Proposing phase I studies: Patients', relatives', nurses' and specialists'perceptions

Purpose: As of now the primary objective of studies on informed consent in phase I trials has been to assess patients' expectations and reasons for pa rticipation. We have previously shown that the quantity of information prov ided through a procedure of subsequent oral interviews with patients was ad equate while the attention paid by the physician to the emotional needs and concerns of patients was not. We wanted therefore to assess and compare th e perceptions of the information provided about the investigational study o f patients, relatives, the research nurse and the investigator responsible for the phase I trial and the impact this information had on the patients' level of anxiety and depression. Patients and methods: The participation to a phase I study was proposed to patients through two subsequent interviews, the latter attended also by pat ients' relatives, the research nurse and the investigator coordinating the phase I trial. After the second interview, attendees were requested to comp lete a questionnaire assessing the principal reason for participating in th e study and the informative, emotional and interactive dimension of the inf ormation. Patients were also requested to complete the Hospital Anxiety and Depression (HAD) scale before and after the second interview. Results: The completed questionnaires of 31 of 42 patients were retrieved a nd analysed. The possibility to benefit from the study was indicated as the main reason for participating by 59% of the patients while it was judged t o be the case in 78% and 86% of the patients by the nurse and the investiga tor, respectively. The information was judged to be clear and sufficient in almost all cases by all attendees, while the investigator judged that a lo wer percentage of patients felt at ease and could express their main worrie s during the interview, had been helped and were less worried after it than it was judged by the nurse and the relatives. Patients' state of anxiety a nd depression was not adversely affected by the information provided. Conclusions: Informing patients on the option of receiving an investigation al treatment within a phase I study is feasible and can be done in a way fe lt appropriate by patients and relatives, nursing and medical professionals . Providing information in an appropriate manner does not increase patients ' anxiety and depression. Divergence between the aims and interests of the investigators and patients might explain the difference in the evaluation o f physician, a problem which could perhaps be partially overcome by the app lication of innovative phase I designs.