FDA Updates Guidance on Conducting Clinical Trials During COVID-19 Emergency to Reflect Real World Challenges

By Deborah L. Livornese

Back in the Spring, one of the first COVID-related guidances FDA issued was on the conduct of clinical trials during the COVID-19 emergency.  This guidance was updated with a Q & A section just a week later (see our blog posts here and here) and several times thereafter.  On July 2, 2020, FDA issued another update to its guidance on “Conduct of Clinical Trials of Medical Products during COVID-19 Public Health Emergency”.

The Q & A Appendix has been updated by the addition of a new question and revisions to existing questions concerning the informed consent process.  These changes expand on and clarify previously suggested methods to obtain informed consent in certain scenarios that have become routine among patients suffering from COVID-19 and recognize the limitations on face-to-face interactions and the retention of paper copies imposed by infection control protocols being implemented in many hospitals.

For hospitalized patients in isolation, the guidance provides for two alternative methods of obtaining and documenting informed consent from a hospitalized patient in isolation if the infection-control procedures prevent the collection of the usual signed consent form.  One alternative is to have a photograph of the signed informed consent transmitted to the clinical trial staff following a telephone or video conference call between the patient and investigator or designee (and any others requested by the patient if feasible), during which the patient has a copy of the consent document and the investigator or designee reviews the consent document with the patient and answers questions.  The patient must state their consent and affirm that they have signed and dated the consent form.

The second method is an alternative for use when a photograph of the signed consent form cannot be transmitted.   In this case, the call between the patient and investigator or designee includes a witness who is otherwise unconnected to the study, as well as others requested by the patient, if feasible.  In lieu of using a witness, the call can be recorded.  As with the first method, the patient will have a copy of the consent document and the investigator or designee will go through the consent document and answers questions, and the patient will affirm verbally that they consent and have signed and dated the form.

In each of the scenarios above, the prospective trial participant has a paper or electronic copy of the consent form that can be signed physically or electronically.  A new question-and-answer (Q12) has been added to the guidance to address obtaining informed consent from a prospective trial participant when:

  • the enrollment timeframe is limited such that providing a physical copy of the consent form via mail or courier is not feasible;
  • the patient can receive a copy of an informed consent document electronically; and,
  • the patient cannot sign it electronically or print it out for signature.

The guidance outlines the steps that must be taken to obtain and document informed consent in this scenario.

The updated guidance also describes what records of these varying consenting procedures must be retained by the clinical trial staff.

Earlier this year FDA established an email box for receipt of questions on clinical trial conduct during the COVID-19 emergency: Clinicaltrialconduct-COVID19@fda.hhs.gov.