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Choosing to participate in a clinical trial is an important personal decision. The following frequently asked questions provide detailed
information about clinical trials. In addition, it is often helpful to talk to a physician, family members, or friends about deciding to join a trial. After identifying some trial options, the next step is to contact the study research staff and ask questions about specific trials.
What is a clinical trial?
A clinical trial (also clinical research) is a research study in human volunteers to answer specific health questions. Carefully conducted clinical trials are the fastest and safest way to find treatments that work in people and ways to improve health. Interventional trials determine whether experimental treatments or new ways of using known therapies are safe and effective under controlled environments. Observational trials address health issues in large groups of people or populations in natural settings.
Why participate in a clinical trial?
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research
Who can participate in a clinical trial?
All clinical trials have guidelines about who can participate. Using inclusion/exclusion criteria is an important
principle of medical research that helps to produce reliable results. The
factors that allow someone to participate in a clinical trial are called "inclusion
criteria" and those that disallow someone from participating are called "exclusion
criteria". These criteria are based
on such factors as age, gender, the type and stage of a disease, previous
treatment history, and other medical conditions. Before joining a clinical
trial, a participant must qualify for the study. Some research studies seek participants with illnesses or
conditions to be studied in the clinical trial, while others need healthy participants.
It is important to note that inclusion and exclusion criteria are not used to
reject people personally. Instead, the criteria are used to identify
appropriate participants and keep them safe. The criteria help ensure that
researchers will be able to answer the questions they plan to study.
The clinical trial process depends on the kind of trial
being conducted (See What are the different types of
clinical trials?) The clinical trial team includes doctors and nurses as
well as social workers and other health care professionals. They check the
health of the participant at the beginning of the trial, give specific
instructions for participating in the trial, monitor the participant carefully
during the trial, and stay in touch after the trial is completed.
Some clinical trials involve more tests and doctor visits
than the participant would normally have for an illness or condition. For all types of trials, the participant
works with a research team. Clinical trial participation is most successful when
the protocol is carefully followed and there is frequent contact with the
Informed consent is the process of learning the key facts about a clinical trial before
deciding whether or not to participate. It is also a continuing process
throughout the study to provide information for participants. To help someone
decide whether or not to participate, the doctors and nurses involved in the
trial explain the details of the study. If the participant's native language is
not English, translation assistance can be provided. Then the research team provides an informed
consent document that includes details about the study, such as its
purpose, duration, required procedures, and key contacts. Risks and potential
benefits are explained in the informed consent document. The participant then
decides whether or not to sign the document.
Informed consent is not a contract, and the participant may withdraw
from the trial at any time.
Side effects are any undesired actions or effects of drug or
treatment. Negative or adverse effects may include headache, nausea, hair loss,
skin irritation, or other physical problems. Experimental treatments must be
evaluated for both immediate and long-term side effects.
The ethical and legal codes that govern medical practice also apply to clinical trials. In addition, most
clinical research is federally regulated with built in safeguards to protect
the participants. The trial follows a carefully controlled protocol, a study plan which details what researchers will do
in the study. As a clinical trial progresses, researchers report the results of
the trial at scientific meetings, to medical journals, and to various
government agencies. Individual participants' names will remain secret and will
not be mentioned in these reports (See Confidentiality
Regarding Trial Participants).
People should know as much as possible about the clinical trial and feel comfortable
asking the members of the health care team questions about it, the care expected
while in a trial, and the cost of the trial. The following questions might be helpful for the participant to discuss
with the health care team. Some of the answers to these questions are found in
the informed consent document.
What is the purpose of the study?
Who is going to be in the study?
Why do researchers believe the new treatment being tested may be effective? Has it been tested before?
What kinds of tests and treatments are involved?
How do the possible risks, side effects, and benefits in the study compare with my current treatment?
How might this trial affect my daily life?
How long will the trial last?
Will hospitalization be required?
Who will pay for the treatment?
Will I be reimbursed for other expenses?
What type of long-term follow up care is part of this study?
How will I know that the treatment is working? Will results of the trials be provided to me?
Plan ahead and write down possible questions to ask.
Ask a friend or relative to come along for support and to hear the responses to the questions.
Bring a tape recorder to record the discussion to replay later.
Every clinical trial in the U.S. must be approved and monitored by an Institutional
Review Board (IRB) to make sure the risks are as low as possible and are
worth any potential benefits. An IRB is an independent committee of physicians,
statisticians, community advocates, and others that ensures that a clinical
trial is ethical and the rights of study participants are protected. All
institutions that conduct or support biomedical research involving people must,
by federal regulation, have an IRB that initially approves and periodically
reviews the research.
Yes. Most clinical trials provide short-term treatments
related to a designated illness or condition, but do not provide extended or
complete primary health care. In addition, by having the health care provider
work with the research team, the participant can ensure that other medications
or treatments will not conflict with the protocol.
Ideas for clinical trials usually come from researchers. After researchers test new therapies or procedures in the laboratory and in animal studies, the treatments with the most promising laboratory results are moved into clinical trials. During a trial, more and more information is gained about a new treatment, its risks and how well it may or may not work.
Who sponsors clinical trials?
Clinical trials are sponsored or funded by a variety of organizations or individuals such as physicians, medical institutions, foundations, voluntary groups, and pharmaceutical companies, in addition to federal agencies such as the National Institutes of Health (NIH), the Department of Defense (DOD), and the Department of Veteran's Affairs (VA). Trials can take place in a variety of locations, such as hospitals, universities, doctors' offices, or community clinics.
What is a protocol?
A protocol is a study plan on which all clinical trials are based. The plan is carefully designed to safeguard the health of the participants as well as answer specific research questions. A protocol describes what types of people may participate in the trial; the schedule of tests, procedures, medications, and dosages; and the length of the study. While in a clinical trial, participants following a protocol are seen regularly by the research staff to monitor their health and
to determine the safety and effectiveness of their treatment.
What is a placebo?
A placebo is an inactive pill, liquid, or powder that has no treatment value. In clinical trials, experimental treatments are often compared
with placebos to assess the treatment's effectiveness. In some studies, the participants in the control group will receive a placebo instead of an active
drug or treatment.
What is a control or control group?
A control is the standard by which experimental observations are evaluated. In many clinical trials, one group of patients will be given an experimental drug or treatment, while the control group is given either a standard treatment for the illness or a placebo.
What are the different types of clinical trials?Treatment trials test new treatments, new combinations of drugs, or new approaches to surgery or
Prevention trials look for better ways to prevent disease in people who have never had the disease or
to prevent a disease from returning. These approaches may include medicines, vitamins, vaccines, minerals, or
Diagnostic trials are conducted to find better tests or procedures for diagnosing a particular disease or condition.
Screening trials test the best way to detect certain diseases or health conditions.
Quality of Life trials (or Supportive Care trials) explore ways to improve comfort and the quality of life for individuals with a chronic illness.
What are the phases of clinical trials?
Clinical trials are conducted in phases. The trials at each phase have a different
purpose and help scientists answer different questions:
In Phase I trials, researchers test a new drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
In Phase II trials, the study drug or treatment is given to a larger group of people (100-300) to see if it is effective and to further evaluate its safety.
In Phase III trials, the study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
In Phase IV trials, post marketing studies delineate additional information including the drug's risks, benefits, and optimal use.
What is an "expanded access" protocol?
Most human use of investigational new drugs takes place in controlled
clinical trials conducted to assess safety and efficacy of new drugs. Data
from the trials can serve as the basis for the drug marketing application.
Sometimes, patients do not qualify for these carefully-controlled trials
because of other health problems, age, or other factors. For patients who
may benefit from the drug use but don't qualify for the trials, FDA
regulations enable manufacturers of investigational new drugs to provide for
"expanded access" use of the drug. For example, a treatment IND
(Investigational New Drug application) or treatment protocol is a relatively
unrestricted study. The primary intent of a treatment IND/protocol is to
provide for access to the new drug for people with a life-threatening or
serious disease for which there is no good alternative treatment. A
secondary purpose for a treatment IND/protocol is to generate additional
information about the drug, especially its safety. Expanded access
protocols can be undertaken only if clinical investigators are actively
studying the new treatment in well-controlled studies, or all studies have
been completed. There must be evidence that the drug may be an effective
treatment in patients like those to be treated under the protocol. The drug
cannot expose patients to unreasonable risks given the severity of the
disease to be treated.
Some investigational drugs are available from pharmaceutical manufacturers
through expanded access programs listed in ClinicalTrials.gov. Expanded
access protocols are generally managed by the manufacturer, with the
investigational treatment administered by researchers or doctors in
office-based practice. If you or a loved one are interested in treatment
with an investigational drug under an expanded access protocol listed in
ClinicalTrials.gov, review the protocol eligibility criteria and location
information and inquire at the Contact Information number.
See "FDA Finds New Ways to Speed Treatments to Patients" for more details.
Link to: http://www.fda.gov/fdac/special/newdrug/speeding.html