Institutional conflicts of interest in health-related research - a scoping review

Institutional conflicts of interest (COIs) have received less attention than individual COIs in health-related research.

To explore how institutional COIs arising from affiliation with a healthcare provider have been studied or discussed in the literature on health-research involving humans.

We conducted a scoping review following the JBI guidance and reported it according to PRISMA-ScR. The review included English‑ or German‑language empirical or conceptual publications that addressed institutional COIs -either independently or in conjunction with individual COI - within health‑related research involving humans conducted at institutions that deliver healthcare services. We systematically searched PubMed, Embase (Elsevier), and Google Scholar in July 2024. Two reviewers independently screened publications. One reviewer extracted data and another checked it. One author mapped and analysed included papers according to the categories of institutional and individual COIs that they addressed, which another author verified.

We included 48 publications published between 1998 and 2022. The majority (88%; n = 42/48) focused on North America, were empirical (67%; n = 32/48), and referred to institutions such as hospitals and clinics (58%; n = 28/48), or universities and academic institutions (58%; n = 28/48). Most institutional COIs described were linked to health-related industries (79%; n = 38/48). Almost all publications mentioned direct financial institutional COIs (98%; n = 47/48) primarily in relation to receiving gifts, endowments, or grants (94%; n = 45/48). One third of publications (n = 16/48) described indirect financial institutional COIs, most frequently through increasing services (27%; n = 13/48). Direct financial individual COI were represented in 73% (n = 35/48) of publications, and indirect financial individual COIs in 6% (n = 3/48). Half of the publications (52%; n = 25/48) illustrated non-financial COIs, particularly related to prestige and reputation (31%; n = 15/48), or career advancements and professional roles (23%; n = 11/48). All publications acknowledged that institutional COIs can have negative consequences, most frequently due to bias and distortion in the research process (94%; n = 45/48). The vast majority of publications (94%; n = 45/48) offered recommendations for managing COIs, including institutional policies (77%; n = 37/48).

Direct financial COIs dominate the literature on institutional COIs, while indirect or non-financial COIs remain under-researched. Institutional COIs are consistently recognised as problematic and institutional policies are most frequently proposed as means to manage them.