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McMahon CE, Foti N, Jeske M, Britton WR, Fullerton SM, Shim JK, Lee SSJ. Interrogating the Value of Return of Results for Diverse Populations: Perspectives from Precision Medicine Researchers. AJOB Empir Bioeth 2024; 15:108-119. [PMID: 37962912 PMCID: PMC11090989 DOI: 10.1080/23294515.2023.2279965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Over the last decade, the return of results (ROR) in precision medicine research (PMR) has become increasingly routine. Calls for individual rights to research results have extended the "duty to report" from clinically useful genetic information to traits and ancestry results. ROR has thus been reframed as inherently beneficial to research participants, without a needed focus on who benefits and how. This paper addresses this gap, particularly in the context of PMR aimed at increasing participant diversity, by providing investigator and researcher perspectives on and questions about the assumed value of ROR in PMR. METHODS Semi-structured interviews with a purposive sample of investigators and researchers across federally funded PMR studies in three national consortia, as well as observations of study activities, focused on how PM researchers conceptualize diversity and implement inclusive practices across research stages, including navigating ROR. RESULTS Interviewees (1) validated the value of ROR as a benefit of PMR, while others (2) questioned the benefit of clinically actionable results to individuals in the absence of sufficient resources for translating findings into health care for diverse and disadvantaged populations; (3) expressed uncertainties in applying the presumed value of ROR as a benefit for non-clinical results; and (4) and debated when the promise of the value of ROR may undermine trust in PMR, and divert efforts to return value beyond ROR. CONCLUSIONS Conceptualizations of diversity and inclusion among PM researchers and investigators raise unique ethical questions where unexamined assumptions of the value of ROR inform study recruitment efforts to enroll minoritized and under-represented populations. A lack of consideration for resources and infrastructure necessary to translate ROR into actionable information may hinder trustworthy community-research relationships. Thus, we argue for a more intentional interrogation of ROR practices as an offer of benefit and for whom.
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Affiliation(s)
- Caitlin E. McMahon
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, United States of America
| | - Nicole Foti
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, United States of America
| | - Melanie Jeske
- Institute on the Formation of Knowledge, University of Chicago, Chicago, Illinois, United States of America
| | - William R. Britton
- Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, United States of America
| | - Stephanie M. Fullerton
- Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Janet K. Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, United States of America
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, United States of America
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Return of individual research results from genomic research: A systematic review of stakeholder perspectives. PLoS One 2021; 16:e0258646. [PMID: 34748551 PMCID: PMC8575249 DOI: 10.1371/journal.pone.0258646] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.
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Burke W, Beskow LM, Trinidad SB, Fullerton SM, Brelsford K. Informed Consent in Translational Genomics: Insufficient Without Trustworthy Governance. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:79-86. [PMID: 29962827 PMCID: PMC6023399 DOI: 10.1177/1073110518766023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neither the range of potential results from genomic research that might be returned to participants nor future uses of stored data and biospecimens can be fully predicted at the outset of a study. Informed consent procedures require clear explanations about how and by whom decisions are made and what principles and criteria apply. To ensure trustworthy research governance, there is also a need for empirical studies incorporating public input to evaluate and strengthen these processes.
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Affiliation(s)
- Wylie Burke
- Department of Bioethics and Humanities, Box 357120, University of Washington, Seattle WA 98195; Work phone: 206-221-5482; Home phone 206-232-6760; Cell phone: 206-619-3191
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Aves, Suite 400, Nashville TN 37203; Work phone: 615-936-2686
| | - Susan Brown Trinidad
- Department of Bioethics and Humanities, Box 357120, University of Washington, Seattle WA 98195; Work phone:206-543-2508;Home phone: 206-842-9241;Cell phone: 360-850-3428
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, Box 357120, University of Washington, Seattle WA 98195; Work phone: 206-616-1864; Home phone: 206-297-1005; Cell phone: 206-529-7029
| | - Kathleen Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Aves, Suite 400, Nashville TN 37203; Work phone: 615-936-2686
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Grill JD. Recruiting to preclinical Alzheimer's disease clinical trials through registries. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:205-212. [PMID: 28439532 PMCID: PMC5399544 DOI: 10.1016/j.trci.2017.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Participant registries are repositories of individuals who have expressed willingness to learn about studies for which they may be eligible. Registries are increasingly being used to improve recruitment to preclinical Alzheimer's disease (AD) clinical trials, which require large screening efforts to identify adequate numbers of participants who meet enrollment criteria. Recruiting to preclinical AD trials from registries is made more efficient through registry collection of data that permits exclusion of those who will not be eligible and identifies individuals most likely to qualify for trials. Such data could include self-reported disease family history or other risk factors but could also include cognitive, genetic, or biomarker testing outcomes. Few data are available to guide investigators overseeing registries and important ethical questions are likely to arise related to their conduct, especially in registries collecting AD risk information. This article outlines three areas of consideration for registry investigators: informed consent, disclosure, and sponsorship.
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Affiliation(s)
- Joshua D Grill
- Department of Psychiatry and Human Behavior, Alzheimer's Disease Research Center, Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine CA, USA
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5
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Elzinga KE, Khan OF, Tang AR, Fernandez CV, Elzinga CL, Heng DY, Vickers MM, Truong TH, Tang PA. Adult patient perspectives on clinical trial result reporting: A survey of cancer patients. Clin Trials 2016; 13:574-581. [PMID: 27559022 DOI: 10.1177/1740774516665597] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The provision of study results to research participants is supported by pediatric and adult literature. This study assessed adult cancer patient preferences surrounding aggregate result disclosure to study participants. METHODS A 46-item questionnaire was given to 250 adult cancer patients who had participated in oncology trials at a single center. Respondents answered questions surrounding their preferences for timing, content, and modality of communication for dissemination of study results. RESULTS Questionnaire completion rate was 76% (189/250). Most patients (92%) strongly felt a right to know study results. Patients preferred result dissemination via letter for trials with positive outcomes, but preferred in-person clinic visits for negative outcomes. Despite this, a majority of participants (59%) found letters acceptable to inform participants of negative results. Only a minority (36%) of the participants found Internet-based disclosure acceptable for negative trial results. Unfortunately, very few patients (8%) recalled having received the results for a study they participated in, and of these patients, less than half fully understood the results they were given. CONCLUSION Most clinical trial participants feel they have a right to study result disclosure, regardless of trial outcome. In-person visits are preferred for negative results, but more feasible alternatives such as letters were still acceptable for the majority of participants. However, Internet-based disclosure was not acceptable to most participants in oncology trials. Time and cost allocations for result disclosure should be considered during grant and ethics board applications, and clear guidelines are required to help researchers share the results with patients.
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Affiliation(s)
- Kate E Elzinga
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Omar F Khan
- Department of Internal Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew R Tang
- Department of Internal Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Daniel Yc Heng
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Michael M Vickers
- Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Tony H Truong
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Patricia A Tang
- Department of Oncology, University of Calgary, Calgary, AB, Canada
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Graham M, Weijer C, Peterson A, Naci L, Cruse D, Fernández-Espejo D, Gonzalez-Lara L, Owen AM. Acknowledging awareness: informing families of individual research results for patients in the vegetative state. JOURNAL OF MEDICAL ETHICS 2015; 41:534-8. [PMID: 25079068 PMCID: PMC4515978 DOI: 10.1136/medethics-2014-102078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/03/2014] [Accepted: 07/15/2014] [Indexed: 05/25/2023]
Abstract
Recent findings in cognitive neuroscience have revealed that some patients previously diagnosed as being in a vegetative state may retain some degree of covert awareness. However, it is unclear whether such findings should be disclosed to the families of these patients. Concerns about the preservation of scientific validity, reliability of results and potential harms associated with disclosure suggest that individual research results should be disclosed only under certain conditions. In the following paper, we offer four criteria for the disclosure of individual research results. Because the results of functional neuroimaging studies to detect covert awareness in vegetative patients are scientifically valid, informative and reasonably reliable and have considerable potential benefit for the patient, researchers have an obligation to disclose such results to family members. Further work is needed to develop educational materials for families and to systematically study the impact of disclosure on the families themselves.
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Affiliation(s)
- Mackenzie Graham
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Charles Weijer
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Andrew Peterson
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Lorina Naci
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Damian Cruse
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Davinia Fernández-Espejo
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Laura Gonzalez-Lara
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Adrian M Owen
- Department of Philosophy, Rotman Institute of Philosophy, Western University, London, Ontario, Canada
- Department of Psychology, The Brain and Mind Institute, Western University, London, Ontario, Canada
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7
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Jarvik GP, Amendola LM, Berg JS, Brothers K, Clayton EW, Chung W, Evans BJ, Evans JP, Fullerton SM, Gallego CJ, Garrison NA, Gray SW, Holm IA, Kullo IJ, Lehmann LS, McCarty C, Prows CA, Rehm HL, Sharp RR, Salama J, Sanderson S, Van Driest SL, Williams MS, Wolf SM, Wolf WA, Burke W. Return of genomic results to research participants: the floor, the ceiling, and the choices in between. Am J Hum Genet 2014; 94:818-26. [PMID: 24814192 DOI: 10.1016/j.ajhg.2014.04.009] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/11/2014] [Indexed: 11/17/2022] Open
Abstract
As more research studies incorporate next-generation sequencing (including whole-genome or whole-exome sequencing), investigators and institutional review boards face difficult questions regarding which genomic results to return to research participants and how. An American College of Medical Genetics and Genomics 2013 policy paper suggesting that pathogenic mutations in 56 specified genes should be returned in the clinical setting has raised the question of whether comparable recommendations should be considered in research settings. The Clinical Sequencing Exploratory Research (CSER) Consortium and the Electronic Medical Records and Genomics (eMERGE) Network are multisite research programs that aim to develop practical strategies for addressing questions concerning the return of results in genomic research. CSER and eMERGE committees have identified areas of consensus regarding the return of genomic results to research participants. In most circumstances, if results meet an actionability threshold for return and the research participant has consented to return, genomic results, along with referral for appropriate clinical follow-up, should be offered to participants. However, participants have a right to decline the receipt of genomic results, even when doing so might be viewed as a threat to the participants' health. Research investigators should be prepared to return research results and incidental findings discovered in the course of their research and meeting an actionability threshold, but they have no ethical obligation to actively search for such results. These positions are consistent with the recognition that clinical research is distinct from medical care in both its aims and its guiding moral principles.
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Affiliation(s)
- Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA.
| | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Jonathan S Berg
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kyle Brothers
- Hudson Alpha Institute for Biotechnology, Huntsville, AL 35806, USA; Department of Pediatrics, University of Louisville, Louisville, KY 40292, USA
| | - Ellen W Clayton
- Department of Pediatrics and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37204, USA
| | - Wendy Chung
- Columbia University, New York, NY 10032, USA
| | | | - James P Evans
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Carlos J Gallego
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Nanibaa' A Garrison
- Department of Pediatrics and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37204, USA
| | - Stacy W Gray
- Brigham and Women's Hospital and Harvard Medical School, Cambridge, MA 02138, USA; Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Iftikhar J Kullo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Cathy McCarty
- Essentia Institute of Rural Health, Duluth, MN 55805, USA
| | - Cynthia A Prows
- Divisions of Human Genetics and Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Heidi L Rehm
- Brigham and Women's Hospital and Harvard Medical School, Cambridge, MA 02138, USA
| | - Richard R Sharp
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph Salama
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Saskia Sanderson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sara L Van Driest
- Department of Pediatrics and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37204, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, PA 17822, USA
| | - Susan M Wolf
- Law School, Medical School, and Consortium on Law and Values in Health, Environment, & the Life Sciences, Minneapolis, University of Minnesota, Minneapolis, MN 55455, USA
| | - Wendy A Wolf
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
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8
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Informed consent for return of incidental findings in genomic research. Genet Med 2013; 16:367-73. [PMID: 24158054 DOI: 10.1038/gim.2013.145] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 08/12/2013] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Researchers face the dilemma of how to obtain consent for return of incidental findings from genomic research. We surveyed and interviewed investigators and study participants, with the goal of providing suggestions for how to shape the consent process. METHODS We performed an online survey of 254 US genetic researchers identified through the NIH RePORTER database, abstracts from the 2011 American Society of Human Genetics meeting, and qualitative semi-structured interviews with 28 genomic researchers and 20 research participants. RESULTS Most researchers and participants endorsed disclosure of a wide range of information about return of incidental findings, including risks, benefits, impact on family members, data security, and procedures, for return of results in the event of death or incapacity and for recontact. However, most researchers were willing to devote 30 min or less to this process and expressed concerns that disclosed information would overwhelm participants, a concern shared by many participants themselves. CONCLUSION There is a disjunction between the views of investigators and participants about the amount of information that should be disclosed and the practical realities of the research setting, including the time available for consent discussions. This strongly suggests the need for innovative approaches to the informed consent process.
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Grill JD, Johnson DK, Burns JM. Should we disclose amyloid imaging results to cognitively normal individuals? Neurodegener Dis Manag 2013; 3:43-51. [PMID: 25285157 PMCID: PMC4184474 DOI: 10.2217/nmt.12.75] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Demonstration of brain accumulation of fibrillar amyloid beta protein via positron emission tomography (PET) with amyloid specific ligands may support the diagnosis of Alzheimer's disease (AD). There is increasing recognition of the potential use of amyloid imaging to detect in vivo the pathology of AD in individuals with no ostensible cognitive impairment. Research use of amyloid PET in cognitively normal patients will be key to pursuit of therapies able to delay cognitive impairment and dementia due to AD. We review the pros and cons of disclosing amyloid imaging results to cognitively normal individuals in clinical and research settings and provide draft recommendations.
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Affiliation(s)
- Joshua D. Grill
- Mary S. Easton Center for Alzheimer's Disease Research, Department of Neurology, UCLA David Geffen School of Medicine
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10
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Isasi R, Knoppers BM, Andrews PW, Bredenoord A, Colman A, Hin LE, Hull S, Kim OJ, Lomax G, Morris C, Sipp D, Stacey G, Wahlstrom J, Zeng F. Disclosure and management of research findings in stem cell research and banking: policy statement. Regen Med 2012; 7:439-48. [PMID: 22594334 DOI: 10.2217/rme.12.23] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Prompted by an increased interest of both research participants and the patient advocacy community in obtaining information about research outcomes and on the use of their biological samples; the international community has begun to debate the emergence of an ethical 'duty' to return research results to participants. Furthermore, the use of new technologies (e.g., whole-genome and -exome sequencing) has revealed both genetic data and incidental findings with possible clinical significance. These technologies together with the proliferation of biorepositories, provide a compelling rationale for governments and scientific institutions to adopt prospective policies. Given the scarcity of policies in the context of stem cell research, a discussion on the scientific, ethical and legal implications of disclosing research results for research participants is needed. We present the International Stem Forum Ethics Working Party's Policy Statement and trust that it will stimulate debate and meet the concerns of researchers and research participants alike.
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Affiliation(s)
- Rosario Isasi
- Center of Genomics & Policy, Faculty of Medicine, Department of Human Genetics, McGill University, Montreal, QC, Canada.
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11
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Hayeems RZ, Miller FA, Li L, Bytautas JP. Not so simple: a quasi-experimental study of how researchers adjudicate genetic research results. Eur J Hum Genet 2011; 19:740-7. [PMID: 21407262 DOI: 10.1038/ejhg.2011.34] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Ethicists contend that researchers are obliged to report genetic research findings to individual study participants when they are clinically significant, that is, when they are clinically useful or personally meaningful to participants. Yet whether such standards are well understood and can be consistently applied remains unknown. We conducted an international, cross-sectional survey of cystic fibrosis (CF) and autism genetics researchers using a quasi-experimental design to explore factors influencing researchers' judgments. Eighty percent of researchers agreed, in principle, that clinically significant findings should be reported to individual participants. Yet judgments about when a specific finding was considered clinically significant or warranted reporting varied by scientific factors (replication, robustness, intentionality, and disease context), capacity of the research team to explain the results, and type of research ethics guidance. Further, judgments were influenced by the researchers' disease community (autism or CF), their primary role (clinical, molecular, statistical) and their beliefs regarding a general reporting obligation. In sum, judgments about the clinical significance of genetic research results, and about whether they should be reported, are influenced by scientific parameters as well as contextual factors related to the specific research project and the individual researcher. These findings call into question the assumption that the conditions under which an obligation to disclose arises are uniformly understood and actionable. Adjudicating the clinical readiness of provisional data may be a responsibility better suited to evaluative experts at arms' length of the provisional data in question, rather than a responsibility imposed upon researchers themselves.
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Affiliation(s)
- Robin Zoe Hayeems
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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12
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Disclosure of individual genetic data to research participants: the debate reconsidered. Trends Genet 2010; 27:41-7. [PMID: 21190750 DOI: 10.1016/j.tig.2010.11.004] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 11/21/2022]
Abstract
Despite extensive debate, there is no consensus on whether individual genetic data should be disclosed to research participants. The emergence of whole-genome sequencing methods is increasingly generating unequalled amounts of genetic data, making the need for a clear feedback policy even more urgent. In this debate two positions can be broadly discerned: a restrictive disclosure policy ('no feedback except life-saving data') and an intermediate policy of qualified disclosure ('feedback if the results meet certain conditions'). We explain both positions and present the principal underlying arguments. We suggest that the debate should no longer address whether genetic research results should be returned, but instead how best to make an appropriate selection and how to strike a balance between the possible benefits of disclosure and the harms of unduly hindering biomedical research.
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Meulenkamp TM, Gevers SK, Bovenberg JA, Koppelman GH, van Hylckama Vlieg A, Smets EMA. Communication of biobanks' research results: what do (potential) participants want? Am J Med Genet A 2010; 152A:2482-92. [PMID: 20799322 DOI: 10.1002/ajmg.a.33617] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to investigate (potential) research participants' (a) information preferences with regard to receiving biobanks' genetic research results, and (b) attitudes towards the duties of researchers to communicate research results. A total group of 1,678 was analyzed, consisting of a sample of the general Dutch population (N=1,163) and patients with asthma, rhinitis, and thrombosis (N=515) who completed a survey including six fictitious genetic research results each presented as aggregate and individual result, varied for treatability and kind of disease. Five questions assessed attitudes towards researchers' duties to communicate research results. Additionally, background characteristics were measured. A majority of the respondents wanted to receive aggregate results as well as individual results. A small majority (59%) held the view that researchers should communicate individual results with no health consequences. One third agreed with an information duty only when treatment is available. A preference for individual results and an attitude in favor of communicating results were both associated with belonging to the general Dutch population rather than being a patient, wanting to learn about own health as the reason for biobank-participation, a monitoring coping style, a general desire for health information, perceived meaningfulness of genetic information and no anticipated anxiousness. A sizable majority of respondents showed a high information preference for individual results, even when it is unclear that treatment is available. Fewer were of the opinion that researchers should make this possible. For their communication policy biobanks should take notice of (potential) participants' high information preferences and expectations.
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Affiliation(s)
- Tineke M Meulenkamp
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
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14
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Arar N, Seo J, Lee S, Abboud HE, Copeland LA, Noel P, Parchman M. Preferences regarding genetic research results: comparing veterans and nonveterans responses. Public Health Genomics 2010; 13:431-9. [PMID: 20829581 DOI: 10.1159/000317099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 06/16/2010] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Communicating genetic research results to participants presents ethical challenges. Our objectives were to examine participants' preferences in receiving future genetic research results and to compare preferences reported by veteran and nonveterans participants. METHODS Secondary analysis was performed on data collected in 2000-2004 from 1,575 consent forms signed by Mexican-American participants enrolled in 2 genetic family studies (GFS) in San Antonio: The Family Investigation of Nephropathy and Diabetes (FIND) and the Extended FIND (EFIND). The consent forms for these studies contained multiple-choice questions to examine participants' preferences about receiving their (1) clinical lab results and (2) future genetic research results. The FIND and EFIND databases had information on subjects' demographic characteristics and some selected clinical variables. We identified veterans using the Veterans Health Administration's (VHA's) centralized data repository. We compared veterans' and nonveterans' preferences using Student's t test for continuous variables and χ² test for discrete variables. A logistic regression analyzed subjects' preference for receiving their research results, controlling for other socio-demographic and clinical variables. RESULTS The sample included 275 (18%) veterans and 1,247 (82%) nonveterans. Our results indicated a strong desire among the majority of participants 1,445 (95%) in getting their clinical lab research results. Likewise, 93% expressed interest in being informed about their future genetic results. There was no significant difference in veterans' and nonveterans' preference to disclosure of the research results (χ² test; p > 0.05). Regression analysis showed no significant relationship (p = 0.449) between the outcome (receiving research results) and veterans' responses after controlling for demographics and educational levels. CONCLUSION Participants believed they would prefer receiving their genetic research results. Veterans are similar to nonveterans in their preferences. Offering genetic research results to participants should be based on well defined and structured plans to enhance interpretation of genetic data.
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Affiliation(s)
- N Arar
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, Audie L. Murphy Memorial Veterans Hospital, San Antonio, TX 78229-3900, USA.
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Abstract
The authors discuss the available data on the effects of communicating aggregate and individual research results on participants, investigators, and the research enterprise.
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Affiliation(s)
- David I Shalowitz
- Bioethics Program, University of Michigan Medical School, Ann Arbor, Michigan, United States of America.
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