MacCAT-CR: uma forma de legitimar o processo de consentimento informado na pesquisa clínica
DOI:
https://doi.org/10.26512/rbb.v16.2020.33892Palavras-chave:
Consentimento informado, Testes clínicos, Ética em Pesquisa, AutonomiaResumo
O consentimento informado é um componente ético essencial dos ensaios clínicos, entretanto, existem muitas dúvidas sobre sua realização adequada nos dias atuais. O consentimento geralmente é obtido formalmente, mas há dúvidas sobre a competência dos participantes de um ensaio clínico em decidir sobre a sua participação. A partir daí, surge a preocupação com a utilização de instrumentos capazes de avaliar a competência dos participantes para expressar uma decisão. O MacArthur Competence Assessment Tool (MacCAT-CR) pode ser considerado uma ferramenta apropriada para avaliar o processo de consentimento informado, pois pode avaliar a capacidade dos participantes de expressar uma decisão sobre sua participação em cada ensaio clínico. Revisamos a aplicação do MacCAT-CR em estudos envolvendo participantes sem comprometimento cognitivo, representativos da maioria dos indivíduos que geralmente participam de estudos clínicos em países em desenvolvimento. Nossos resultados demonstram que poucos estudos avaliaram o uso dessa ferramenta aplicada a indivíduos representativos dos participantes dos estudos clínicos, uma vez que a maioria das publicações estão voltadas para a avaliação do processo de consentimento em indivíduos com autonomia limitada. Discute-se a importância ética em garantir que a autonomia dos participantes da pesquisa se manifeste por meio da avaliação da eficácia do processo de consentimento, especialmente em países em desenvolvimento.
Downloads
Referências
Anandaiah A, Rock L. Twelve tips for teaching the informed consent conversation. Med Teach. 2019; 41(4):465–70.
Appelbaum PS, Grisso T. MacArthur competence assessment tool for clinical research (MacCAT-CR). Sarasota, FL: Professional Resource Press; 2001. 84 p.
Baker DW. The meaning and the measure of health literacy. J Gen Intern Med. 2006; 21(8):878–83.
Baón-Pérez BS, Álvarez-Marrodán I, Navío-Acosta M, Verdura-Vizcaíno EJ, Ventura-Faci T. Spanish Validation of the MacArthur Competence Assessment Tool for Clinical Research Interview for Assessing Patients’ Mental Capacity to Consent to Clinical Research. J Empir Res Hum Res Ethics JERHRE. 2017;12(5):343–51.
Cohn EG, Jia H, Smith WC, Erwin K, Larson EL. Measuring the process and quality of informed consent for clinical research: development and testing. Oncol Nurs Forum. 2011; 38(4):417–22.
Desch K, Li J, Kim S, Laventhal N, Metzger K, Siemieniak D, et al. Analysis of informed consent document utilization in a minimal-risk genetic study. Ann Intern Med. 2011;155(5):316–22.
Fanaroff AC, Li S, Webb LE, Miller V, Navar AM, Peterson ED, et al. An Observational Study of the Association of Video- Versus Text-Based Informed Consent With Multicenter Trial Enrollment: Lessons From the PALM Study (Patient and Provider Assessment of Lipid Management). Circ Cardiovasc Qual Outcomes. 2018;11(4):e004675.
Gillies K, Duthie A, Cotton S, Campbell MK. Patient reported measures of informed consent for clinical trials: A systematic review. PloS One. 2018;13(6):e0199775.
Hein IM, Troost PW, Lindeboom R, Benninga MA, Zwaan CM, van Goudoever JB, et al. Key factors in children’s competence to consent to clinical research. BMC Med Ethics. 2015;16(1):74.
Hein IM, Troost PW, Lindeboom R, de Vries MC, Zwaan CM, Lindauer RJL. Assessing children’s competence to consent in research by a standardized tool: a validity study. BMC Pediatr. 2012;12:156.
Hein IM, De Vries MC, Troost PW, Meynen G, Van Goudoever JB, Lindauer RJL. Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children’s competence to consent to clinical research. BMC Med Ethics. 2015;16(1):76.
Henry J, Palmer BW, Palinkas L, Glorioso DK, Caligiuri MP, Jeste DV. Reformed consent: adapting to new media and research participant preferences. IRB. 2009; 31(2):1–8.
Hobza V, Hamrik Z, Bucksch J, De Clercq B. The Family Affluence Scale as an Indicator for Socioeconomic Status: Validation on Regional Income Differences in the Czech Republic. Int J Environ Res Public Health. 2017;14(12).
Hochhauser M. Informed consent and patient’s rights documents: a right, a rite, or a rewrite? Ethics Behav. 1999; 9(1):1–20.
Jeste DV, Palmer BW, Appelbaum PS, Golshan S, Glorioso D, Dunn LB, et al. A new brief instrument for assessing decisional capacity for clinical research. Arch Gen Psychiatry. 2007; 64(8):966–74.
Kant I, Ellington JW, Kant I. Grounding for the metaphysics of morals; with, On a supposed right to lie because of philanthropic concerns. 3rd ed. Indianapolis: Hackett Pub. Co; 1993. 78 p
Lan T-H, Wu B-J, Chen H-K, Liao H-Y, Lee S-M, Sun H-J. Validation of Chinese version of the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) in patients with schizophrenia spectrum disorders. Psychiatry Res. 2013; 210(2):634–40.
McGregor KA, Ott MA. Banking the Future: Adolescent Capacity to Consent to Biobank Research. Ethics Hum Res. 2019; 41(4):15–22.
Michaud P-A, Blum RW, Benaroyo L, Zermatten J, Baltag V. Assessing an Adolescent’s Capacity for Autonomous Decision-Making in Clinical Care. J Adolesc Health Off Publ Soc Adolesc Med. 2015; 57(4):361–6.
Miranda V da C, Fêde AB de S, Lera AT, Ueda A, Antonangelo DV, Brunetti K, et al. [How to consent without understanding?]. Rev Assoc Medica Bras 1992. 2009; 55(3):328–34.
Moher D, Liberati A, Tetzlaff J, Altman DG, for the PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339(jul21 1):b2535–b2535.
Murray B. Informed consent: what must a physician disclose to a patient? Virtual Mentor VM. 2012;14(7):563–6.
Nelson LR, Stupiansky NW, Ott MA. The Influence of Age, Health Literacy, and Affluence on Adolescents’ Capacity to Consent to Research. J Empir Res Hum Res Ethics JERHRE. 2016;11(2):115–21.
Nishimura A, Carey J, Erwin PJ, Tilburt JC, Murad MH, McCormick JB. Improving understanding in the research informed consent process: a systematic review of 54 interventions tested in randomized control trials. BMC Med Ethics. 2013;14:28.
Ossemane EB, Moon TD, Sacarlal J, Sevene E, Kenga D, Gong W, et al. Assessment of Parents’/Guardians’ Initial Comprehension and 1-Day Recall of Elements of Informed Consent Within a Mozambican Study of Pediatric Bacteremia. J Empir Res Hum Res Ethics JERHRE. 2018;13(3):247–57.
Paris A, Brandt C, Cornu C, Maison P, Thalamas C, Cracowski J-L. Informed consent document improvement does not increase patients’ comprehension in biomedical research. Br J Clin Pharmacol. 2010; 69(3):231–7.
Rodrigues Filho E, Prado MM do, Prudente COM. Compreensão e legibilidade do termo de consentimento livre e esclarecido em pesquisas clínicas. Rev Bioét. 2014; 22(2):325–36.
Spatz ES, Krumholz HM, Moulton BW. The New Era of Informed Consent: Getting to a Reasonable-Patient Standard Through Shared Decision Making. JAMA. 2016; 315(19):2063–4.
Supady A, Voelkel A, Witzel J, Gubka U, Northoff G. How is informed consent related to emotions and empathy? An exploratory neuroethical investigation. J Med Ethics. 2011; 37(5):311–7.
Suhonen R, Stolt M, Launis V, Leino-Kilpi H. Research on ethics in nursing care for older people: A literature review. Nursing Ethics. 2010;17(3):337-352. doi:10.1177/0969733010361445
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2021 Revista Brasileira de Bioética
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.