The Ethics of Decentralized Clinical Trials and Informed Consent: Taking Technologies' Soft Impacts into Account.

IF 1.8 3区 哲学 Q2 ETHICS Health Care Analysis Pub Date : 2024-05-19 DOI:10.1007/s10728-024-00483-1
Tessa I van Rijssel, Ghislaine J M W van Thiel, Johannes J M van Delden
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Abstract

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials.

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分散临床试验和知情同意的伦理:考虑技术的软影响。
分散式临床试验(DCT)有可能推动临床试验的开展,但也会引发一些伦理问题,包括获得有效的知情同意。关于数字化带来的伦理问题的讨论主要集中在与数据保护、安全性和数据质量等相关的直接风险上。但我们认为,需要从更广的视角来看待 DCT 的伦理问题,以应对 DCT 实践带来的新挑战。数字化通过塑造行为、体验、社会关系和价值观,产生了超越其直接目的的影响。我们研究了知情同意程序中受 DCT 影响的四个要素,同时考虑到技术的这些软影响:(i) 告知参与者并测试其理解程度,(ii) 与责任和负担相关的自由,(iii) 参与者与研究者关系中的信任,以及 (iv) 对隐私概念的影响。我们的分析表明,广阔的视野是优化开展 DCT 的关键。此外,我们还深入分析了 DCT 对知情同意的伦理影响。像 DCT 这样的技术可能会产生深远的影响,而现有的监管框架并没有立即解决这些问题,但认识到这一点非常重要。这些发现可以指导未来的 DCT 实践,在这种新颖的临床试验方法中促进临床研究的重要价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
3
期刊介绍: Health Care Analysis is a journal that promotes dialogue and debate about conceptual and normative issues related to health and health care, including health systems, healthcare provision, health law, public policy and health, professional health practice, health services organization and decision-making, and health-related education at all levels of clinical medicine, public health and global health. Health Care Analysis seeks to support the conversation between philosophy and policy, in particular illustrating the importance of conceptual and normative analysis to health policy, practice and research. As such, papers accepted for publication are likely to analyse philosophical questions related to health, health care or health policy that focus on one or more of the following: aims or ends, theories, frameworks, concepts, principles, values or ideology. All styles of theoretical analysis are welcome providing that they illuminate conceptual or normative issues and encourage debate between those interested in health, philosophy and policy. Papers must be rigorous, but should strive for accessibility – with care being taken to ensure that their arguments and implications are plain to a broad academic and international audience. In addition to purely theoretical papers, papers grounded in empirical research or case-studies are very welcome so long as they explore the conceptual or normative implications of such work. Authors are encouraged, where possible, to have regard to the social contexts of the issues they are discussing, and all authors should ensure that they indicate the ‘real world’ implications of their work. Health Care Analysis publishes contributions from philosophers, lawyers, social scientists, healthcare educators, healthcare professionals and administrators, and other health-related academics and policy analysts.
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