title: A booklet on participants' rights to improve consent for clinical research: a randomized trial.
abstract: OBJECTIVE
  Information on the rights of subjects in clinical trials has become increasingly complex and difficult to understand. This study evaluates whether a simple booklet which is relevant to all research studies improves the understanding of rights needed for subjects to provide informed consent.
  
  
  METHODS
  21 currently used informed consent forms (ICF) from international clinical trials were separated into information related to the specific research study, and general information on participants' rights. A booklet designed to provide information on participants' rights which used simple language was developed to replace this information in current ICF's Readability of each component of ICF's and the booklet was then assessed using the Flesch-Kincaid Reading ease score (FK). To further evaluate the booklet 282 hospital inpatients were randomised to one of three ways to present research information; a standard ICF, the booklet combined with a short ICF, or the booklet combined with a simplified ICF. Comprehension of information related to the research proposal and to participant's rights was assessed by questionnaire.
  
  
  RESULTS
  Information related to participants' rights contributed an average of 44% of the words in standard ICFs, and was harder to read than information describing the clinical trial (FK 25 versus (vs.) 41 respectively, p = 0.0003). The booklet reduced the number of words and improved FK from 25 to 42. The simplified ICF had a slightly higher FK score than the standard ICF (50 vs. 42). Comprehension assessed in inpatients was better for the booklet and short ICF 62%, (95% confidence interval (CI) 56 to 67) correct, or simplified ICF 62% (CI 58 to 68) correct compared to 52%, (CI 47 to 57) correct for the standard ICF, p = 0.009. This was due to better understanding of questions on rights (62% vs. 49% correct, p = 0.0008). Comprehension of study related information was similar for the simplified and standard ICF (60% vs. 64% correct, p = 0.68).
  
  
  CONCLUSIONS
  A booklet provides a simple consistent approach to providing information on participant rights which is relevant to all research studies, and improves comprehension of patients who typically participate in clinical trials.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Auckland, New Zealand. Jocelyne.Benatar@adhb.govt.nz
authors.forename: Jocelyne R
authors.initials: JR
authors.lastname: Benatar
authors.forename: John
authors.initials: J
authors.lastname: Mortimer
authors.forename: Matthew
authors.initials: M
authors.lastname: Stretton
authors.forename: Ralph A H
authors.initials: RA
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D035843:Biomedical Research / Q000193:education* / Q000458:organization & administration; D002986:Clinical Trials as Topic; D032882:Comprehension; D032962:Consent Forms / Q000941:ethics / Q000592:standards*; D003625:Data Collection / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D011795:Surveys and Questionnaires