Research Ethics
Conflicts of Interest in Research
Clarity, Disclosure and Professional Integrity
Overview
In clinical practice, integrity means putting the patient’s interests first. In research, integrity means putting truth first, even when personal, professional, or institutional interests are at stake. But what happens when those interests overlap?
A conflict of interest (COI) does not necessarily mean someone is unethical. It means there is potential for judgment to be influenced by external pressures, whether financial, relational, or by reputation. COIs become problematic when they are hidden, unmanaged, or left unexamined.
This lesson explores how conflicts of interest arise in PA-led research, how to recognize and disclose them, and how to safeguard both the scientific process and your professional reputation.
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Define conflict of interest in the context of health research
Recognize common types of COIs that arise in PA-led research
Apply disclosure standards to REB applications, consent forms, and publications
Manage conflicts through appropriate safeguards and third-party oversight
Write clear, transparent COI statements for various research contexts
Lesson Outline
Lesson Exercises
Additional Resources
What is ‘Conflict of Interest’?
A conflict of interest occurs when a secondary interest could influence, or appear to influence, how a researcher designs, conducts, interprets, or reports research.
This secondary interest can include financial gain, professional advancement, or personal relationships.
The Tri-Council Policy Statement (TCPS 2) defines COIs as situations that “may reasonably be perceived to influence a researcher's objectivity” (Government of Canada, 2022, Article 7.4). Notice the language: “reasonably be perceived.” The perception of bias can be just as damaging as actual bias, especially in health research where public trust is essential.
COIs are not inherently unethical. What matters is whether they are disclosed, managed, and monitored.
The Reality of PA Research
As a PA, you likely occupy multiple professional roles simultaneously: clinician, educator, researcher, preceptor, committee member. You may collaborate with drug or medical equipment companies, receive funding from industry, or work within systems where your employer has a stake in research outcomes.
You may also be researching your own patients, reviewing outcomes from your own clinical decisions, or publishing QI data that reflects on your department or hospital’s performance. Each of these scenarios carries potential for conflict.
Without proactive disclosure and transparency, these situations can erode your credibility, affect participant recruitment, and delay publication or ethics approval. REBs, journals, and participants deserve to know where your interests lie so they can assess the validity and trustworthiness of your work.
COI Examples in PA-Led Research
Financial Conflicts
Receiving honoraria, research funding, or consulting fees from a medical device or pharmaceutical company whose product is being studied.
Example: You are evaluating a wound care product and receive speaker fees from the manufacturer.
Professional Conflicts
Researching an initiative that directly benefits your department or advances your career without transparency about that connection.
Example: You are studying a new workflow process that, if successful, could lead to your promotion to clinical lead.
Personal or Relational Conflicts
Recruiting friends, students, or colleagues into your study, or co-authoring with a supervisor who has evaluative power over you.
Example: You are a student researcher and your capstone supervisor is also a co-author on your manuscript.
Institutional Conflicts
Publishing favourable results on a hospital-funded initiative without disclosing the funding relationship or institutional support.
Example: Your hospital’s innovation office developed a tool you are evaluating, and the hospital is seeking external funding based on your results.
Intellectual Bias
Strong personal investment in a theory or model you are testing, which may unconsciously skew your interpretation of findings.
Example: You developed a clinical protocol years ago and are now researching its effectiveness. Your professional reputation is tied to its success.
Conflict of Interests are about influence, not just intent.
You may believe you’re acting objectively, but disclosure allows others to assess the potential for bias.
Disclosure as a Professional Standard
Disclosure is not about disqualifying yourself from research. It is about providing enough information for ethics boards, journals, participants, and peers to assess the context and trust the process.
Every REB application, grant proposal, and journal submission asks about conflicts of interest for good reason.
Disclosure:
Allows REBs and editors to assess risk and recommend safeguards
Signals transparency to funders, readers, and participants
Protects you from accusations of misconduct after the fact
Disclosure does not disqualify you from doing the research. It shows you are taking your responsibilities seriously.
What to Disclose
All current and recent funding sources (industry, institutional, internal)
Financial ties to any company whose products or services are studied
Any dual roles (such as supervisor/assessor and researcher)
Any situations where your objectivity might reasonably be questioned
Where to Disclose
Your REB application (especially in the conflict of interest section)
Participant consent forms (if the COI could impact the participant)
Presentations, posters, and publications (usually under "Disclosures" or "Competing Interests")
If the conflict of interest connection is worth considering, it is likely worth disclosing.
Transparency builds trust. Omission invites scrutiny.
The 3-Part COI Playbook
1. Acknowledge It
You do not get points for being “conflict-free.” You earn trust by showing you know where you might be biased and you are not afraid to admit it.
Ask yourself: Is there any relationship, funding source, or role that could reasonably influence how I design, conduct, interpret, or report this research? If the answer is yes or maybe, acknowledge it.
2. Disclose It
Put it on your REB form, your consent documents (if relevant), and your poster or publication. Be clear and specific.
Example: “This study is supported by [Company Name], which had no role in analysis or reporting.”
Do not hide behind vague language. “Industry support” is not the same as “funded by [Specific Company Name].” Readers and participants deserve specifics.
3. Manage It
Once a conflict is disclosed, the next step is ensuring it is appropriately managed. Depending on the nature of the conflict, this may involve:
Using a third party to conduct recruitment or obtain consent
Having another team member independently analyze or verify data
Clearly stating funder roles (or lack thereof) in study design or reporting
Avoiding involvement in manuscript decisions if your role introduces significant bias
Consulting your institution or REB for guidance on appropriate safeguards
Case Scenario
Subtle COI
The Scenario
You are leading a QI project in your fracture clinic that involves evaluating a new digital follow-up tool. The tool was developed by your hospital’s innovation office, and your department hopes to expand its use system-wide. You are also listed on the hospital’s grant proposal promoting the tool.
Analysis
There are a few multiple overlapping conflicts that could influence how you design, conduct, interpret or report your research:
Institutional Conflict: Your hospital's innovation office developed the tool and has a vested interest in its success. System-wide adoption brings prestige, funding, and validation, while failure reflects poorly on the institution. Even without personal financial gain, you work for an organization that benefits from positive results.
Departmental Pressure The Issue: Your department hopes to expand the tool system-wide. Colleagues, managers, and leadership have expectations. Negative findings could disappoint those who championed the tool, affect departmental priorities or funding, and influence your standing within the department.
Professional Stake in the Grant Proposal The Issue: Your name is attached to a document promoting the tool’s value. If your research shows the tool is ineffective, it undermines the proposal, creates professional awkwardness with collaborators, and could affect future funding opportunities. Your reputation and professional relationships are now tied to the tool’s success.
When Your Paycheque and Your Research Point in the Same Direction: You are simultaneously the researcher evaluating the tool, an employee of the institution that created it, and a contributor to promotional materials about it. This triple role creates unconscious pressure that can shape study design, data interpretation, and reporting. You may feel conflicted about publishing conclusions that could harm your employer’s interests.
Disclosure matters. Not because you would deliberately falsify data, but because bias does not require intent. This includes risks of:
Unconscious bias could influence how you design the study (choosing metrics that favour the tool)
Selective emphasis could shape how you interpret results (highlighting positives, minimizing negatives)
Soft language could make limitations less visible (“areas for growth” vs. “significant usability problems”)
Institutional pressure could discourage you from publishing negative findings
What Should You Do?
Disclose your role in the tool’s development and its institutional support in your REB application and publication. Even though you have no direct financial stake, the institutional connection creates potential bias.
Consider using an independent reviewer for patient feedback. Someone without ties to the innovation office should assess whether the tool is genuinely effective or whether enthusiasm is influenced by institutional priorities.
Avoid language that markets the tool as superior unless your data strongly supports it. Be careful not to overstate findings in ways that serve institutional interests rather than scientific accuracy.
Why It Matters
This process is about ensuring that participants and readers can judge the potential for bias with full information. If your hospital benefits from favourable results, others deserve to know that when evaluating your conclusions.
Sample COI Statements
1. Financial Interest
“The primary investigator has received educational honoraria from [Company Name] in the past 12 months. This study is independently conducted, and the company has no role in the design, data collection, analysis, or publication of results.”
2. Departmental or Institutional Affiliation
“This project evaluates a digital follow-up tool developed by the PA’s hospital innovation office. While the researcher holds no financial stake, the study is institutionally supported. Findings will be interpreted independently and reported transparently.”
3. Student or Supervisory Relationships
“Two co-investigators have a current student–supervisor relationship. All research contributions are documented, and authorship decisions follow ICMJE criteria. Supervision was independent of participant recruitment and data analysis.”
4. Dual Role (Clinician–Researcher)
“The PA is both the primary care provider and principal investigator for this patient population. To minimize coercion, a third-party recruiter is used, and consent is obtained by staff unaffiliated with the clinical care team.”
5. No Conflict to Declare
“The authors declare no conflicts of interest. No funding, financial relationships, or institutional affiliations influenced the design or conduct of this study.”
Be specific, be transparent, and when in doubt, disclose. Perceived conflicts matter as much as real ones.
Use consistent language across your REB forms, publications, and presentations. Being forthcoming with transparency helps protect your credibility.
Final thoughts
In applied research, PAs bring crucial frontline insight and systems knowledge. But that proximity to patient care also demands ethical clarity. Declaring a conflict of interest does not call your integrity into question, but concealing one might.
By approaching disclosure as a routine part of your research planning (not an afterthought), you protect the credibility of your work, the rights of your participants, and the trust placed in you as both a clinician and a researcher.
Lesson 4 Summary
Conflicts are common. COIs often arise naturally in academic and clinical environments. Recognizing them is part of ethical professionalism.
Disclosure is critical. Always disclose relevant relationships or roles that could influence your objectivity.
Transparency builds trust. Include COIs in REB forms, consent documents, presentations, and manuscripts.
Not all COIs disqualify you. Most can be responsibly managed with appropriate safeguards.
Perception matters. Even if you believe you are unbiased, others deserve clarity to make their own assessment.
References
American Medical Association. (n.d.). Conflicts of interest in research: Code of medical ethics opinion 7.1.4. https://code-medical-ethics.ama-assn.org/ethics-opinions/conflicts-interest-research
College of Physicians and Surgeons of Ontario. (2024). Conflicts of Interest and Industry Relationships. https://www.cpso.on.ca/en/Physicians/Policies-Guidance/Policies/Physicians-Relationships-with-Industry-Practice
Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice; Lo B, Field MJ, editors. Conflict of Interest in Medical Research, Education, and Practice. Washington (DC): National Academies Press (US); 2009. Summary. Available from: https://www.ncbi.nlm.nih.gov/books/NBK22926/
Lo, B., & Field, M. J. (Eds.). (2009). Conflict of interest in medical research, education, and practice. National Academies Press. https://nap.nationalacademies.org/catalog/12598/conflict-of-interest-in-medical-research-education-and-practice
National Academies of Sciences, Engineering, and Medicine. 2009. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: The National Academies Press. https://doi.org/10.17226/12598.
Lesson 4
Self-Knowledge Quiz
Answer 3 questions to help you check your understanding of key concepts from this lesson. Once you submit, you will receive immediate to help reinforce what you’ve learned.