TY - JOUR
T1 - Patients’ Views About the Disclosure of Collateral Findings in Pragmatic Clinical Trials
T2 - a Focus Group Study
AU - Bollinger, Juli M.
AU - Geller, Gail
AU - Weinfurt, Kevin
AU - May, Elizabeth
AU - Morain, Stephanie R.
AU - Mathews, Debra J.H.
AU - Sugarman, Jeremy
N1 - Funding Information:
This work was supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director. Supplemental funding for this work was provided by the National Center for Complementary and Integrative Health under award number U24AT009676. Acknowledgments
Funding Information:
The authors thank Jerry Jarvik, MD, MPH, and Kathryn T. James, PA-C, MPH, for their input on this project and the focus group participants for sharing their time and perspectives.
Publisher Copyright:
© 2020, Society of General Internal Medicine.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Pragmatic clinical trials (PCTs) are increasingly being conducted to efficiently generate evidence to inform healthcare decision-making. Despite their growing acceptance, PCTs may involve a variety of ethical issues, including the management of pragmatic clinical trial-collateral findings (PCT-CFs), that is, information that emerges in PCTs that is unrelated to the primary research questions but may have implications for patients, clinicians, and health systems. Objective: We sought to understand patients’ views about PCT-CF disclosure, including how, by whom, and the nature and extent of information provided. Design: Prospective, qualitative focus group study. Participants: Focus groups were conducted in Baltimore, MD; Houston, TX; and Seattle, WA (overall N = 66), during July and August 2019. Approach: All groups discussed a hypothetical scenario involving the detection of a PCT-CF of contraindicated medications. Participants were asked about their reactions to the PCT-CF and issues related to its disclosure. Key Results: Reactions to learning about the PCT-CF were mixed, ranging from fear of a significant health problem, anger that the contraindicated medications had gone unnoticed and/or for being included in research without their permission, to gratitude for the information. Preferences for how such disclosures are made varied but were driven by several consistent desires, namely minimizing patient harm and anxiety and demonstrating trust and respect. Many wanted their treating clinician to be informed of the PCT-CF so that they would be prepared to answer patients’ questions and to discuss treatment options. Conclusions: The detection of PCT-CFs is likely to increase with further expansion of PCTs. As such, clinicians will undoubtedly become involved in the management of PCT-CFs. Our data illustrate some of the challenges clinicians may face when their patients are informed of a PCT-CF and the need to develop guidance for disclosing PCT-CFs in ways that align with patients’ preferences and values.
AB - Background: Pragmatic clinical trials (PCTs) are increasingly being conducted to efficiently generate evidence to inform healthcare decision-making. Despite their growing acceptance, PCTs may involve a variety of ethical issues, including the management of pragmatic clinical trial-collateral findings (PCT-CFs), that is, information that emerges in PCTs that is unrelated to the primary research questions but may have implications for patients, clinicians, and health systems. Objective: We sought to understand patients’ views about PCT-CF disclosure, including how, by whom, and the nature and extent of information provided. Design: Prospective, qualitative focus group study. Participants: Focus groups were conducted in Baltimore, MD; Houston, TX; and Seattle, WA (overall N = 66), during July and August 2019. Approach: All groups discussed a hypothetical scenario involving the detection of a PCT-CF of contraindicated medications. Participants were asked about their reactions to the PCT-CF and issues related to its disclosure. Key Results: Reactions to learning about the PCT-CF were mixed, ranging from fear of a significant health problem, anger that the contraindicated medications had gone unnoticed and/or for being included in research without their permission, to gratitude for the information. Preferences for how such disclosures are made varied but were driven by several consistent desires, namely minimizing patient harm and anxiety and demonstrating trust and respect. Many wanted their treating clinician to be informed of the PCT-CF so that they would be prepared to answer patients’ questions and to discuss treatment options. Conclusions: The detection of PCT-CFs is likely to increase with further expansion of PCTs. As such, clinicians will undoubtedly become involved in the management of PCT-CFs. Our data illustrate some of the challenges clinicians may face when their patients are informed of a PCT-CF and the need to develop guidance for disclosing PCT-CFs in ways that align with patients’ preferences and values.
KW - collateral finding
KW - patient perspective
KW - pragmatic clinical trial
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U2 - 10.1007/s11606-020-06113-5
DO - 10.1007/s11606-020-06113-5
M3 - Article
C2 - 32815061
AN - SCOPUS:85089704996
SN - 0884-8734
VL - 35
SP - 3436
EP - 3442
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 12
ER -