Form 25 Adult CIRB Reviewer Findings - Initial Review of Coopera

NIH NCI Central Institutional Review Board (CIRB) Initiative (NCI)

Attachment 6A - CIRB Adult_Initial_Review_Form_110110

Adult CIRB Reviewer Findings - Initial Review of Cooperative Group Protocol (Attach 6A)

OMB: 0925-0625

Document [pdf]
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Attachment 6A:

NCI Adult CIRB
REVIEWER FINDINGS
INITIAL REVIEW OF COOPERATIVE GROUP PROTOCOL

OMB#: 0925 – xxxx Expiry Date: xx/xx/xx
STATEMENT OF CONFIDENTIALITY
Collection of this information is authorized under 42 USC 285a. While your participation is
completely voluntary, to participate in the NCI CIRB, completion of this form is required. Data
collected as part of the NCI CIRB review is private and protected by law. Under the provisions of
Section 301d of the Public Health Service Act, no information that could permit identification of a
participating individual may be released. All such information will be kept private under the
Privacy Act and will be presented only in statistical or summary form.
NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN
Public reporting burden for this collection of information is estimated to average 4 hours per
response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not
return the completed form to this address.

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NCI Adult CIRB
REVIEWER FINDINGS
INITIAL REVIEW OF COOPERATIVE GROUP PROTOCOL
DOCUMENT NAME:
DOCUMENT DESCRIPTION:
Name of Reviewer:
Date Completed:
1. I have reviewed the following documents (check all that apply)
NCI Adult CIRB Application for Treatment Studies or NCI Adult/Pediatric CIRB
Application for Ancillary Studies
Study Protocol
Cooperative Group Model Informed Consent Document(s)
CIRB Approved Informed Consent Document(s)
Investigator’s Brochure
Study instruments to be completed by participants
Recruitment materials
Other (specify)

2. Does this protocol have scientific value?
•

Is the study worthwhile?

3. Does the protocol have scientific validity?
•
•
•
•

Are the background assumptions that lead to the hypothesis valid?
Is literature/background described to justify the trial?
Is the hypothesis or research question clearly stated?
Is the study design appropriate to prove the hypothesis?
(Consider sensitive and specific measures of difference, statistical testing,

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sample size)

4. Does the study have a valid scientific design and yet pose an inappropriate risk for
subjects?
•

•

Is there substantial evidence that one of the arms is inferior to another or to
standard/conventional
care or will deprive a subject of his/her right to receive a life-prolonging
treatment?
Is it possible that one arm will expose a subject to a serious risk of harm?

5. Are risks to subjects minimized?
•
•
•

•

Does the research design minimize risks to subjects?
Do the procedures expose subjects to unnecessary risks?
Are procedures already being performed on the subjects for diagnostic or
treatment purposes
being used whenever appropriate?
Can alternative procedures be used that would expose the subjects to fewer
risks?

6. Are the risks to subjects reasonable in relation to anticipated benefits, if any, to
subjects and the importance
of the knowledge that may reasonably be expected to result? *
•
•

What is the perceived level of risk/discomfort/inconvenience to the subject?
Is there the prospect of direct benefit to the subjects?

* (Consider only those risks and benefits that may result from research as opposed to those that would
result from alternative therapies not involved in the research.)

7. Is the selection of subjects equitable?
•
•
•
•

Who is to be enrolled?
How will subjects be identified and recruited?
Are these subjects appropriate for the protocol?
What is the rationale for the inclusion/exclusion of specific populations?

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8. Are additional safeguards in place for subjects likely to be vulnerable to coercion or
undue influence?
•

Are appropriate protections in place for vulnerable subjects (e.g., pregnant
women, fetuses,
socially- or economically -disadvantaged, decisionally impaired, extremely
ill/desperate)?

9. Will informed consent be obtained from research subjects or their legally
authorized representatives?
•
•
•

Does the informed consent document include the eight required elements?
Is the consent document understandable to subjects/legal gardian?
Is the CIRB requested to waive or alter any informed consent requirement?

10. Is there adequate provision for monitoring the data collected to ensure the safety
of subjects?
•

What research oversight process will be used to enhance subject safety? (e.g.,
data safety monitoring boards)

11. Are there adequate provisions to protect the privacy of subjects and to maintain
the confidentiality of data?
•
•

Will personally-identifiable research data be protected to the extent possible
from access or use?
Are any special privacy and confidentiality issues properly addressed, e.g., use
of genetic information?

12. Additional Remarks

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File Typeapplication/pdf
File TitleAttachment 6A - CIRB Adult_Initial_Review_Form_110110.doc
Authorjdugan
File Modified0000-00-00
File Created2010-10-29

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