{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:20:34Z","timestamp":1788268834086,"version":"build-2803163510"},"reference-count":10,"publisher":"Ubiquity Press, Ltd.","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Integr Care"],"abstract":"<jats:p>This perspective paper draws on our experience as a clinician researcher and a patient partner involved in the implementation and evaluation of an integrated care program for people with complex needs. Although an organization actively engaged in integrated care agreed to participate in a research project evaluating implementation, no patient referrals were ultimately received from case managers. Using a real-world vignette, we examine how well-intentioned protective practices within integrated care settings can lead to de facto exclusion from research. We explore the ethical tensions this creates\u2014particularly regarding justice, autonomy, and equity\u2014and outline practical lessons to support more inclusive research practices embedded in integrated care programs.\n\u00a0\nResum\u00e9\nCet article de r\u00e9flexion s\u2019appuie sur notre exp\u00e9rience de chercheuse clinicienne et de patiente partenaire engag\u00e9es dans la mise en \u0153uvre et l\u2019\u00e9valuation d\u2019un programme de soins int\u00e9gr\u00e9s destin\u00e9 aux personnes ayant des besoins complexes. Bien qu\u2019une organisation de sant\u00e9 fortement engag\u00e9e dans cette approche ait accept\u00e9 de participer \u00e0 un projet de recherche sur sa mise en \u0153uvre, aucun patient n\u2019a finalement \u00e9t\u00e9 orient\u00e9 vers nous par les gestionnaires de cas. \u00c0 partir d\u2019une vignette clinique, nous examinons comment des pratiques de protection bien intentionn\u00e9es, au sein des structures de soins int\u00e9gr\u00e9s, peuvent mener \u00e0 l\u2019exclusion de certains patients de la recherche. Nous explorons les tensions \u00e9thiques qui en d\u00e9coulent \u2014 notamment en mati\u00e8re de justice, d\u2019autonomie et d\u2019\u00e9quit\u00e9 \u2014 et pr\u00e9sentons des pistes concr\u00e8tes pour favoriser des pratiques de recherche plus inclusives au sein des programmes de soins int\u00e9gr\u00e9s.\n\u00a0\nMots-cl\u00e9s : soins int\u00e9gr\u00e9s; \u00e9thique; recherche inclusive; filtrage des patients; besoins complexes<\/jats:p>","DOI":"10.5334\/ijic.11036","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:33:44Z","timestamp":1788262424000},"page":"12","source":"Crossref","is-referenced-by-count":0,"title":["Protecting or Excluding? Ethical Tensions in Integrated Care Research with People with Complex Needs"],"prefix":"10.5334","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6140-9916","authenticated-orcid":false,"given":"Catherine","family":"Hudon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8961-576X","authenticated-orcid":false,"given":"Marie-Dominique","family":"Poirier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"issue":"3","key":"key20260901113335_B1","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1016\/S2468-2667(19)30248-8","article-title":"Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study","volume":"5","year":"2020","journal-title":"Lancet Public Health"},{"key":"key20260901113335_B2","author":"Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada","year":"2022","journal-title":"TriCouncil Policy Statement: Ethical Conduct for Research Involving Humans TCPS22022"},{"key":"key20260901113335_B3","doi-asserted-by":"crossref","DOI":"10.56759\/rgxl7405","volume-title":"International Ethical Guidelines for Health-related Research Involving Humans","author":"Council for International Organizations of Medical Sciences","year":"2016"},{"key":"key20260901113335_B4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ijnurstu.2019.05.016","article-title":"Exploring the roles, functions, and background of patient navigators and case managers: A scoping review","volume":"98","year":"2019","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"key20260901113335_B5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/NCM.0000000000000425","article-title":"Roles, Training, and Qualifications of a Case Manager in the Canadian Health Care Industry: A Narrative Review","volume":"26","year":"2021","journal-title":"Prof Case Manag"},{"issue":"3","key":"key20260901113335_B6","first-page":"4","article-title":"The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research","volume":"81","author":"Department of Health E, Welfare, National Commission for the Protection of Human Subjects of B, Behavioral R","year":"2014","journal-title":"J Am Coll Dent"},{"issue":"6","key":"key20260901113335_B7","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1136\/jme.2009.031716","article-title":"Clinician gate-keeping in clinical research is not ethically defensible: an analysis","volume":"36","year":"2010","journal-title":"J Med Ethics"},{"issue":"4","key":"key20260901113335_B8","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1177\/17470161241273813","article-title":"When a gatekeeper denies a researcher access: circumstances of gate closure in social work research","volume":"21","year":"2025","journal-title":"Research Ethics"},{"issue":"2","key":"key20260901113335_B9","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1080\/23294515.2017.1305007","article-title":"Primary care physicians\u2019 views about gatekeeping in clinical research recruitment: A qualitative study","volume":"8","year":"2017","journal-title":"AJOB Empir Bioeth"},{"issue":"7","key":"key20260901113335_B10","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1136\/jme.2006.017681","article-title":"Clinical research with economically disadvantaged populations","volume":"33","year":"2007","journal-title":"J Med Ethics"}],"container-title":["International Journal of Integrated Care"],"original-title":[],"link":[{"URL":"https:\/\/ijic.org\/articles\/11036\/files\/6a96b803ad512.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ijic.org\/articles\/11036\/files\/6a96b81c1be7f.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ijic.org\/articles\/11036\/files\/6a96b803ad512.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T12:47:22Z","timestamp":1788266842000},"score":1,"resource":{"primary":{"URL":"https:\/\/ijic.org\/articles\/10.5334\/ijic.11036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":10,"URL":"https:\/\/doi.org\/10.5334\/ijic.11036","relation":{},"ISSN":["1568-4156"],"issn-type":[{"value":"1568-4156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}