Keywords
COVID-19, pandemic, research ethics, clinical trials, case studies
This article is included in the HRB-TMRN gateway.
This article is included in the Coronavirus (COVID-19) collection.
COVID-19, pandemic, research ethics, clinical trials, case studies
Protocol V2 includes suggestions from the reviewers. The Title was amended to reflect that the review more accurately fits a Rapid Review methodology. Some sentences were added in or amended to clarify that a description of the Standard Operating Procedures of an Irish Research Ethics Committee pre-COVID 19 will be included in the publication of this Rapid Review, along with how the Committee adapted their procedures to ensure timely and through ethical review during the pandemic. The details of the search strategy and outcome were clarified. Some references were added or amended per the reviewer’s advice. Clarification was also provided regarding the rationale for the contributions of the lay persons to this review.
See the authors' detailed response to the review by Linda Biesty
See the authors' detailed response to the review by Bethany Spielman
In December 2019 the first reports of a novel coronavirus, now designated SARS-CoV-2, emerged from China1. Since then SARS-CoV-2 has spread across the globe and is the agent responsible for a viral pneumonitis called COVID-192. Its virulence, the rapidity of its spread and the lack of either a vaccine or a treatment have led to the adoption of unprecedented public health measures worldwide3; and to high levels of interest and anxiety in the general population4.
The international medical and scientific research community has responded to the COVID-19 pandemic by generating a huge amount of literature to which the general public has access5. The COVID-19 related publications range from commentary and case reports to epidemiological studies and clinical trials. It is the policy of many journals during the pandemic to offer rapid review in order to make reports and research on COVID-19 available quickly6. However, London and Kimmelman have expressed concern that scientific and methodological research standards will fall in the urgency to produce results7. Similarly, the authors have observed considerable variability in the reported ethical review of the studies published and seek to conduct a systematic review of this question – how well are ethical disclosures ethical disclosures reported in the COVID-19 literature? Spector-Bagdady et al pointed out that clinicians and medical centres are faced with difficult decisions regarding which trials to participate in and are faced with challenges with implementing both an ethical and efficient recruitment method for COVID-19 trials8. Tansey and colleagues also highlighted the importance of having a framework in place for ethical review in an emergency situations9. Along with the results of this Rapid Review, a description will be provided of the response of an Irish Ethics Committee to the challenges presented by the COVID-19 pandemic. The Standard Operating Procedures of this Ethics Committee will be presented, along with how these were adapted to ensure thorough and timely ethical review during the COVID-19 pandemic.
The protocol is designed in line with the PRISMA-P checklist for systematic review10,11. The protocol is not eligible for registration on the PROSPERO database, as the question of interest relates to reporting and methodology rather than to a clinical outcome for participants.
The ethical standards of interest described by Yank and Rennie12 will be used. These include an assessment of the standards agreed by the International Committee of Medical Journal Editors13 following the Declaration of Helsinki14; the report of consent obtained for the study and the report of ethical review of the study.
The search parameters are: Pubmed search of the term “COVID-19” with the filters of Free full text and English language publication – the rationale for this search is that it would be reasonable for a lay member of the public to conduct such a search. No start date is applied and the finish date of the search is April 14th 2020.
The bibliography of the search will be saved and the assessors will use an Excel spreadsheet to record excluded and included studies, using the reference number from the search bibliography. Papers may be included if they are defined by an assessor as a case report, case series, observational study or clinical trial. Papers will be excluded if they are classified as a commentary, editorial, review, guideline, non-clinical report, cell-based study, animal study, epidemiologic study or report of a mathematical model. Two reviewers will conduct the initial assessment (half of the papers each, identified by the initial search). The reviewers will confer where there is any uncertainty.
Two independent reviewers will conduct a bias assessment. Each independent reviewer will assess 10 studies each for each initial assessor, identified randomly from the search bibliography (20 papers in total by each independent assessor). A threshold of 20% discrepancy between initial and independent assessors has been set to determine whether a further methodological revision is required. A further five records each will be reviewed following this initial method assessment.
For case studies and case series, the assessor will record: the first three authors; journal; study title; whether written consent reported; if not written consent whether oral consent reported or whether not available (i.e. patient deceased); whether written consent to publish provided to journal; the wording of consent; the nature of identifiers reported (such as location, occupation etc); whether the article included a statement of compliance with International Conference on Harmonisation (ICH) good clinical practice (GCP)/Declaration of Helsinki standards.
For observational studies and clinical trials, the assessor will record: the first three authors; journal; study title; whether written consent reported; the wording of consent; if not written consent whether oral consent reported; review by research ethics committee; whether that committee is identifiable on line; whether the article included a statement of compliance with ICH GCP/Declaration of Helsinki standards and in the case of a clinical trial, whether the trial was registered.
The outcome is the proportion of papers where informed consent to publish (in case studies and series) and for inclusion in a clinical research study as well as publication (observational studies and clinical trials) was recorded. An assessment of the role of ethics committees will be included; specifically, whether ethics committee approval was sought and whether requirement for consent was waived by said committee and whether there is a geographical or publication pattern associated with the reported role of the ethics committee.
This is a methodologic review; therefore, bias in interpretation of results is not relevant to this study. The proposed assessment of the ethics reporting standard categorized by journal may identify a publication bias.
A quantitative summary of numbers of studies identified, and their classification by assessor, will be provided. A further summary of consent reported and the nature of that consent will be prepared. The proportion of studies reporting ethical review and including a statement of compliance with ethical guidelines for conduct of clinical research studies (observational study or clinical trial), will be included. A qualitative description of the measures to preserve anonymity of the participants will be made.
This study will not be clinical in nature and does not meet the requirement for a research ethics committee review. In view of the nature of the study and the impact of ethical conduct of research on public confidence in research, it is proposed to share the final draft of the study manuscript with two lay volunteers for a lay perspective on the findings prior to submission for publication. The protocol will be made available for the public on the UCD COVID-19 website.
The search bibliography and finalized Excel spreadsheets will be included as supplementary documents with the final publication. As a publication relating to COVID-19, it is anticipated that this will be open access. Should this not be the case the authors will make these files available on request to the corresponding author.
The purpose of conducting this review is to describe the existing publication status for ethical declarations in COVID-19 clinical research and discuss the potential impact on public trust in clinical research. It is proposed to include the findings with a description of how n Irish Research Ethics Committee conducted ethical assessment both expeditiously and safely in a time of pandemic; in order to maintain ethical standards, maximize public access to participation in clinical trials and research, and maintain public confidence in future research studies and their findings.
Figshare: PRISMA-P checklist for ‘Protocol for systematic review of ethical declarations made in clinical publications concerning COVID-19’. https://doi.org/10.6084/m9.figshare.12249224.v111.
The completed PRISMA-P checklist is available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).
All authors contributed to the protocol design. LOS and RC drafted the manuscript which was approved by all authors. Funding was acquired by PD.
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Bioethics and law of human subjects research.
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Qualitative research, trial methodology, evidence synthesis (qualitative and quantitative).
Is the rationale for, and objectives of, the study clearly described?
Yes
Is the study design appropriate for the research question?
Yes
Are sufficient details of the methods provided to allow replication by others?
Yes
Are the datasets clearly presented in a useable and accessible format?
Not applicable
References
1. London AJ, Kimmelman J: Against pandemic research exceptionalism.Science. 2020; 368 (6490): 476-477 PubMed Abstract | Publisher Full TextCompeting Interests: No competing interests were disclosed.
Reviewer Expertise: Bioethics and law of human subjects research.
Is the rationale for, and objectives of, the study clearly described?
Partly
Is the study design appropriate for the research question?
Yes
Are sufficient details of the methods provided to allow replication by others?
Partly
Are the datasets clearly presented in a useable and accessible format?
Not applicable
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Qualitative research, trial methodology, evidence synthesis (qualitative and quantitative).
Alongside their report, reviewers assign a status to the article:
Invited Reviewers | ||
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Version 2 (revision) 20 Jul 20 |
read | read |
Version 1 13 May 20 |
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Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list:
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