Therapeutic appropriation: a new concept in the ethics of clinical research

Abstract

Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of 'misunderstandings' that research participants may have. In this paper, we describe a new concept-therapeutic appropriation Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an opportunity to enhance patients' clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them.

Men's experiences of recontact about a potential increased risk of prostate cancer due to Lynch Syndrome: “Just another straw on the stack”

“…Rather, the men demonstrated awareness of the research aims and simultaneously hoped to benefit from an incidental aspect of the study: surveillance for prostate cancer risk. The opportunistic approach to enhancing one's clinical care, through research participation, has been labeled “therapeutic appropriation” (McDougall et al, ).…”

The culture of hope and ethical challenges in clinical trials: A qualitative study of oncologists and haematologists’ views

“…Joffe and Weeks 19 have shown that not only patients but also physicians and investigators might share such misconceptions of clinical trials. 20 This is further discussed by McDougall et al., 21 who suggest a new concept, therapeutic appropriation (TA). TA occurs, they state, when ‘patients, or clinicians, actively reframe research participation as an opportunity to enhance patients’ clinical care, while simultaneously acknowledging the generalised research aims’.…”

Primary care physicians' views about gatekeeping in clinical research recruitment: A qualitative study

“…This paper reports on the findings from the physicians only, with the findings from the patient interviews reported elsewhere. 19 The primary care clinics were selected using purposive sampling, to capture general and specialist (for example, women's health) primary care practices who were involved in clinical research. Contact with the clinics was established through primary care research networks and public listings.…”