title: Potential subjects' responses to an ethics questionnaire in a phase I study of deep brain stimulation in early Parkinson's disease.
abstract: BACKGROUND
  Central to ethically justified clinical trial design is the need for an informed consent process responsive to how potential subjects actually comprehend study participation, especially study goals, risks, and potential benefits. This will be particularly challenging when studying deep brain stimulation and whether it impedes symptom progression in Parkinson's disease, since potential subjects will be Parkinson's patients for whom deep brain stimulation will likely have therapeutic value in the future as their disease progresses.
  
  
  METHODS
  As part of an expanded informed consent process for a pilot Phase I study of deep brain stimulation in early stage Parkinson's disease, an ethics questionnaire composed of 13 open-ended questions was distributed to potential subjects. The questionnaire was designed to guide potential subjects in thinking about their potential participation.
  
  
  RESULTS
  While the purpose of the study (safety and tolerability) was extensively presented during the informed consent process, in returned responses 70 percent focused on effectiveness and 91 percent included personal benefit as poten- tial benefit from enrolling. However, 91 percent also indicated helping other Parkinson's patients as motivation when considering whether or not to enroll.
  
  
  CONCLUSIONS
  This combination of responses highlights two issues to which investigators need to pay close attention in future trial designs: (1) how, and in what ways, informed consent processes reinforce potential subjects' preconceived understandings of benefit, and (2) that potential subjects see themselves as part of a community of Parkinson's sufferers with responsibilities extending beyond self-interest. More importantly, it invites speculation that a different paradigm for informed consent may be needed.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, California, USA. stuart.finder@cshs.org
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Finder
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bliton
authors.forename: Chandler E
authors.initials: CE
authors.lastname: Gill
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Davis
authors.forename: Peter E
authors.initials: PE
authors.lastname: Konrad
authors.forename: P David
authors.initials: PD
authors.lastname: Charles
mesh_terms: D000328:Adult; D000368:Aged; D017321:Clinical Trials, Phase I as Topic; D032882:Comprehension; D003657:Decision Making; D046690:Deep Brain Stimulation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data; D035842:Research Subjects / Q000523:psychology*; D011795:Surveys and Questionnaires