title: Patients' perspectives of enrollment in research without consent: the patients' experiences in emergency research-progesterone for the treatment of traumatic brain injury study.
abstract: OBJECTIVE
  Research in acute illness often requires an exception from informed consent. Few studies have assessed the views of patients enrolled in exception from informed consent trials. This study was designed to assess the views of patients and their surrogates of exception from informed consent enrollment within the context of a randomized, placebo-controlled trial of an investigational agent for traumatic brain injury.
  
  
  METHODS
  Interactive interview study.
  
  
  METHODS
  Nested within the Progesterone for the Treatment of Traumatic Brain Injury trial, a Phase III randomized controlled trial in acute traumatic brain injury.
  
  
  METHODS
  Patients and surrogates (for patients incapable of being interviewed) enrolled in Progesterone for the Treatment of Traumatic Brain Injury under exception from informed consent at 12 sites.
  
  
  METHODS
  None.
  
  
  RESULTS
  Interviews focused on respondents' acceptance of exception from informed consent enrollment in Progesterone for the Treatment of Traumatic Brain Injury, use of placebo and randomization, understanding of major study elements, and views regarding regulatory protections. Descriptive statistical analysis was performed; textual data were analyzed thematically. Eighty-five individuals were interviewed. Eighty-four percent had positive attitudes toward Progesterone for the Treatment of Traumatic Brain Injury inclusion. Seventy-eight percent found their inclusion under exception from informed consent acceptable, and 72% found use of exception from informed consent in Progesterone for the Treatment of Traumatic Brain Injury acceptable in general. Only two respondents clearly disagreed with both personal and general exception from informed consent enrollment. The most common concerns (26%) related to absence of consent. Eighty percent and 92% were accepting of placebo use and randomization, respectively. Although there were few black respondents (n = 11), they were less accepting of personal exception from informed consent enrollment than white respondents (55% vs 83%; p = 0.0494).
  
  
  CONCLUSIONS
  Acceptance of exception from informed consent in this placebo-controlled trial of an investigational agent was high and exceeded acceptance among community consultation participants. Exception from informed consent enrollment appears generally consistent with patients' preferences.
authors.affiliation: 1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. 2Department of Epidemiology, Rollins School of Public Health, Atlanta, GA. 3Atlanta VA Medical Center, Atlanta, GA. 4Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 5Department of Emergency Medicine, Hennepin County Medical Center and University of Minnesota School of Medicine, Minneapolis, MN. 6Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA. 7Department of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, CA. 8Department of Emergency Medicine, University of Texas Medical School at Houston, Houston, TX. 9Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, OH. 10Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA. 11Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
authors.forename: Neal W
authors.initials: NW
authors.lastname: Dickert
authors.forename: Victoria M
authors.initials: VM
authors.lastname: Scicluna
authors.forename: Jill M
authors.initials: JM
authors.lastname: Baren
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Biros
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Fleischman
authors.forename: Prasanthi R
authors.initials: PR
authors.lastname: Govindarajan
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Jones
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Pancioli
authors.forename: David W
authors.initials: DW
authors.lastname: Wright
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Pentz
mesh_terms: D000328:Adult; D000368:Aged; D035843:Biomedical Research / Q000379:methods*; D001930:Brain Injuries / Q000188:drug therapy*; D004630:Emergencies; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010465:Perception; D010919:Placebos; D011374:Progesterone / Q000627:therapeutic use*; D044469:Racial Groups; D035842:Research Subjects / Q000523:psychology; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D010919:Placebos; D011374:Progesterone