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Informed Consent in the NICU Setting: An Ethically Optimal Model for Research Solicitation

Abstract

Recruiting patients for studies in the Neonatal Intensive Care Unit is a complex endeavour. Much discussion has occurred regarding the optimal recruitment “model” for this environment. This paper discusses current and suggested recruitment models for the NICU setting and presents a systematic approach to the consent process that focuses on the protection and promotion of parental autonomy. The proposed model incorporates several key considerations for an ethically optimal approach to the inclusion of neonates in research: informing parents about research and their rights prior to any solicitation, asking parents if they wish to be approached for research, approaching for one study at a time, assuring the study is relevant to the infants’ current clinical status, minimising information overload, allowing parents appropriate time (which will vary from study to study) to consider their choice, and providing a waiting period between subsequent approaches. It is argued that parental ability to make a truly informed choice may be improved when following the proposed model.

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References

  1. Grodin MA . Historical origins of the Nuremberg Code In: Annas GJ, Grodin MA, editors. The Nazi Doctors and the Nuremberg Code. New York: Oxford University Press; 1992 p. 121–144.

    Google Scholar 

  2. Mason S . Obtaining informed consent for neonatal randomized controlled trials-an “elaborate ritual”? Arch Dis Child 1997;76:F143–5.

    Article  CAS  Google Scholar 

  3. Shields-Poe D, Pinelli J . Variables associated with parental stress in the neonatal intensive care unit. Neonat Netw 1997;16:29–37.

    CAS  Google Scholar 

  4. Singhal N, Oberle K, Burgess E, Huber-Okrainec J . Parents’ perceptions of research with newborns. J Perinatol 2002;22:57–63.

    Article  Google Scholar 

  5. Pinch WJ, Spielman ML . The parents’ perspective: ethical decision making in neonatal intensive care. J Adv Nurs 1990;15:712–719.

    Article  CAS  Google Scholar 

  6. Manning DJ . Presumed consent in emergency neonatal research. J Med Ethics 2000;26:249–253.

    Article  CAS  Google Scholar 

  7. Modi N . Neonatal research. Lancet 1998;351:530.

    Article  CAS  Google Scholar 

  8. Ubel P . Is information always a good thing? Med Care 2002;40:39–44.

    Article  Google Scholar 

  9. Macklin, R . Understanding informed consent. Acta Oncol 1999;38:83–87.

    Article  CAS  Google Scholar 

  10. Kuczewski MG, Marshall P . The decision dynamics of clinical research. Med Care 2002;40:45–54.

    Article  Google Scholar 

  11. Taylor B . Parental autonomy and consent to treatment. J Adv Nurs 1999;29:570–576.

    Article  CAS  Google Scholar 

  12. Hewlett S . Consent to clinical research-adequately voluntary or substantially influenced? J Med Ethics 1996;22:232–237.

    Article  CAS  Google Scholar 

  13. Pierro A, Spitz L . Informed cosent in clinical research: the crisis in paediatrics. Lancet 1997;349:1703.

    Article  CAS  Google Scholar 

  14. Morley C . Consent is not always practical in emergency treatments. BMJ 1997;314:1480.

    Article  CAS  Google Scholar 

  15. Modi N . Clinical trials and neonatal intensive care. Arch Dis Child 1994;70:F231–F232.

    Article  CAS  Google Scholar 

  16. Truog RD, Robinson W, Randolph A . Is informed consent always necessary for randomized, controlled trials? N Engl J Med 1999;340:804–807.

    Article  CAS  Google Scholar 

  17. Wiswell TE, Gannon CM, Jacob J, et al. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics 2000;105:1–7.

    Article  CAS  Google Scholar 

  18. United States Department of Health and Human Services, National Institutes of Health Office for Protection form Research Risks, 2001, http://ohrp.osophs.dhhs.gov/humansubjects/guidance/45cfr46.htm.

  19. Mutch L, King R . Obtaining parental consent — opting in or opting out? Arch Dis Child 1985;60:979–980.

    Article  CAS  Google Scholar 

  20. Rogers CG, Tyson JE, Kennedy KA, Broyles RS, Hickman JF . Conventional consent with opting in versus simplified consent with opting out: an exploratory trial for studies that do not increase patient risk. J Pediatr 1998;132:606–611.

    Article  CAS  Google Scholar 

  21. Stenson BJ, Becher J-C, McIntosh N . Neonatal research: the parental perspective. Arch Dis Child Fetal Neonatal Ed 2004;89:F321–F324.

    Article  CAS  Google Scholar 

  22. Zupancic JA, Gillie P, Streiner DL, Watts JL, Schmidt B . Determinants of parental authorization for involvement of newborn infants in clinical trials. Pediatrics 1997;99:e6 (http://www.pediatrics.org/cgi/content/full/99/1/e6).

    Article  CAS  Google Scholar 

  23. Meisel A, Kuczewski M . Legal and ethical myths about informed consent. Arch Intern Med 1996;156:2521–2526.

    Article  CAS  Google Scholar 

  24. Bridson J, Hammond C, Leach A, Chester MR . Making consent patient centred. BMJ 2003;327:1159–1161.

    Article  Google Scholar 

  25. Catlin A . Commentary on “Waiting in Araf”. Informed consent: issues and regulations. Ped Nurs 1998;24:573–577.

    CAS  Google Scholar 

  26. Harth SC, Johnstone RR, Thong YH . The psychological profile of parents who volunteer their children for clinical research:a controlled study. J Med Ethics 1992;18:86–93.

    Article  CAS  Google Scholar 

  27. Beveridge J, Bodnaryk K, Ramachandran C . Family-centred care in the NICU. Can Nurs 2001;97:14–18.

    CAS  Google Scholar 

  28. Kant I, Paton HJ, (trans) Groundwork of the Metaphysic of Morals. New York: Harper & Row; 1964 p. 96.

    Google Scholar 

  29. Harth SC, Thong YH . Parental perceptions and attitudes about informed consent in clinical research involving children. Soc Sci Med 1995;40:1573–1577.

    Article  CAS  Google Scholar 

  30. Caplan A, Keynote Address. The Association of Clinical Research Professionals Annual North American Conference and Exposition. Philadelphia; 2003.

  31. Levene M, Wright I, Griffiths G . Is informed consent in neonatal randomized controlled trials ritual? Lancet 1996;347:475.

    Article  CAS  Google Scholar 

  32. Loue S, Okello D, Kawuma M . Research bioethics in the Ugandan context: a program summary. J Law, Med Ethics 1996;24:47–53.

    Article  CAS  Google Scholar 

  33. Bosk CL . Obtaining voluntary consent for research in desperately ill patients. Med Care 2002;40:64–68.

    Article  Google Scholar 

  34. Baum M . New approach for recruitment into randomised controlled trials. Lancet 1993;341:812–813.

    Article  CAS  Google Scholar 

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Golec, L., Gibbins, S., Dunn, M. et al. Informed Consent in the NICU Setting: An Ethically Optimal Model for Research Solicitation. J Perinatol 24, 783–791 (2004). https://doi.org/10.1038/sj.jp.7211198

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