Human subjects policies + procedures

Thousands of individuals are paid for participating in biomedical and behavioral research funded either by federal departments and agencies or private institutions. Although payments are usually monetary, both patients and normal healthy volunteers may be offered other rewards in lieu of or in addition to money. Free medical care, extra vacation time, and academic rewards (in the form of a research credit or a letter of recommendation) are examples of alternative rewards.

Regardless of the form of remuneration, the issues for IRBs remain the same. The Human Research Protection Program must consider whether paid participants in research are recruited fairly, informed adequately, and paid appropriately. Taking into consideration the subjects' medical, employment, and educational status — and their financial, emotional and community resources — HRPP must determine whether the rewards offered for participation in research constitute undue influence.

One of the primary responsibilities of HRPP is to ensure that a subject's decision to participate in research will be truly voluntary, and that consent will be sought only under circumstances that provide the prospective subject sufficient opportunity to consider whether to participate and that minimize the possibility of coercion or undue influence.

Clear cases of coercion (i.e., actual threats) are readily identifiable; it is more difficult to recognize undue inducement. An offer one could not refuse is essentially coercive (or "undue"). Undue inducements may be troublesome because: (1) offers that are too attractive may blind prospective subjects to the risks or impair their ability to exercise proper judgment; and (2) they may prompt subjects to lie or conceal information that, if known, would disqualify them from enrolling — or continuing — as participants in a research project.

Application and consent form

If you intend to pay participants, your application should describe — in the Abstract section of the application and in the Payments section of the consent form — how much and on what schedule and conditions.

HRPP considerations

HRPP must attempt to make sure that prospective subjects realize that their participation is voluntary, and that choosing not to participate will not adversely affect their relationship with the institution or its staff in any way. To make this determination, HRPP should know who the subjects will be, what incentives are being offered, and the conditions under which the offer will be made.

Appropriateness of incentive

Determining the appropriateness of the incentive is another matter. For research that requires subjects to undergo only minor inconvenience or discomfort, a modest payment will usually be adequate. Reimbursement for travel may also be provided. In more complex research projects, IRBs tend to base their assessment on the prevailing payment practices within their institution or general locale (payment for time and effort).

Volunteers are often compensated for their participation according to an established fee schedule, based upon the complexity of the study, the type and number of procedures to be performed, the time involved, and the anticipated discomfort or inconvenience. Standard payments may be established for each tissue or fluid sample collected, depending on the type of sample (blood, urine, or saliva) and the time (day or evening) the sample is to be collected. Alternatively, subjects may be paid an hourly rate or a fixed amount, depending on the duration of the study and whether the study requires admission to a research ward. Extra payments are usually provided for a variety of additional inconveniences (for example, the imposition of dietary restrictions).

Payments may vary according to a number of factors, and, therefore, IRBs may need to become familiar with the accepted standards within their community as well as the anticipated discomforts and inconveniences involved in a particular study to judge appropriateness of payments. Some institutions have a ceiling on the amount an individual may earn in any one study or during a given length of time (for example, per year, per semester). Researchers must also consider the method of delivering payment to participants, providing it is appropriate and does not put participants at additional risk (i.e., breach of confidentiality, safety, etc.).

One of the most perplexing problems for IRBs is how to assess the appropriateness of payment offers for experiments that involve the assumption of risk or significant discomfort. On a practical level, it is probably impossible for an IRB to determine what amount of money or type of reward would unduly influence a particular individual to accept a given degree of risk. Although our society generally accepts the premise that those assuming risk deserve reward, the application of this rule in establishing payment for subjects in biomedical and behavioral experiments is still being debated. The appropriateness of proposed payments is a matter each institution must address in formulating its policies.

IRB members tend to approach the problem of assuming risk for pay from one of two positions. One side argues that normal healthy volunteers are able to exercise free choice, and that — because judging the acceptability of risk and weighing the benefits is a personal matter — IRBs should refrain from imposing their own views on potential subjects. On this view, IRB responsibility should be confined to ensuring that consent is properly informed. Other IRB members argue that the IRB should protect potential subjects from inducements that may affect their ability to make an informed, voluntary choice. It should be noted that, in this context, incentives need not be financial to cause problems. Free health care for persons with limited resources and major medical problems may be a significant inducement to participate in research (even if the research activity is nontherapeutic). There is no consensus as to whether this kind of inducement is unacceptable. In assessing this potential problem, IRBs might consider whether only the destitute agree to volunteer or if people who can obtain good medical care on their own agree to participate as well. IRBs may need to monitor subject recruitment to make such determinations.

Points to consider

1. Are all conditions in keeping with standards for voluntary and informed consent?
2. Are the incentives offered reasonable, based upon the complexities and inconveniences of the study and the particular subject population?
3. Are there special standards that the IRB ought to apply to the review of research in which volunteers are asked to assume significant risk?
4. Should the IRB monitor subject recruitment to determine whether coercion or undue influence is a problem?
    

Accounting and tax considerations

The University of Kansas requires that consent forms for participants who are to be paid through funding include the following statement in the Payments section: "Researchers may ask for your social security number in order to comply with federal and state tax and accounting regulations."

For tax purposes, there are two types of subjects: U.S. citizens/permanent residents or non-U.S. citizens. Payments to non-U.S. citizens are subject to additional review to determine if the individual is eligible to receive payments and to determine tax liability. Contact KU Office of Research accounting services for assistance.

Gift certificates

Gift certificates are considered the same as monetary payment and require the same advisory wording in the consent form.

Lotteries or drawings

Offering the chance of winning a prize for participation constitutes gambling, according to Kansas statute. Three elements make an activity illegal under Kansas statute when all three are present: 1) chance, 2) consideration, and 3) prize. Therefore, to make an activity legal, eliminate one of those elements — such as consideration — by allowing anyone to submit their name on a ticket or form for a drawing for a prize without having to complete the survey or questionnaire. Otherwise, the act of completing the survey is the consideration that allows only those who participate in the study and complete the survey to have a chance for the prize. The other option is to eliminate the reference to the drawing in your information statement.

Some institutions have adopted policies regarding the recruitment and payment of volunteers. In general, they attempt to minimize the possibility of coercion or undue influence by requesting that subjects be recruited by open, written invitation rather than by personal solicitation. Institutions try to ensure that the consent document contains a detailed account of the terms of payment, including a description of the conditions under which a subject would receive partial or no payment (for example, what will happen if they withdraw part way through the research).