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Making the case for completion bonuses in clinical trials.

Emily A Largent1, Holly Fernandez Lynch1

  • 1Department of Medical Ethics and Health Policy, Perelman School of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.

Clinical Trials (London, England)
|December 21, 2018
PubMed
Summary

Completion bonuses in clinical trials are ethically debated but not coercive. With oversight, they can help reduce participant attrition without unduly influencing decisions to withdraw.

Keywords:
Research ethicscoercioncompletion bonushuman subjects researchpaymentundue influence

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Area of Science:

  • Clinical Research Ethics
  • Medical Sociology

Background:

  • Participant attrition is a significant challenge in clinical trials.
  • Completion bonuses, financial incentives for trial completion, are used to mitigate attrition.
  • Ethical concerns exist regarding potential coercion or undue influence on participants' right to withdraw.

Purpose of the Study:

  • To evaluate the ethical implications of completion bonuses in clinical trials.
  • To determine if completion bonuses are inherently coercive or unduly influential.
  • To propose appropriate safeguards for the ethical use of completion bonuses.

Main Methods:

  • Conceptual analysis of ethical principles related to research incentives.
  • Examination of the distinction between completion bonuses and other research payments.
  • Consideration of the role of institutional review board oversight.

Main Results:

  • Completion bonuses are not considered coercive.
  • Under effective institutional review board oversight, undue influence is unlikely.
  • Completion bonuses may, in some instances, encourage prolonged participation.

Conclusions:

  • Completion bonuses are ethically permissible tools to combat clinical trial attrition.
  • Additional safeguards may be warranted in specific cases.
  • Eliminating completion bonuses is an unnecessary approach that fails to address attrition ethically.