Elements of Informed Consent:
Requirements and Guidelines for Consent Forms:

Informed consent is the process of communicating to the subject the purpose, risks, benefits, and voluntary nature of a specific study.

The consent form documents that the communication process took place.  The consent form must contain all of the required "elements" of informed consent.  The "sample consent form" should be used as a guide for writing a consent form.  The consent form should be written in lay terms; jargon and technical language should be avoided.  The IRB recommends that researchers write the consent forms using simple declarative sentences, avoid technical language.

Tips for completing consent form:

·         Write the form in second person "You," e.g., "You are invited to participate in a research project conducted by HealthPartners AVOID language like "You have been told” or "you understand.” Numerous language and coercion pitfalls result when using those phrases.

·         Define or explain research terms like "randomization" (like the flip of a coin), "double-blind" (neither the researcher nor the subject will know.)

·         Quantities for blood drawing should be listed in lay term equivalents, not milliliters. (teaspoon equivalents)

·         Headings for paragraphs are helpful and make the form easier to read.

·         Typeface should be a comfortable-readable size; avoid fine print.  The form may not fit onto one page; additional pages are acceptable as long as they are essential.

·         Signature space should be added to document "assent" of children to participate in the study.  Parent signatures are still required.

Elements of informed consent that must appear in the consent form:

(Based on DHHS Guidelines, FDA Regulations and requirements made by the IRB)

1.   An explanation of the purposes of the research and the expected duration of the subject's participation, (including an estimate of the total amount of the subject's time involved in participation, a description of the procedures to be followed, and identification of any procedures which are experimental.  The reason for the subjects' selection.  An approximate number of subjects involved in the study may be relevant.

2.   A description of any reasonably foreseeable risks or discomforts to the subject.  A statement that the particular treatment or procedure may involve risks to the subject (or to the embryo or fetus, if the subject is, or may become pregnant which are currently unforeseeable.

3.   A description of any benefits to the subjects or others which may reasonably be expected from the research. If there is no benefit to participation to the individual subject an honest declaration of that fact must be included in the text of the consent form.

4.   A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject.  If any standard treatment is withheld as a result of participation, the subjects must be informed.

5.   For research involving more than minimal risk, or involving any invasive procedure, an explanation as to whether any compensation for injury and any medical treatment are available if injury occurs and, if so, what they consist of, or where further information may be obtained. 

6.   An offer to answer questions and an explanation of whom to contact for answers to pertinent questions about the research and research subjects' rights, and whom to contact in the event of a research-related problem.  A telephone number should be included.

7.   A statement that participation is voluntary, the subject may refuse to participate, and may discontinue participation at any time without penalty or loss of benefits to which he/she is otherwise entitled.  The consequences of a subject's decision to withdraw from the research, if any, and procedures for an orderly termination of participation by the subject, should be included.

8.   A statement describing the extent to which confidentiality of records identifying the subject will be maintained.  If data obtained will be made available to any person or organization other than the subject, the investigator, and the investigator's staff, or become part of a permanent record maintained in the subject's name, the purposes of the disclosure, and the nature of the information to be furnished must be described.  That statement should note that the FDA and or drug company sponsor may inspect the research records, if applicable.  If audio or video tape recording, photographs, or movies will be taken, they should be described.  The duration of time they will be retained before erasure or destruction should be specified.  Use of such data for other purposes, including educational purposes, must be disclosed and permission obtained in a special portion of the consent form.

9.   An offer to the subject of a copy of the consent form.

10.  Space for signatures and date.  If applicable there should be a signature for parent or guardian, including space to indicate relationship to the subject.  The signature of the investigator is recommended in order that it can be established who discussed the study with the subject.

11.  Anticipated circumstances under which the subject's participation may be terminated by the investigator without regard to the subject's consent. i.e. when in the investigator’s opinion, it would be detrimental to the subject to continue.

12.   Any additional costs to the subject that may result from participation in the research.

13.   A statement that significant new findings developed during the course of the research which may relate to the subject's willingness to continue participation will be provided to the subject.

14.  Space provided to document oral or written assent of minors.  Note: if a parent "Consents" to allow a child to participate, and the child refuses to "assent', the child's refusal should take precedence and the research may not be undertaken. (Mere failure to object should not be construed as assent to participate.)

15.  If a subject will receive compensation or if there is an inducement or reward for participation, specific information concerning the terms of disbursement must be clearly described on the consent form.  FDA regulations require that payment to subjects is pro-rated over time so that in the event a subject withdraws from a study, prior to termination of the research, he/she received some compensation for participation.


The "sample consent form" should be used as a guide for writing a consent form.  Rules and regulations are subject to change and revision.  Standards for consent documents change over time, the investigator should be prepared to revise and update consent forms at the request of the IRB.

SAMPLE CONSENT FORM

[Insert Title of Study and, "Consent Form"]

You are invited to be in a research study of [insert general statement about study]. You were selected as a possible participant because [explain how subject was identified]. We ask that you read this form and ask any questions you may have before you decide whether or not you want to-be in the study.

This study is being conducted by: [Indicate HealthPartners affiliation]

Background Information:

The purpose of this Study is: [Explain research question and purpose in lay language]

[Explain if the drug or device tested is experimental or if any procedures are experimental]

Procedures:

If you agree to be in this study, we would ask you to do the following things: [Explain tasks and procedures: subjects should be told about assignment to study groups, length of time for participation frequency of procedures etc. If standard treatment is withheld, the subject must be so informed. Reminder: quantities, such as blood drawn. should be listed in lay term equivalents, i.e., teaspoons]

Risks and Benefits of Being in the Study:

The study has several risks: First, ____________________; Second, ______________________ [Risk must be explained, including the likelihood of the risk.]

[If there are significant physical or psychological risks to participation, the subject should be told under what conditions the researcher would terminate the study.]

The benefits to participation are: [If no benefit, state that fact here.]

You will receive payment: [Include payment or reimbursement information here.  Explain when disbursement will occur and conditions of payment.]

Alternatives to participating in this study:

[A disclosure of appropriate alternative procedures or courses of treatment that might be advantageous to the subject must be included.]

Compensation:

The following statement must be included in the consent form.

In the event that this research activity results in an injury, treatment will be available, including first aid, emergency treatment and follow-up care as needed.  Payment for any such treatment must be provided by you or your third party payer, if any, (such as health insurance, Medicare, etc.)

Costs

[Any additional costs or charges for the research procedures must be disclosed with estimated amounts.]

Confidentiality:

The records of this study will be kept private.  In any sort of report we might publish, we will not include any information that will make it possible to identify a subject.  Your record for the study may, however, be reviewed by the drug manufacturer or by representatives of the Food and Drug, Administration. [Include study sponsor, if applicable.] To that extent, confidentiality isn't absolute.

Voluntary Nature of the Study:

Your decision whether or not to participate will not affect your current or future relations with HealthPartners [or with other cooperating institutions, insert names].  If you decide to participate, you are free to withdraw at any time without affecting those relationships. [Explain here if monetary benefits will be adjusted due to early withdrawal.]

New Information:

If during the course of this research study, there are any significant new findings discovered which might influence your willingness to continue, the researchers will inform you of those developments.

Contacts and Questions:

The researchers conducting this study are                   and                                   . You may ask any questions you have now.  If you have questions later, you may contact them at Phone:        [If the researcher is a student, include advisor's name and telephone number here.]

[Subjects should have access to a disinterested party if they have concerns about their participation.  Please use the following statement or revise accordingly.] 

As is the case for all patients at Regions Hospital , you have access to the Patient Representative (651-254-2372) if you have questions or concerns that have not been answered by your doctor or the researcher or about your rights as a research subject.

You will be given a copy of this form to keep for your records.

Statement of Consent:

I have read the above information.  I have asked questions and have received answers.  I consent to participate in the study.

Signature of Subject:                                                      Date                

Signature of parent or guardian:                                        Date                

Signature of Investigator                                                  Date