Evaluation of the Informed Consent Process of a Multicenter Tuberculosis Treatment Trial.
BACKGROUND
Ethical principles obligate researchers to maximize study participants' comprehension during the informed consent process for clinical trials. A pilot evaluation of the consent process was conducted during an international clinical trial of treatment for pulmonary tuberculosis to assess the feasibility of conducting an evaluation in a larger population and to guide these future efforts.


METHODS
Study staff administered an informed consent assessment tool (ICAT) to a convenience sample of trial participants, measuring comprehension of consent components as derived from the Common Rule and FDA Title 21 Part 50, and satisfaction with the process. Participating site staff completed a consent process questionnaire about consent practices at their respective sites and provided improvement recommendations. ICAT scores and corresponding practices were compared where both were completed.


RESULTS
ICATs (n= 54) were submitted from one site in Spain (n= 10), one in Uganda (n= 30), and five in the United States (n= 14). Participants were primarily male (76%), born in Africa (n= 31, 57%), and had a median age of 27 years (interquartile range [IQR]: 24-42). Median ICAT scores were 80% (IQR: 67-93) for comprehension and 89% (IQR: 78-100) for satisfaction. Ugandan participants scored higher than participants from other sites on comprehension (87% vs. 64%) and satisfaction (100% vs. 78%). Staff from 14 sites completed consent process questionnaires. Median ICAT scores for comprehension and satisfaction were higher at sites that utilized visual aids. Practice recommendations included shorter forms, simpler documents, and supplementary materials.


CONCLUSIONS
Participants achieved high levels (≥80%) of comprehension and satisfaction with their current consent processes. Higher ICAT scores at one site suggest an additional evaluation may identify approaches to improve comprehension and satisfaction in future trials. Through this pilot evaluation, complexities and challenges were identified in obtaining consent in a large, international multicenter trial and provided insights for a more robust assessment of the consent process in future trials.
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention and CDC Foundation.
Kimberley N
KN
Chapman
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention.
Eric
E
Pevzner
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention.
Joan M
JM
Mangan
Denver Public Health and University of Colorado Health Sciences Center.
Peter
P
Breese
Uganda-Case Western Reserve University Research Collaboration.
Dorcas
D
Lamunu
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention.
Robin
R
Shrestha-Kuwahara
Uganda-Case Western Reserve University Research Collaboration and Community Research Advisory Group, Tuberculosis Trials Consortium.
Joseph G
JG
Nakibali
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention and Tuberculosis Trials Consortium (TBTC).
Stefan V
SV
Goldberg
Comprehension; informed consent; satisfaction; tuberculosis