It is necessary to strengthen networking which is helpful Bioactive compound not only for recruitment but also for exchange of ideas and views regarding new research proposals, discussing strategies for enhancing recruitment and in dealing with Ethics Committee related issues.[41] While doing international studies, several ethical issues might crop up [Table 2]. Table 2 Ethical issues that might arise when studies are carried out in different countries[26,42] Traditionally, pediatric oncology has a high accrual to trials. In most oncology trials, the treating physician is the one performing the research and this fact could be at least partly responsible for better accrual rates. This creates a situation wherein the parents struggle to distinguish between research and treatment.

This may vitiate the consent process and raise a question whether high accrual rates are attained at the expense of voluntariness.[43,44] A balance of ethical recruitment and high accrual is necessary for optimal recruitment to clinical trials.[43] Higher accrual rates can be attained if the research question is considered important by both researchers and parents, if both the parties are comfortable, with clinical and personal equipoise; if there is a constant communication channel between the researcher and family, and information provided about the trial is personal, tailored and timely. The retention is better; if throughout the recruitment process, the parents feel that the doctor gives priority to their child’s care over the scientific imperative of the trial and that if the trial continuation brought significant physical or emotional cost, the doctor would withdraw the child.

[43] For certain uncommon diseases, the number of prospective participants available is smaller than the number of participants required for several simultaneously ongoing clinical trials testing various therapeutic interventions for that condition. This situation where an individual patient could be eligible for enrollment for Entinostat several trials creates a unique ethical dilemma.[45] The researchers have to choose from one of the three approaches: Full disclosure, www.selleckchem.com/products/CP-690550.html paternalistic and random assignment. The researcher taking the full disclosure approach provides information about all ongoing concurrent trials, allowing parents and participants to make the decision regarding the trial to enroll with. In the paternalistic approach the researcher, considering that he/she knows what is in the best interest of the patient, decides which trial the patient should join. This approach introduces bias besides compromising parental autonomy. The random approach randomly allocates patients to each trial. This strategy may erode patient autonomy.