Assessment of Informed Consent by Ethics Committees in Portugal: Procedures and Constraints in an Observational Study
DOI:
https://doi.org/10.20344/amp.24899Keywords:
Ethics Committees, Ethics Committees, Research, Informed Consent, Research, PortugalAbstract
Introduction: Ethics committees (ECs) play a central role in ethical oversight and in protecting research participants. However, empirical evidence on their composition and practices in Portugal remains limited. The aim of this study was to characterize members of ECs, assess their activity and main constraints, and explore their views on the assessment of informed consent (IC) in research.
Methods: A cross-sectional observational study was conducted between March and June 2025 using an anonymous online questionnaire distributed to ECs in healthcare institutions, higher education institutions and research centers. The survey collected sociodemographic data, information on EC composition and functioning, and perceptions regarding IC documents.
Results: Eighty-one EC members participated. Most respondents were women (63.0%), aged 51 - 60 years (33.3%) or 61 years and older (30.9%), and nearly half had more than five years of EC experience (49.4%). The ECs represented were mainly based in healthcare institutions (50.6%) and higher education institutions (42.0%). The most frequently reported constraints were lack of training (87.7%) and insufficient time allocated to EC work (79.0%). Respondents reported no previous training in bioethics (56.8%) or data protection (47.0%). However, requests for revisions to the consent form were frequent, primarily due to unclear language (91.4%). Twenty-one percent rated the IC as poor or average, identifying lack of investigator training as the main reason. Regarding withdrawal of consent, 35.8% stated that it would depend on compliance with certain formalities, whereas 5,0% reported not knowing. In addition, nearly half of the respondents (45.7%) indicated that they had no personal experience in obtaining IC. Variability emerged regarding the importance attributed to certain consent components, particularly study conditions and procedures related to the communication of new information, the format of data retention, and contact details for the EC and the data protection officer.
Conclusion: Portuguese EC members recognize informed consent as a central ethical safeguard, but their responses reveal heterogeneity in the assessment of some informational components, together with structural constraints related to training and time allocated to EC activities. Strengthening training, harmonizing guidance and improving institutional support may enhance the consistency and pedagogical value of EC review.
Downloads
References
Stark L. Behind closed doors: IRBs and the making of ethical research. 1st ed. Chicago: The University of Chicago Press; 2012. DOI: https://doi.org/10.7208/chicago/9780226770888.003.0001
Leitão HS, Barbosa C. Da lâmina fina ao microscópio: fundamentos de bioética e a histologia jurídica do consentimento informado. Lex Medicinae. 2025;22:49-71.
Clapp JT, Gleason KA, Joffe S. Justification and authority in institutional review board decision letters. Soc Sci Med. 2017;194:25-33. DOI: https://doi.org/10.1016/j.socscimed.2017.10.013
Portugal. Lei n.º 21/2014. Diário da República, I Série, n.º 75 (2014/04/16).
Portugal. Decreto-Lei n.º 80/2018. Diário da República, I Série, n.º 198 (2018/10/15).
Refolo P, Raimondi C, Sacchini D, Spagnolo AG. The new organization of ethics committees in Italy: what is the future of clinical ethics? J Bioeth Inq. 2025;22:405-14. DOI: https://doi.org/10.1007/s11673-024-10389-1
Schober S, Klee S, Trautinger F. The role of institutional ethics committees in Austria: report of the commission on ethics and scientific integrity of the Karl Landsteiner university of health sciences 2018-2023. Wien Klin Wochenschr. 2025;137:432-7. DOI: https://doi.org/10.1007/s00508-024-02462-x
Abbott L, Grady C. A systematic review of the empirical literature evaluating IRBs: what we know and what we still need to learn. J Empir Res Hum Res Ethics. 2011;6:3-19. DOI: https://doi.org/10.1525/jer.2011.6.1.3
Angell EL, Jackson CJ, Ashcroft RE, Bryman A, Windridge K, Dixon-Woods M. Is ‘inconsistency’ in research ethics committee decision-making really a problem? An empirical investigation and reflection. Clin Ethics. 2007;2:92-9. DOI: https://doi.org/10.1258/147775007781029500
Massano J, Almeida FN. Comissões de ética em Portugal: velhos e novos desafios. Acta Med Port. 2020;33:295-6. DOI: https://doi.org/10.20344/amp.13709
Nunes L. Uma cartografia das comissões de ética do ensino superior politécnico em Portugal. Práxis Educativa. 2023;18:1-23. DOI: https://doi.org/10.5212/PraxEduc.v.18.22135.075
Rates CM, Costa MR, Pessalacia JD. Characterization of risks in search of an ethics committee in research protocols: bioethical analysis. Rev Bioét. 2014;22:491-6. DOI: https://doi.org/10.1590/1983-80422014223032
Länsimies-Antikainen H, Laitinen T, Rauramaa R, Pietilä AM. Evaluation of informed consent in health research: a questionnaire survey. Scand J Caring Sci. 2010;24:56-64. DOI: https://doi.org/10.1111/j.1471-6712.2008.00684.x
Pietrzykowski T, Smilowska K. The reality of informed consent: empirical studies on patient comprehension-systematic review. Trials. 2021;22:57. DOI: https://doi.org/10.1186/s13063-020-04969-w
Nishimura A, Carey J, Erwin PJ, Tilburt JC, Murad MH, McCormick JB. Improving understanding in the research informed consent process: a systematic review of 54 interventions tested in randomized control trials. BMC Med Ethics. 2013;14:28. DOI: https://doi.org/10.1186/1472-6939-14-28
Sumathipala A, Siribaddana S, Hewage S, Lekamwattage M, Athukorale M, Siriwardhana C, et al. Informed consent in Sri Lanka: a survey among ethics committee members. BMC Med Ethics. 2008;9:10. DOI: https://doi.org/10.1186/1472-6939-9-10
Hammerschmidt DE, Keane MA. Institutional review board (IRB) review lacks impact on the readability of consent forms for research. Am J Med Sci. 1992;304:348-51. DOI: https://doi.org/10.1097/00000441-199212000-00003
Kane EI, Gallo JJ. Perspectives of IRB chairs on the informed consent process. AJOB Empir Bioeth. 2017;8:137-43. DOI: https://doi.org/10.1080/23294515.2016.1253628
McMillan G. IRB policies for obtaining informed consent from non-english-speaking people. Ethics Hum Res. 2020;42:21-9. DOI: https://doi.org/10.1002/eahr.500050
Klitzman R. How US institutional review boards decide when researchers need to translate studies. J Med Ethics. 2014;40:193-7. DOI: https://doi.org/10.1136/medethics-2012-101174
de Lange DW, Guidet B, Andersen FH, Artigas A, Bertolini G, Moreno R, et al. Huge variation in obtaining ethical permission for a non-interventional observational study in Europe. BMC Med Ethics. 2019;20:39. DOI: https://doi.org/10.1186/s12910-019-0373-y
United States Food and Drug Administration. Institutional review boards frequently asked questions: guidance for institutional review boards and clinical investigators. 2025. [consultado 2026 abr 17]. Disponível em: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/institutional-review-boards-frequently-asked-questions.
United States Food and Drug Administration. Informed consent: guidance for IRBs, clinical investigators, and sponsors. 2023. [consultado 2026 abr 17]. Disponível em: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/informed-consent.
United Kingdom Health Departments Research Ethics Service. Standard operating procedures for research ethics committees. Version 7.7. 2025. [consultado 2026 abr 17]. Disponível em: https://www.hra.nhs.uk/about-us/committees-and-services/res-and-recs/research-ethics-committee-standard-operating-procedures.
Ministry of Education, Culture, Sports, Science and Technology; Ministry of Health, Labour and Welfare; Ministry of Economy, Trade and Industry. Ethical guidelines for medical and biological research involving human subjects. 2021. [consultado 2026 abr 17]. Disponível em: https://www.mhlw.go.jp/content/001457376.pdf.
Direção-Geral da Saúde. Consentimento informado, esclarecido e livre dado por escrito: Norma n.º 015/2013. Lisboa: DGS; 2013.
World Health Organization. Templates for informed consent forms. [consultado 2026 mar 31]. Disponível em: https://www.who.int/groups/research-ethics-review-committee/guidelines-on-submitting-research-proposals-for-ethics-review/templates-for-informed-consent-forms.
Dukaew N, Na Takuathung M, Sakuludomkan W, Chairaksa K, Klinjan P, Morakote N, et al. Regulatory compliance and readability of informed consent forms in industry-sponsored drug development clinical trials. Clin Trials. 2023;20:517-27. DOI: https://doi.org/10.1177/17407745231174528
Flory J, Emanuel E. Interventions to improve research participants’ understanding in informed consent for research: a systematic review. JAMA. 2004;292:1593-601. DOI: https://doi.org/10.1001/jama.292.13.1593
Glaser J, Nouri S, Fernandez A, Sudore RL, Schillinger D, Klein-Fedyshin M, et al. Interventions to improve patient comprehension in informed consent for medical and surgical procedures: an updated systematic review. Med Decis Making. 2020;40:119-43. DOI: https://doi.org/10.1177/0272989X19896348
Tam NT, Huy NT, Thoa LT, Long NP, Trang NTH, Hirayama K, et al. Participants’ understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis. Bull World Health Organ. 2015;93:186-98H. DOI: https://doi.org/10.2471/BLT.14.141390
Koonrungsesomboon N, Laothavorn J, Karbwang J. Understanding of essential elements required in informed consent form among researchers and institutional review board members. Trop Med Health. 2015;43:117-22. DOI: https://doi.org/10.2149/tmh.2014-36
Hallinan D, Boehm F, Külpmann A, Elson M. Information provision for informed consent procedures in psychological research under the General Data Protection Regulation: a practical guide. Adv Methods Pract Psychol Sci. 2023;6. DOI: https://doi.org/10.1177/25152459231151944
Quezada-Tavarez K, Dutkiewicz L, Krack N. Voicing challenges: GDPR and AI research. Open Res Eur. 2022;2:126. DOI: https://doi.org/10.12688/openreseurope.15145.1
Ducato R. Data protection, scientific research, and the role of information. Comput Law Secur Rev. 2020;37:105412. DOI: https://doi.org/10.1016/j.clsr.2020.105412
Fons-Martinez J, Murciano-Gamborino C, Diez-Domingo J. Evolution of informed consent in research: from the Hippocratic Oath to the tailored consent. Open Res Eur. 2024;4:72. DOI: https://doi.org/10.12688/openreseurope.17311.1
Entidade Reguladora da Saúde. Consentimento informado: relatório final. Porto: ERS; 2009.
Gefenas E, Lekstutiene J, Lukaseviciene V, Hartlev M, Mourby M, Ó Cathaoir K. Controversies between regulations of research ethics and protection of personal data: informed consent at a cross-road. Med Health Care Philos. 2022;25:23-30. DOI: https://doi.org/10.1007/s11019-021-10060-1
Grady C. Institutional review boards: purpose and challenges. Chest. 2015;148:1148-55. DOI: https://doi.org/10.1378/chest.15-0706
Ferretti A, Ienca M, Sheehan M, Blasimme A, Dove ES, Farsides B, et al. Ethics review of big data research: what should stay and what should be reformed? BMC Med Ethics. 2021;22:51. DOI: https://doi.org/10.1186/s12910-021-00616-4
Brelsford KM, Ruiz E, Beskow LM. Developing informed consent materials for non-english-speaking participants: an analysis of four professional firm translations from english to spanish. Clin Trials. 2018;15:557-66. DOI: https://doi.org/10.1177/1740774518801591
Ferreira PL, Barradas A, Ribeiro I. Quality of informed consent in phase III clinical trials in Portugal: the participants’ perspective. Acta Med Port. 2024;37:601-8. DOI: https://doi.org/10.20344/amp.20570
Macedo JC, Macedo E, Nunes R. Advance directives in Portugal: a qualitative survey. Healthcare. 2024;12:195. DOI: https://doi.org/10.3390/healthcare12020195
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Acta Médica Portuguesa

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.



