PT  - JOURNAL ARTICLE
AU  - Jenny McLeish
AU  - Fiona Alderdice
AU  - Helen Robberts
AU  - Christina Cole
AU  - Jon Dorling
AU  - Chris Gale
ED  - ,
TI  - Challenges of a simplified opt-out consent process in a neonatal randomised controlled trial: qualitative study of parents’ and health professionals’ views and experiences
AID  - 10.1136/archdischild-2020-319545
DP  - 2021 May 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - 244--250
VI  - 106
IP  - 3
4099  - http://fn.bmj.com/content/106/3/244.short
4100  - http://fn.bmj.com/content/106/3/244.full
SO  - Arch Dis Child Fetal Neonatal Ed2021 May 01; 106
AB  - Background More effective recruitment strategies like alternative approaches to consent are needed to facilitate adequately powered trials. Witholding Enteral feeds Around Transfusion was a multicentre, randomised, pilot trial that compared withholding and continuing feeds around transfusion. The primary clinical outcome was necrotising enterocolitis. The trial used simplified opt-out consent with concise parent information and no consent form.Objective To explore the views and experiences of parents and health professionals on the acceptability and feasibility of opt-out consent in randomised comparative effectiveness trials.Methods A qualitative, descriptive interview-based study nested within a randomised trial. Semistructured interview transcripts were analysed using inductive thematic analysis.Setting Eleven neonatal units in England.Participants Eleven parents and ten health professionals with experience of simplified consent.Results Five themes emerged: ‘opt-out consent operationalised as verbal opt-in consent’, ‘opt-out consent normalises participation while preserving parental choice’, ‘opt-out consent as an ongoing process of informed choice’, ‘consent without a consent form’ and ‘choosing to opt out of a comparative effectiveness trial’, with two subthemes: ‘wanting “normal care”’ and ‘a belief that feeding is better’.Conclusion Introducing a novel form of consent proved challenging in practice. The principle of a simplified, opt-out approach to consent was generally considered feasible and acceptable by health professionals for a neonatal comparative effectiveness trial. The priority for parents was having the right to decide about trial participation, and they did not see opt-out consent as undermining this. Describing a study as ‘opt-out’ can help to normalise participation and emphasise that parents can withdraw consent.Data are available upon reasonable request. Following the consent process, the individual qualitative interview transcripts will not be made publicly available.