Post-Trial Responsibilities for Participants Implanted With Neurosurgical Devices: A Qualitative Study.

The issue of post-trial responsibility is about what is owed to research participants after a clinical trial ends, who is responsible, and how long this responsibility must endure. Despite two decades of international guidance on this issue, research involving novel high-risk interventions-such as implantable neurotechnologies-raises underexplored ethical tensions. Trials of implantable devices carry surgical risks and require access to multidisciplinary teams and specialised clinical infrastructures. These factors can foster participant dependence on investigator teams and trial institutions for post-trial care and support. With research and development in this area accelerating, actionable ethical guidance on the post-trial responsibilities of trial stakeholders is urgently needed. Recent normative commentaries have examined the post-trial responsibilities of clinical trial investigators, who play a central role in study design, trial coordination, and follow-up. A persistent challenge is demarcating investigator responsibilities of research integrity from those of therapeutic care when developing ethical guidance on post-trial responsibilities. Recognising the value of empirical engagement for informing further ethical reflection, we conducted qualitative semi-structured interviews with n = 21 investigators involved in neurosurgical device trials. We contend that investigators frequently experience institutional and regulatory pressures that shape how they interpret and enact responsibilities for participants' post-trial wellbeing, often in ways that extend beyond standard expectations of clinical research practice.