MRCT Center Return of Individual Results to Participants Toolkit, Version 1.0 (Accessed At
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MRCT Center Return of Individual Results to Participants Toolkit Framework Version 1.2 22 November 2017 Return of Individual Results Toolkit Table of Contents INTRODUCTION .............................................................................................................................................. 2 Figure 1: Clinical Trial Data Types That May be Returned ........................................................................ 3 Figure 2: Return of Individual Results Tasks and Tools by Trial Phase for Clinical Teams ......................... 4 1. TOOLS FOR THE TEAM PLANNING THE STUDY ....................................................................................... 5 Tool 1: Rationale Matrix for Returning Various Data Types ....................................................................... 5 Tool 2: Points to Consider Along the Clinical Trial Timeline ....................................................................... 9 Tool 3: Selected Return of Individual Results Regulations and Resources ............................................... 16 Return of Results implications Under HIPAA / CLIA ................................................................................. 18 Tool 4: Informed Consent Language for Return of Individual Results ...................................................... 20 2. TOOLS FOR INSTITUTIONAL REVIEW BOARDS/ETHICS COMMITTEES .................................................. 27 Tool 5: Checklist for Institutional Review Board (IRB) and Ethics Committees ....................................... 27 3. TOOLS FOR SITE STAFF WHO RETURN RESULTS ................................................................................... 31 Tool 6: Sample Authorization Form: Designation of Third Party .............................................................. 31 Tool 7: End of Study Form ........................................................................................................................ 33 Tool 8: Sample Form: Communication of Study Arm and Individual Study Results at the End of Trial .... 37 4. CASE STUDIES ....................................................................................................................................... 39 Case Study 1: HER2 Negative Metastatic Breast Cancer ......................................................................... 39 Case Study 2: Clinical Trial Of Asthma Inhalers With Incidental Findings ................................................. 40 Case Study 3: Biomarkers For Early Prostate Cancer ............................................................................... 41 Case Study 4: Discovering Sexually Transmitted Infections In A Cohort Study In SE Asian Country ........ 43 Case Study 5: Incidental Findings In The Context Of Universal Health Coverage In SE Asian Country ..... 45 Case Study 6: Discovering HIV Status In Healthy Clinical Trial Participants In India ................................. 46 Case Study 7: Retrospective Pharmacogenomics Research Using Exploratory Techniques..................... 48 Case Study 8: The Role of CLIA Regulations and A Priori Informed Consent in Releasing Genetic Data to Family Members ................................................................................................................ 50 Case Study 9: A Patient Engagement Pilot Initiative to Provide Patients with Access to Data During a Clinical Trial......................................................................................................................... 52 Case Study 10: Pfizer Link: Returning Clinical Data to Patients with Online Patient Community and Blue Button® ............................................................................................................................... 53 Case Study 11: Hypothetical Case: Incidental Findings From A Clinical Research Study Involving The Generation Of Exploratory Genetic Data ............................................................................ 55 MRCT Center Return of Individual Results Toolkit Page 1 November 22, 2017 | Version 1.2 © MRCT Center INTRODUCTION The Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard (MRCT Center) Return of Individual Results workgroup is a multi-stakeholder group comprised of 45 international members from academic and medical centers, industry, clinical research organizations, regulatory agencies, institutional review boards, non-profit agencies, and patient advocacy organizations. The workgroup developed this Toolkit to accompany the MRCT Center Return of Individual Results to Participants: Recommendations Document. The Recommendations Document addresses the basic principles, processes, content and data types (urgent results, routine results, end of study individual results, exploratory results) for returning individual results to study participants. This Toolkit provides practical tools, forms, checklists, sample letters and case studies. It is meant to include hands-on instruments for implementing the basic principles of the Recommendations Document. This Toolkit includes tools for the study team that plans the study, for the Ethics Committee/Institutional Review Board and for site staff who return results. The Toolkit also contains practical implementation tips and case studies of scenarios for prospective trials, ongoing trials and retrospective/closed trials as well as cases in which the informed consent does not explicitly plan for return of results. The case studies are accompanied by analyses that reflect considerations for returning individual results. The MRCT Center encourages broad dissemination of the Toolkit along with the Recommendations Document. The MRCT Center appreciates feedback and additional contributions (addressed to [email protected]) so that we can continuously improve this Toolkit. If these materials are used in their entirety or in part, attribution should be made to the “MRCT Center Return of Individual Results to Participants Toolkit, Version 1.0 (accessed at www.mrctcenter.org/…...).” The toolkit is based on the Principles from the MRCT Center Return of Individual Results to Participants Recommendations Document. Principles: Return of Individual Results to Participants 1. Providing individual research results responds to the expressed interests and expectations of many clinical trial participants that their results be communicated to them. 2. Considerations pertaining to the return of individual research results to clinical trial participants should be integrated into the clinical trial and proactively planned. 3. The informed consent process should include information about the sponsor’s intention regarding the return of research results and allow for discussion of participants’ preferences to receive these results. 4. The plan for the return of individual research results should be reviewed by an independent ethics body overseeing the research to ensure the rights and welfare of research participants are protected. 5. If results are offered, participants should be able to choose whether or not to receive their individual research results. MRCT Center Return of Individual Results Toolkit Page 2 November 22, 2017 | Version 1.2 © MRCT Center 6. Sponsors and investigators have an obligation to return individual research results responsibly, taking into account medical significance, analytical validity and personal utility. 7. Individual research results should be returned in ways and at times that maintain the integrity of the research, insofar as the safety and welfare of the research participants are not at risk. 8. The purpose of research is not clinical care, and return of individual research results cannot substitute for appropriate clinical care and advice. 9. Return of individual research results should be planned and executed in compliance with institutional policies and local, regional, and national laws and regulations. Figure 1 summarizes the high-level return of individual results tasks by phase, and suggests when specific Data Types might be considered for return. Figure 2 mentions the tasks and lists the Tools presented in this Toolkit and demonstrates how each Tool fits into the clinical trial timeline. Figure 1: Clinical Trial Data Types That May be Returned MRCT Center Return of Individual Results Toolkit Page 3 November 22, 2017 | Version 1.2 © MRCT Center Figure 2: Return of Individual Results Tasks and Tools by Trial Phase for Clinical Teams Planning and Design Protocol and IC Active Trial Post-Trial Post-Trial Phase Development Phase Phase Analysis Phase Publication Phase • Urgent, medically • Individual Study Results actionable findings (Data (Data Type C) Type A) • Aggregate Study Results • Individual incidental and (Plain Language Summary; routine findings, including Data Type E) screening results (Data • Exploratory Results (Data be returned Data to Type Type B) Type D), in some cases • Choose which data types • Develop ICF including • Select designee(s) if any to • Sponsor - Prepare Return • Prepare and release and identify what data participant option to receive results of Individual Results Return of Individual will be returned. receive results and • Confirm opt-in/opt-out Materials (Data Type C) Results materials • Understand the global modality for return decision made in ICF • MD or PCP confirm the • Prepare and release context for and legal • Train site staff in Return of • Return Data Types A and designee(s), if any, who Aggregate Study Results constraints of Return of Individual Results B, as appropriate