Evaluating the Impact of Incentives on Clinical Trial Participation: Protocol for a Mixed Methods, Community-Engaged Study

Abstract

Background Monetary incentives in research are frequently used to support participant recruitment and retention. However, there are scant empirical data regarding how researchers decide upon the type and amount of incentives offered. Likewise, there is little guidance to assist study investigators and institutional review boards (IRBs) in their decision-making on incentives. Monetary incentives, in addition to other factors such as the risk of harm or other intangible benefits, guide individuals’ decisions to enroll in research studies. These factors emphasize the need for evidence-informed guidance for study investigators and IRBs when determining the type and amount of incentives to provide to research participants. Objective The specific aims of our research project are to (1) characterize key stakeholders’ views on and assessments of incentives in biomedical HIV research; (2) reach consensus among stakeholders on the factors that are considered when choosing research incentives, including consensus on the relative importance of such factors; and (3) pilot-test the use of the guidance developed via aims 1 and 2 by presenting stakeholders with vignettes of hypothetical research studies for which they will choose corresponding incentive types. Methods Our 2-year study will involve monthly, active engagement with a stakeholder advisory board of people living with HIV, researchers, and IRB members. For aim 1, we will conduct a nationwide survey (N=300) among people living with HIV to understand their views regarding the incentives used in HIV research. For aim 2, we will collect qualitative data by conducting focus groups with people living with HIV (n=60) and key informant interviews with stakeholders involved in HIV research (people living with HIV, IRB members, and biomedical HIV researchers: n=36) to extend and deepen our understanding of how incentives in HIV research are perceived. These participants will also complete a conjoint analysis experiment to gain an understanding of the relative importance of key HIV research study attributes and the impact that these attributes have on study participation. The data from the nationwide survey (aim 1) will be triangulated with the qualitative and conjoint analysis data (aim 2) to create 25 vignettes that describe hypothetical HIV research studies. Finally, individuals from each stakeholder group will select the most appropriate incentive that they feel should be used in each of the 25 vignettes (aim 3). Results The stakeholder advisory board began monthly meetings in March 2021. All study aims are expected to be completed by December 2022. Conclusions By studying the role of incentives in HIV clinical trial participation, we will establish a decision-making paradigm to guide the choice of incentives for HIV research and, eventually, other types of similar research and facilitate the ethical recruitment of clinical research participants. Trial Registration ClinicalTrials.gov NCT04809636; https://clinicaltrials.gov/ct2/show/NCT04809636 International Registered Report Identifier (IRRID) DERR1-10.2196/33608

Compensating patients in trials: Perspectives from an ethical committee versus sponsor

“…Currently, there is a lack of tools and guidelines available to accurately assess this additional burden, which makes it difficult to determine appropriate compensation. [10][11][12] Secondly, payment for risk could be considered, but there is no agreement on that issue both among research ethicists 3,[13][14][15][16][17][18][19] and among public policymakers. For example, the 2016 CIOMS Guidelines state that 'the level of compensation should not be related to the level of risk' (Commentary on Guideline 13).…”

“…additional visits or invasive procedures) caused by participating in clinical trials is a challenging task. Currently, there is a lack of tools and guidelines available to accurately assess this additional burden, which makes it difficult to determine appropriate compensation 10–12 . Secondly, payment for risk could be considered, but there is no agreement on that issue both among research ethicists 3,13–19 and among public policymakers.…”