Global public perceptions of participation in pandemic and non-pandemic trials in the intensive care unit: a cross-sectional survey across 13 countries

Public views of clinical trial participation are not frequently sought. As potential patients and study participants, their views are profoundly important, particularly in the intensive care unit (ICU) where alternative consent models are required and for multi-centre trials enrolling diverse populations. To understand public opinions on pandemic and non-pandemic ICU trials, consent and emerging trial designs, following the COVID-19 pandemic. To identify factors associated with acceptability of clinical trials including in countries where public opinions have not been previously assessed. An international cross-sectional scenario-based online survey with responses collected from March 17 to April 10, 2023. The views of nationally representative quota samples of people in 13 countries; Australia, Canada, France, Germany, Ghana, India, Ireland, Italy, Japan, New Zealand, Pakistan, the United Kingdom and the United States of America were analysed using descriptive and regression analyses. Of 9726 survey respondents, 7382 (75.9%) felt pandemic research is important and should be established before a pandemic so it is ready to respond (76.1%). Respondents indicated that special rules should apply to make it quicker and easier to do pandemic research (72.8%) and that patients and public should be involved (73%). Fewer respondents would not agree to participate in low-risk (1627, 16.7%) and higher-risk (1823, 18.7%) pandemic ICU trials, and non-pandemic ICU trials (17.3%, asked in 9 countries). Respondents preferred alternative consent models (79.8%), including deferred and substitute decision maker consent, and were supportive of biological sample collection (71.4%), adaptive trials (79.6%) and precision medicine (80.8%). Prior experience of an ICU or pandemic illness, higher pandemic knowledge, trust in healthcare professionals and greater or uncertain therapeutic misconception were predictive of willingness to participate. Age and country-level differences in willingness were observed. Respondents had overall lower trust in their government to manage a pandemic outbreak (45.3%), also a predictive factor for agreement to participate. There is public support for pandemic and non-pandemic ICU trials with acceptance of alternative consent, biological sample collection and trial designs, but there is a need for researchers to further build trust and engage with the public to increase understanding and inform trials.