Supporting informed clinical trial decisions: Results from a randomized controlled trial evaluating a digital decision support tool for those with intellectual disability


Autoři: Lauren A. McCormack aff001;  Amanda Wylie aff002;  Rebecca Moultrie aff001;  Robert D. Furberg aff003;  Anne C. Wheeler aff002;  Katherine Treiman aff001;  Donald B. Bailey, Jr. aff002;  Melissa Raspa aff002
Působiště autorů: Public Health Research Division, RTI International, Research Triangle Park, North Carolina, United States of America aff001;  Center for Newborn Screening, RTI International, Research Triangle Park, North Carolina, United States of America aff002;  Health Quality & Analytics, RTI International, Research Triangle Park, North Carolina, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223801

Souhrn

Background

Informed consent requires that individuals understand the nature of the study, risks and benefits of participation. Individuals with intellectual disabilities (ID) have cognitive and adaptive impairments that may affect their ability to provide informed consent. New treatments and clinical trials for fragile X syndrome, the most commonly known inherited cause of ID, necessitate the development of methods to improve the informed consent process. The goal of this study was to compare the efficacy of a digital decision support tool with that of standard practice for informed consent and to examine whether the tool can improve decisional capacity for higher functioning individuals.

Methods

Participants (N = 89; mean age = 21.2 years) were allocated to the experimental group (consenting information provided via the digital decision support tool), or the comparison group (information provided via standard practice). Participants were assessed on four aspects of decisional capacity (Understanding, Appreciating, Reasoning, and Expressing a choice). We used regression analyses to test the impact of the tool on each outcome, repeating the analyses on the higher functioning subsample.

Results

No differences existed in any domain of decisional capacity for the sample in full. However, participants in the higher IQ subsample who used the tool scored better on Understanding after adjustment (β = 0.25, p = 0.04), but not on Appreciating or Reasoning. No differences by experimental group existed in the decision to join the hypothetical trial for the full sample or higher functioning subsample.

Conclusions

A decision support tool shows promise for individuals with fragile X syndrome with higher cognitive abilities. Future studies should examine the level of cognitive ability needed for sufficient understanding, whether these findings can be translated to other clinical populations, and the impact of the tool in larger trials and on trial retention.

Klíčová slova:

Autism – Clinical trials – Cognition – Cognitive impairment – Decision making – Medical doctors – Reasoning – Working memory


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