title: Key stakeholder perceptions about consent to participate in acute illness research: a rapid, systematic review to inform epi/pandemic research preparedness.
abstract: BACKGROUND
  A rigorous research response is required to inform clinical and public health decision-making during an epi/pandemic. However, the ethical conduct of such research, which often involves critically ill patients, may be complicated by the diminished capacity to consent and an imperative to initiate trial therapies within short time frames. Alternative approaches to taking prospective informed consent may therefore be used. We aimed to rapidly review evidence on key stakeholder (patients, their proxy decision-makers, clinicians and regulators) views concerning the acceptability of various approaches for obtaining consent relevant to pandemic-related acute illness research.
  
  
  METHODS
  We conducted a rapid evidence review, using the Internet, database and hand-searching for English language empirical publications from 1996 to 2014 on stakeholder opinions of consent models (prospective informed, third-party, deferred, or waived) used in acute illness research. We excluded research on consent to treatment, screening, or other such procedures, non-emergency research and secondary studies. Papers were categorised, and data summarised using narrative synthesis.
  
  
  RESULTS
  We screened 689 citations, reviewed 104 full-text articles and included 52. Just one paper related specifically to pandemic research. In other emergency research contexts potential research participants, clinicians and research staff found third-party, deferred, and waived consent to be acceptable as a means to feasibly conduct such research. Acceptability to potential participants was motivated by altruism, trust in the medical community, and perceived value in medical research and decreased as the perceived risks associated with participation increased. Discrepancies were observed in the acceptability of the concept and application or experience of alternative consent models. Patients accepted clinicians acting as proxy-decision makers, with preference for two decision makers as invasiveness of interventions increased. Research regulators were more cautious when approving studies conducted with alternative consent models; however, their views were generally under-represented.
  
  
  CONCLUSIONS
  Third-party, deferred, and waived consent models are broadly acceptable to potential participants, clinicians and/or researchers for emergency research. Further consultation with key stakeholders, particularly with regulators, and studies focused specifically on epi/pandemic research, are required. We highlight gaps and recommendations to inform set-up and protocol development for pandemic research and institutional review board processes.
  CRD42014014000.
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Neaudd Meirionnydd, Heath Park Campus, Cardiff, Wales, CF14 4YS, UK. GobatNH@cardiff.ac.uk.
authors.forename: Nina H
authors.initials: NH
authors.lastname: Gobat
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Neaudd Meirionnydd, Heath Park Campus, Cardiff, Wales, CF14 4YS, UK. GalM@cardiff.ac.uk.
authors.forename: Micaela
authors.initials: M
authors.lastname: Gal
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Neaudd Meirionnydd, Heath Park Campus, Cardiff, Wales, CF14 4YS, UK. FrancisNA@cardiff.ac.uk.
authors.forename: Nick A
authors.initials: NA
authors.lastname: Francis
authors.affiliation: College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK. HoodK1@cardiff.ac.uk.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.affiliation: Cochrane Institute of Primary Care and Public Health, Cardiff University, Neaudd Meirionnydd, Heath Park Campus, Cardiff, Wales, CF14 4YS, UK. WatkinsA6@cardiff.ac.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Watkins
authors.affiliation: University College Dublin, Dublin, Ireland. jill.turner@ucd.ie.
authors.forename: Jill
authors.initials: J
authors.lastname: Turner
authors.affiliation: University College Dublin, Dublin, Ireland. ronnie.g.moore@ucd.ie.
authors.forename: Ronald
authors.initials: R
authors.lastname: Moore
authors.affiliation: University of Western Australia, Perth, Australia. steve.webb@uwa.edu.au.
authors.forename: Steve A R
authors.initials: SA
authors.lastname: Webb
authors.affiliation: Oxford University, Oxford, UK. christopher.butler@phc.ox.ac.uk.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: University College Dublin, Dublin, Ireland. alistair.nichol@ucd.ie.
authors.forename: Alistair
authors.initials: A
authors.lastname: Nichol
mesh_terms: D001291:Attitude of Health Personnel; D002986:Clinical Trials as Topic / Q000941:ethics / Q000523:psychology*; D032882:Comprehension; D016638:Critical Illness; D058872:Epidemics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000523:psychology*; D058873:Pandemics; D057240:Patient Preference; D018579:Patient Selection / Q000941:ethics; D010465:Perception; D019727:Proxy; D012108:Research Personnel / Q000941:ethics / Q000523:psychology*; D035842:Research Subjects / Q000523:psychology*; D020458:Third-Party Consent / Q000941:ethics