A Code of Practice for Declaring and Dealing with Competing Interests

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A competing interest, or conflict of interest (COI), in practical terms, it is a situation in which an individual in a position of trust, or who holds a decision-making or assessment role, has competing personal and/or professional interests that ‘could make it difficult for [that] individual to fulfil their duties impartially, and potentially could improperly influence the performance of their official duties and responsibilities’.[1] However, it is important to note that ‘there is nothing inherently unethical about conflicts of interests as long as they are acknowledged and openly declared’.[2]

Cancer Council Australia’s Code of practice for declaring and dealing with competing interests (the Code) has been developed based on the UK National Institute for Health and Clinical Excellence’s Policy on declaring and managing interests for NICE advisory committees,[3] and on the National Health and Medical Research Council’s (NHMRC) guidelines on identifying and managing conflicts of interest (Standard 4 Identify and manage conflicts of interest).[4]

The purpose of the Code is to ensure that a Cancer Council Australia (CCA) guideline, project or policy (the Project) is developed and conducted in an ethical, fair and impartial manner. To ensure this aim, individuals appointed to the Cancer Council Australia Management Committees, Working Parties, Advisory Groups, Committees or Subcommittees (hereafter Committee/Group) are required to acknowledge and declare any possible or probable COIs. This is required to meet Standard A.6 of the NHMRC Procedures and requirements for meeting the 2011 NHMRC standard for clinical practice guidelines and is a pre-requisite for ensuring public confidence in the integrity of guidelines, projects and policies developed and overseen by Cancer Council Australia.[4]

Documented COIs can be appropriately negotiated or addressed between the individual and the CCA. Areas in which an individual could have competing interests and where COIs could occur include:

  • professional positions
  • membership on committees of other organisations
  • consultancies
  • boards of directors
  • advisory groups
  • family and personal relationships
  • financial interests (e.g. receiving recompense in the form of cash, services or equipment from outside bodies to support professional activities or research grants).


Appointees to Cancer Council Australia Committees/Groups identify any potential COIs in order that:

  • such interests can be assessed by the Committee/Group and Cancer Council Australia’s Board of Directors; for clinical guidelines interests are assessed by the Management Committee
  • management plans are developed to appropriately address the identified COI when necessary
  • individuals can form their own judgment about their appropriateness in seeking inclusion in the guideline development process.

Identified COIs are included in the COI register for a Committee/Group in line with the NHMRC principles of guidelines development and management of COI.

The policies and principles outlined in this Code aim to assist an individual to identify and declare any competing interests with respect to activities and duties performed as a member of a Committee/Group.

Issues that require consideration include, but are not limited to, the four points below.

In addition to these, individuals appointed to a position on a Management Committee, Working Party or author subcommittee are expected to adhere to the CCA’s vision, mission and values, and to conduct themselves in accordance with its policies and procedures. Appointed individuals agree not to make public statements public statements that conflict with CCA’s stated policies and positions.


What interests are involved?

The following is intended as a guide to the types of interest that should be declared. If a person covered by the Code is uncertain whether an interest should approach:

  • Committee/Group members and employees of CCA should seek guidance from CCA’s Director of Cancer Control Policy and Chair of the Committee/Group.
  • For clinical guidelines, Working Party and subcommittee members should seek guidance from the Management Committee via the Chair.
  • Contractors’ employees should seek guidance from their head or department.

Although attention is given to members’ or employees’ pecuniary interests, CCA is conscious that risks to an individual’s reputation could also be (or perceived to be) prejudicial to their advice. Arrangements covering ‘reputational risk’ are therefore also considered in this document (see below).


A. A personal pecuniary interest involves a current personal payment, which may either relate to the manufacturer or owner of a product or service being evaluated (‘specific’ interest) or to the industry or sector from which the product or service comes (‘non-specific’ interest). The main examples include the following:

  • any consultancy, directorship, position in or work for a healthcare industry for which the individual receives regular or occasional payment in cash or in kind, and which has been undertaken in the 12 months preceding the meeting at which the declaration is made, or which is planned but has not taken place
  • any fee-paid work commissioned by a healthcare industry for which the individual is paid in cash or in kind, and which has been undertaken in the 2 months preceding the meeting at which the declaration is made, or which is planned but has not taken place
  • any shareholdings or other beneficial interests in a healthcare industry that are either held by the individual or held by another party for whom the individual has legal responsibility (e.g. children, or relatives whose full Power of Attorney is held by the individual).
  • expenses and/or hospitality provided by a healthcare industry company beyond that reasonably required for accommodation, meals and travel to attend meetings and conferences, which have been undertaken in the 12 months preceding the meeting at which the declaration is made, or which are planned but have not taken place
  • funds that include investments in the healthcare industry that are held in a portfolio over which individuals can instruct the fund manager as to the fund composition
  • research grants, received from government and non-government organisations, to investigate topics and issues that are related to the aims of the Project.

No personal interest exists in the case of:

  • assets over which individuals have no financial control (e.g. wide portfolio unit trusts and occupational pension funds) and where the fund manager has full discretion as to its composition
  • accrued pension rights from earlier employment in the healthcare industry.



B. A non-personal pecuniary interest involves payment or other benefit that benefits a department or organisation for which an individual has managerial responsibility, but which is not received personally. This may either relate to the product or service being evaluated, in which case it is regarded as ‘specific’, or to the manufacturer or owner of the product or service but is unrelated to the matter under consideration, in which case it is regarded as ‘non-specific’. The main examples include the following:

  • the holding of a fellowship endowed by the healthcare industry
  • any payment or other support by the health industry or by CCA that does not convey any pecuniary or material benefit to an individual personally but that might benefit him or her. Examples include:
i. a grant from a company for the running of a unit or department for which a member is responsible
ii. a grant or fellowship or other payment to sponsor a post or member of staff in the unit for which a member is responsible
iii. the commissioning of research or other work by, or advice from, staff who work in a unit for which the member is responsible
iv. one or more contracts with, or grants from, CCA.

An individual covered by this Code is under no obligation to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

C. A personal non-pecuniary interest in a topic under consideration might include, but is not limited to:

  • a clear opinion, reached at the conclusion of a research project, about the clinical and/or cost effectiveness of an intervention under review
  • a public statement in which an individual is covered by this consideration, which could reasonably be interpreted as prejudicial to an objective interpretation of the evidence
  • holding office in a professional organisation or advocacy group with a direct interest in the matter under consideration
  • other reputational risks in relation to an intervention under review.



D. A personal family interest relates to the personal interests of a family member and involves a current payment to the family member of the employee or member. The interest may relate to the manufacturer or owner of a product or service being evaluated, in which case it is regarded as ‘specific’, or to the industry or sector from which the product or service comes, in which case it is regarded as ‘non-specific’. The main examples include the following:

  • any consultancy, directorship, position in or work for a healthcare industry that attracts regular or occasional payments in cash or in kind
  • any fee-paid work commissioned by a healthcare industry for which the member is paid in cash or in kind
  • any shareholdings or other beneficial interests in a healthcare industry, which are either held by the family member or for which an individual covered by this Code has legal responsibility (e.g. children, or adults whose full Power of Attorney is held by the individual)
  • expenses and hospitality provided by a healthcare industry company (except where they are provided to a general class of people such as attendees at an open conference)
  • funds which include investments in the healthcare industry that are held in a portfolio over which individuals can instruct the fund manager as to the composition of the fund.

No personal family interest exists in the case of:

  • assets over which individuals have no financial control (e.g. wide portfolio unit trusts and occupational pension funds) and where the fund manager has full discretion as to its composition (e.g. the Universities Superannuation Scheme)
  • accrued pension rights from earlier employment in the healthcare industry.

Disclosing competing interests

Individuals are required to provide information about their personal and professional activities and interests that could be perceived as having an apparent or a potential impact on their impartiality when contributing as a member of the Project.

An apparent (or perceived) conflict of interest exists where it appears that individual private interests could improperly influence the performance of their duties and responsibilities whether this is, in fact, the case. Individuals must be conscious that perceptions of conflict of interest may be as important as an actual conflict.[1]
A potential conflict of interest arises where an individual has a private interest which is such that an actual conflict of interest would arise if the member were to become involved in relevant (that is conflicting) official duties and responsibilities in the future.[1]

In being appointed to the Committee/Group, an apparent or potential COI may arise in the following situations (though this list is not exhaustive), where an individual:

  • has a contractual or unpaid/paid employment arrangement with an organisation that is involved in a request which will be under their consideration as a Committee/Group member
  • owns shares in or controls a company or other organisation involved in any current application that is under his/her consideration, or in which he/she has direct involvement
  • is involved in any other Committee/Group process where he/she may have a direct or indirect involvement in the matters being considered

A competing interest may also exist where the individual’s partner or immediate family member has any of the interests or involvements listed.

At the time of accepting an appointment to participate in the Project, an individual must provide information (as detailed in this document) of the financial and other private/professional interests of themselves and their immediate family/partner, which may represent an apparent or potential COI.

The obligation to disclose an apparent or potential COI is ongoing. Accordingly, after the initial disclosure, individuals are required to provide updates to CCA if there are significant changes to their or their immediate family/partner’s private interests as they become aware of those changes. The private information provided by individuals will be treated by CCA as confidential and in accordance with the Information Privacy Principles set out in the Privacy Act.

If an individual appointed to participate in the Committee/Group has, or acquires, an interest, pecuniary or otherwise, that could conflict with the proper performance of their appointed functions, they must disclose to CCA, in writing, details of the nature of the interest as soon as possible after the relevant facts come to the individual’s knowledge. In cases where a member declares a COI in relation to a matter under consideration by CCA, Committee/Group, the Chair and/or CCA Director Cancer Control Policy will determine the extent to which that individual may be involved in discussion or decisions concerning that matter.

When should interests be declared and what action is required?

The table below summarises the actions which should be taken when interests are declared.

Type of interest Action (for all other CCA advisory Committees/Groups) Action (for clinical guidelines)
Personal specific pecuniary Declare and withdraw Declare and withdraw
Personal non-specific pecuniary Declare and participate (unless, exceptionally, the Committee/Group rules otherwise) Declare and participate (unless, exceptionally, the guideline Management Committee rules otherwise)
Personal family specific interest Declare and withdraw Declare and withdraw
Personal family non-specific Declare and participate (unless, exceptionally, the Committee/Group rules otherwise) Declare and participate (unless, exceptionally, the guideline Management Committee rules otherwise)
Non-personal specific pecuniary interest Declare and participate, unless the individual has personal knowledge of the intervention

or matter either through their own work, or through direct supervision of other people’s work.

In either of these cases they should declare this interest and not take part in the proceedings

except to answer questions,

Declare and participate, unless the individual has personal knowledge of the intervention

or matter either through their own work, or through direct supervision of other people’s work.

In either of these cases they should declare this interest and not take part in the proceedings

except to answer questions,

Non-personal non-specific pecuniary Declare and participate (unless, exceptionally, the Committee/Group rules otherwise) Declare and participate (unless, exceptionally, the guideline Management Committee rules otherwise)
Personal specific non-pecuniary Declare – action is at discretion of the Committee/Group Declare – action is at discretion of the guideline Management Committee

A. On appointment

Any uncertainty about potential competing interests of members of advisory bodies on appointment should be resolved at the discretion of the relevant Chair and the Committee/Group.

B. At meetings

Members and other individuals covered by this Code who are attending to take part in the meeting should declare relevant interests at each meeting and at appeal panels, and state into which of the following categories they believe the interest falls:

  • A person declaring a personal specific pecuniary or personal family specific interest shall take no part in the proceedings as they relate to the intervention or matter and will normally leave the meeting until the matter has been concluded. In exceptional circumstances they may, at the discretion of the Chair, answer questions from other members but should then leave the meeting until the discussion has been concluded.
  • A person declaring a personal non-specific pecuniary interest may take part in the proceedings unless, exceptionally, the Committee/Group rules otherwise.
  • A person declaring a non-personal specific pecuniary interest, or a personal family non-specific interest may take part in the proceedings unless they has personal knowledge of the intervention or matter either through their own work or through direct supervision of other people’s work. In either of these cases they should declare this interest and not take part in the proceedings except to answer questions.
  • A person declaring a non-personal non-specific pecuniary interest may take part in the proceedings unless, exceptionally, the Committee/Group rules otherwise.
  • When someone declares a personal non-pecuniary interest the Committee/Group shall determine, on a case-by-case basis, whether they should take part in the proceedings.


C. In evidence publications

Where an individual covered by this Code is responsible for authoring, in whole or part, a document that is prepared specifically to inform CCA’s advisory bodies, they must declare any interests in accordance with this Code.


D. Record of interests and their publication

A record is kept by CCA of:

  • names of individuals who have declared interests on appointment, as the interest first arises or through the annual declaration, and the nature of the interest
  • names of individuals who have declared interests at meetings giving dates, names of relevant interventions and companies, details of the interest declared and whether the member took part in the proceedings.

Summary

When an individual is seeking appointment or has been invited to the Committee/Group, they are responsible for reading this document, reviewing their current activities for apparent or potential competing interests, and bringing any existing and future possible and probable COIs to the attention of CCA.

References

  1. 1.0 1.1 1.2 Australian Research Council. ARC Conflict of Interest and Confidentiality Policy. Canberra: Australian Government; 2019 Nov 5. Report No.: Version 2019.1. Available from: https://www.arc.gov.au/policies-strategies/policy/arc-conflict-interest-and-confidentiality-policy.
  2. Tileagă, C. Cautious morality: Public accountability, moral order and accounting for a conflict of interest. Discourse Studies 2010;12(2), 223-239 Abstract available at https://journals.sagepub.com/doi/10.1177/1461445609356501.
  3. NICE. Policy on declaring and managing interests for NICE advisory committees. London, UK: National Institute for Health and Clinical Excellence (UK); 2020 Feb. Report No.: Version 1.2. Available from: https://www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/Declaring-managing-interests-for-advisory-committees.docx.
  4. 4.0 4.1 National Health and Medical Research Council. 2016 NHMRC Standards for Guidelines. [homepage on the internet] Canberra: NHMRC Australian Government; [cited 2019 Aug 22]. Available from: https://www.nhmrc.gov.au/guidelinesforguidelines/standards.