Cited by 269Ethics in Clinical ResearchStatistical Methods in EpidemiologyEthics and bioethics in healthcare

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Written informed consent and selection bias in observational studies using medical records: systematic review

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Kho, M. E, Duffett, M., Willison, D. J, Cook, D. J, Brouwers, M. C·2009·BMJ

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Abstract

OBJECTIVES: To determine whether informed consent introduces selection bias in prospective observational studies using data from medical records, and consent rates for such studies. DESIGN: Systematic review. DATA SOURCES: Embase, Medline, and the Cochrane Library up to March 2008, reference lists from pertinent articles, and searches of electronic citations. STUDY SELECTION: Prospective observational studies reporting characteristics of participants and non-participants approached for informed consent to use their medical records. Studies were selected independently in duplicate; a third reviewer resolved disagreements. DATA EXTRACTION: Age, sex, race, education, income, or health status of participants and non-participants, the participation rate in each study, and susceptibility of these calculations to threats of selection and reporting bias. RESULTS: Of 1650 citations 17 unique studies met inclusion criteria and had analysable data. Across all outcomes there were differences between participants and non-participants; however, there was a lack of consistency in the direction and the magnitude of effect. Of 161 604 eligible patients, 66.9% consented to use of data from their medical records. CONCLUSIONS: Significant differences between participants and non-participants may threaten the validity of results from observational studies that require consent for use of data from medical records. To ensure that legislation on privacy does not unduly bias observational studies using medical records, thoughtful decision making by research ethics boards on the need for mandatory consent is necessary.

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Flow diagram of included studies. *Two separate publications reported different outcomes from same studyw18 w19CC BY-NC · PubMed Central

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Authors: Kho, M. E., Duffett, M., Willison, D. J., Cook, D. J., & Brouwers, M. C.
Affiliations: McMaster University (CA)
McMaster Children's Hospital (CA)
Cancer Care Ontario (CA)
Corresponding author: Kho, M. E
ORCID: Kho, M. E
Duffett, M.
Willison, D. J
Brouwers, M. C
Venue: BMJ
Publisher: BMJ
Published: 2009-03-12
Volume: 338
Issue: mar12 2
Pages: b866-b866
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.b866
PMC: PMC2769263
OpenAlex: W2022496558
Cited by: 269
References: 22
Citations by year: 2026: 12 · 2025: 15 · 2024: 23 · 2023: 22 · 2022: 9 · 2021: 12 · 2020: 15 · 2019: 24 · 2018: 16 · 2017: 9 · 2016: 12 · 2015: 25 · 2014: 11 · 2013: 19 · 2012: 15
FWCI: 2.03
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
Locations: BMJ (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords: written informed consent, selection bias, medical records, consent rates, research ethics committees, reporting bias
MeSH terms: Humans, Informed Consent, Medical Records, Research Design, Selection Bias

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Written informed consent and selection bias in observational studies using medical records: systematic review

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