants is required for most randomized clinical trials (RCTs). However, some exceptions-for example, emergency research-are widely accepted.

METHODS: The literature on various approaches to randomization without consent (RWOC) has never been systematically reviewed. Our goal was to provide a survey and narrative synthesis of published proposals for RWOC. We focused on proposals to randomize at least some participants in a study without first obtaining consent to randomization. This definition included studies that omitted informed consent entirely, omitted informed consent for selected patients (e.g., the control group), obtained informed consent to research but not to randomization, or only obtained informed consent to randomization after random assignment had already occurred. It omitted oral and staged consent processes that still obtain consent to randomization from all participants before randomization occurs.

RESULTS: We identified ten different proposals for RWOC: two variants of cluster randomization, two variants of the Zelen design, consent to postponed information, two-stage randomized consent, cohort multiple RCT, emergency research, prompted optional randomization trials, and low-risk pragmatic RCTs without consent.

CONCLUSION: Of all designs discussed here, only cluster randomized designs and emergency research are routinely used, with the justification that informed consent is infeasible in those settings. Other designs have raised concerns that they do not appropriately respect patient autonomy. Recent proposals have emphasized the importance for RWOC of demonstrating such respect through systematic patient engagement, transparency, and accountability, potentially in the context of learning health care systems.

DOI10.1007/s11606-016-3780-5
Alternate JournalJ Gen Intern Med
PubMed ID27384536
PubMed Central IDPMC5130947
Grant ListK08 HS023898 / HS / AHRQ HHS / United States
Category: 
Faculty Publication