Physician compensation for industry-sponsored clinical trials in multiple sclerosis influences patient trust

https://doi.org/10.1016/j.msard.2016.04.001Get rights and content

Highlights

  • A national online survey of MS patient views of conflict of interest is developed.

  • Patient trust is adversely affected by physician payment in clinical trials.

  • Former participation in a clinical trial is associated with higher levels of trust.

  • Patient trust is negatively influenced by various physician-industry relationships.

Abstract

Background

Perceived physician financial conflicts of interest of can affect patient trust. Payment to physicians for industry sponsored clinical trials in multiple sclerosis is a relatively new potential source of physician conflict of interest. There is limited available data on how physician payment for trial involvement in multiple sclerosis clinical trials may influence patient trust.

Objective

To understand how patient trust is influenced by information about physician payment for multiple sclerosis clinical trials.

Methods

An anonymous online instrument was developed.

Results

597 people with multiple sclerosis participated in the study. The study found that 61% of patients who had not previously participated in a clinical trial estimated that they would have lower levels of trust in their physician if the physician was paid for involvement in their clinical trial. Among former clinical trial participants, 38% self-reported a lower level of trust. Other potential physician-industry relationships, such as industry consulting or giving industry-sponsored talks, also adversely affected trust, though to a lesser extent than physician payment for subject participation in clinical trials.

Conclusions

Results of this study demonstrate that physician payment for study participation in multiple sclerosis clinical trials is a potential conflict that can adversely affect patient trust.

Introduction

Patient perceptions of physician-pharma relationships influence patient trust Grande et al., 2012, Perry et al., 2014, Weinfurt et al., 2006. The Patient Protection and Affordable Care Act's Open Payment program, which requires pharmaceutical, device, and life science industries to self-report financial relationships with physicians, can be viewed in part as a response to growing concern about the effect of these relationships on trust.2 Research on pharma-physician relationships and trust has focused on paradigmatic interactions, such as payment for consulting, physician stock ownership, physician gifts (meals, travel, entertainment), and free drug samples (Perry et al., 2014). The tremendous growth in industry-sponsored clinical trial research (Fisher and Kalbaugh, 2012) has generated a new role for the physician-researcher: physician as compensated recruiter for clinical trials. Detailed disclosure of physician compensation for conduct of clinical trials is not uniformly included as part of informed consent and documentation practices in industry-sponsored clinical trials (ISCT) (Solomon et al., 2015). The impact of physician compensation for industry-sponsored clinical trials on trust in academic and non-academic physician-researchers has received comparatively little attention. This potential conflict of interest is particularly important in multiple sclerosis given recent rapid development and FDA approval of new medications for MS (Research, 2013) and a global market value of new therapeutics estimated at up to US$16bn by 2016 (IMS Institute for Health Informatics, 2016).

In this article, we describe the findings of a survey of patients with multiple sclerosis studying their views of trust and industry-physician relationships. The survey explored how MS patients who had or had not previously participated in ISCTs perceived trust in their physician to be influenced by potential physician-industry relationships (such as payment for conducting clinical trials, for consulting, or for giving talks). Perceptions of trust were assessed relative to a hypothetical MS clinical trial in trial-naïve patients and to a prior clinical trial in former MS trial participants. We conducted a national online survey of 597 patients with multiple sclerosis.

Section snippets

Methods

An anonymous survey instrument of patient attitudes toward physician–industry relationships was developed by the contributing authors and distributed through SurveyMonkey.com to people self-identifying as having MS. The survey directed respondents to questions based on specific responses, and captured an IP address to prevent multiple submissions by a single individual. The survey instrument was not previously validated. The instrument was reviewed by the University of Vermont Institutional

Study results

Table 1 contains demographic data of survey participants. A total of 597 people with MS participated in the study and 552 completed the entire survey. Responses from partially completed surveys were included in the results, and questions not answered were coded as missing.

The Oregon chapter of the NMSS emailed each member individually about this study while other participating state chapters relied on newsletters and social media. Of the respondents, 41% (240) identified Oregon as their home

Associations/comparisons

Among respondents who considered participating in a clinical trial, for the question “how would your level of trust in your neurologist change if your neurologist received money toward their salary based on your participation in the study?” we found that the fewer visits with their neurologist per year, the lower the trust (p:0.0075). Trust also decreased with fewer visits within the past year for the situation where the neurologist gave talks to pharma in the past (p<0.0001), consulted in the

Discussion

Trust is a lynchpin of medical practice (Pellegrino and Thomasma, 1999) and research (Kass et al., 1996) Patients' trust in physicians is thought to affect “patients' willingness to seek care, reveal sensitive information, submit to treatment, participate in research, adhere to treatment regimens, remain with a physician, and recommend physicians to others”. (Hall et al. (2001) Patient trust in physicians is influenced by patient perceptions of physician traits (honesty (Hillen et al., 2011)),

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