How are adults with capacity-affecting conditions and associated communication difficulties included in ethically-sound research? A documentary-based survey of ethical review and recruitment processes under the research provisions of the Mental Capacity Act (2005) for England and Wales

Karen Bunning (Lead Author), Oluseyi Florence Jimoh, Rob Heywood, Anne Killett, Hayley Ryan, Ciara Shiggins, Peter E. Langdon

Research output: Contribution to journalArticlepeer-review

2 Downloads (Pure)

Abstract

Objectives: This study aimed to determine the characteristics of ethical review and recruitment processes, concerning the inclusion of adults with capacity-affecting conditions and associated communication difficulties in ethically-sound research, under the provisions of the Mental Capacity Act (MCA, 2005) for England and Wales.
Design: A documentary-based survey was conducted focusing on adults with capacity-affecting conditions and associated communication difficulties. The survey investigated: (i) retrospective studies during the implementation period of the MCA (2007-2017); (ii) prospective applications to MCA-approved Research Ethics Committees (RECs) during a 12-month period (2018-19); (iii) presentational and linguistic content of participant information sheets used with this population.
Setting: Studies conducted and approved in England and Wales.
Sample: Studies focused on adults with the following capacity-affecting conditions: acquired brain injury; aphasia after stroke; autism; dementia; intellectual disabilities; mental health conditions. The sample comprised: (i) 1,605 studies; (ii) 83 studies; (iii) 25 participant information sheets.
Primary and secondary outcome measures: The primary outcome was the inclusion/exclusion of adults with capacity-affecting conditions from studies. The secondary outcome was the provisions deployed to support their inclusion.
Results: The retrospective survey showed an incremental rise in research applications post-MCA implementation from 2 (2012) to 402 (2017). The prospective survey revealed exclusions of people on the bases of: ‘lack of capacity’ (n=21; 25%); ‘communication difficulties’ (n=5; 6%); ‘lack of consultee’ (n=11; 13%); and ‘limited English’ (n=17; 20%). REC recommendations focused mainly on participant-facing documentation. The participant information sheets were characterised by inconsistent use of images, typography and layout, volume of words and sentences; some simplified language content, but variable readability scores.
Conclusions: People with capacity-affecting conditions and associated communication difficulties continue to be excluded from research, with recruitment efforts largely concentrated around participant-facing documentation. There is a need for a more nuanced approach if such individuals are to be included in ethically-sound research.
Original languageEnglish
Article numbere059036
Pages (from-to)e059036
JournalBMJ Open
Volume12
Issue number3
Early online date31 Mar 2022
DOIs
Publication statusPublished - Mar 2022

Keywords

  • brain injuries
  • dementia
  • ethics
  • mental health
  • neurodevelopmental disorders
  • stroke
  • survey

Cite this