Novel consent process for research in dying patients unable to give consent

Abstract

Objectives: To develop a process of advance consent to enable research to be undertaken in patients in the terminal phase. Design: Feasibility study of an advance consent process to support a randomised controlled trial of two antimuscarinic drugs (hyoscine hydrobromide and glycopyrronium bromide) in the management of noisy respirations associated with retained secretions ("death rattle"). Setting: Palliative care wards in a major cancer centre. Participants: Patients admitted to a palliative care ward who may develop "death rattle" and thus be eligible for randomisation. Main outcome measures: Patient accrual; acceptability of the consent process. Results: Of the 107 patients approached to date, 58 patients gave advance consent to participate in the study. Of these, 15 patients developed death rattle and were randomised to receive either hyoscine or glycopyrronium; 16 patients died elsewhere; 15 patients died on the palliative care wards but were not randomised; 12 patients are still alive. Conclusions: Initial assessment suggests that this is a workable consent process allowing research to be undertaken in patients who are unable to give consent at the time of randomisation. Patient accrual rates to date are lower than needed to recruit adequate numbers in the time allotted to answer the research question.