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Rodriguez Llorian E, Kopac N, Waliji LA, Borle K, Dragojlovic N, Elliott AM, Lynd LD. A Rapid Review on the Value of Biobanks Containing Genetic Information. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1286-1295. [PMID: 36921900 DOI: 10.1016/j.jval.2023.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Increasing access to health data through biobanks containing genetic information has the potential to expand the knowledge base and thereby improve screening, diagnosis, and treatment options for many diseases. Nevertheless, although privacy concerns and risks surrounding genetic data sharing are well documented, direct evidence in favor of the hypothesized benefits of data integration is scarce, which complicates decision making in this area. Therefore, the objective of this study is to summarize the available evidence on the research and clinical impacts of biobanks containing genetic information, so as to better understand how to quantify the value of expanding genomic data access. METHODS Using a rapid review methodology, we performed a search of MEDLINE/PubMed and Embase databases; and websites of biobanks and genomic initiatives published from 2010 to 2022. We classified findings into 11 indicators including outputs (a direct product of the biobank activities) and outcomes (changes in scientific and clinical capacity). RESULTS Of 8479 abstracts and 101 gray literature sources were reviewed, 96 records were included. Although most records did not report key indicators systematically, the available evidence concentrated on research indicators such as publications and gene-disorder association discoveries (63% of studies), followed by research infrastructure (26%), and clinical indicators (11%) such as supporting the diagnosis of individual patients. CONCLUSIONS Existing evidence on the benefits of biobanks is skewed toward easily quantifiable research outputs. Measuring a comprehensive set of outputs and outcomes inspired by value frameworks is necessary to generate better evidence on the benefits of genomic data sharing.
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Affiliation(s)
- Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Louloua Ashikhusein Waliji
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kennedy Borle
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
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Aarden E. Infrastructuring European scientific integration: Heterogeneous meanings of the European biobanking infrastructure BBMRI-ERIC. SOCIAL STUDIES OF SCIENCE 2023; 53:572-598. [PMID: 37306097 PMCID: PMC10363945 DOI: 10.1177/03063127231162629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While transnational research infrastructure projects long preceded the formal integration process that created the European Union, their advancement is an increasingly central part of EU research policy and of European integration in general. This paper analyses the Biobanking and Biomolecular Resources Research Infrastructure-European Research Infrastructure Consortium (BBMRI-ERIC) as a recent example of institutionalized scientific collaboration in Europe that has formally been established as part of EU science policy. BBMRI-ERIC, a network of European biobanks, is expected to contribute to both European science and European integration. Yet its achievements in these domains are interpreted differently by various actors involved. This paper draws on STS conceptualizations of infrastructures as relational, experimental, and promissory assemblages. These support the formulation of a working definition of research infrastructures that in turn helps to explore the heterogeneous meanings attributed to BBMRI-ERIC. The paper describes the creation of this distributed European research infrastructure, and divergent understandings of what it means for BBMRI-ERIC to be distributed, to be European and to be a research infrastructure. This analysis demonstrates how building a research infrastructure is also an effort to define what it means to be European-a process in which what is European about science and what science can do for Europe is continuously (re-)imagined, contested and negotiated.
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Affiliation(s)
- Erik Aarden
- University of Klagenfurt, Klagenfurt, Austria
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3
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Murtagh MJ, Machirori M, Gaff CL, Blell MT, de Vries J, Doerr M, Dove ES, Duncanson A, Hastings Ward J, Hendricks-Sturrup R, Ho CWL, Johns A, Joly Y, Kato K, Katsui K, Kumuthini J, Maleady-Crowe F, Middleton A, Milne R, Minion JT, Matshaba M, Mulrine S, Patch C, Ryan R, Viney W. Engaged genomic science produces better and fairer outcomes: an engagement framework for engaging and involving participants, patients and publics in genomics research and healthcare implementation. Wellcome Open Res 2021; 6:311. [PMID: 35592835 PMCID: PMC9086526 DOI: 10.12688/wellcomeopenres.17233.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
Genomic science is increasingly central to the provision of health care. Producing and applying robust genomics knowledge is a complex endeavour in which no single individual, profession, discipline or community holds all the answers. Engagement and involvement of diverse stakeholders can support alignment of societal and scientific interests, understandings and perspectives and promises better science and fairer outcomes. In this context we argue for F.A.I.R.E.R. data and data use that is Findable, Accessible, Interoperable, Reproducible,
Equitable and
Responsible. Yet there is a paucity of international guidance on how to engage publics, patients and participants in genomics. To support meaningful and effective engagement and involvement we developed an
Engagement Framework for involving and engaging participants, patients and publics in genomics research and health implementation. The
Engagement Framework is intended to support all those working in genomics research, medicine, and healthcare to deliberatively consider approaches to participant, patient and public engagement and involvement in their work. Through a series of questions, the
Engagement Framework prompts new ways of thinking about
the aims and purposes of engagement, and support reflection on the strengths, limitations, likely outcomes and impacts of choosing different approaches to engagement. To guide genomics activities, we describe four themes and associated questions for deliberative reflection: (i) fairness; (ii) context; (iii) heterogeneity, and (iv) recognising tensions and conflict. The four key components in the
Engagement provide a framework to assist those involved in genomics to reflect on decisions they make for their initiatives, including the strategies selected, the participant, patient and public stakeholders engaged, and the anticipated goals.
The Engagement Framework is one step in an actively evolving process of building genomics research and implementation cultures which foster responsible leadership and are attentive to objectives which increase equality, diversity and inclusion in participation and outcomes.
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Affiliation(s)
| | | | - Clara L. Gaff
- University of Melbourne, Melbourne, Australia
- Melbourne Genomics Health Alliance, Melbourne, Australia
| | | | | | | | | | | | | | | | | | - Amber Johns
- International Cancer Genome Consortium, Glasgow, UK
- Garvan Institute of Medical Research, Sydney, Australia
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, Canada
| | - Kazuto Kato
- GEM-Japan, Tokyo, Japan
- Osaka University, Suita, Japan
| | - Keiko Katsui
- Japan Agency for Medical Research and Development, Tokyo, Japan
| | - Judit Kumuthini
- University of Western Cape, Cape Town, South Africa
- H3ABioNet/H3Africa, Cape Town, South Africa
| | | | | | | | | | - Mogomotsi Matshaba
- H3ABioNet/H3Africa, Cape Town, South Africa
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gabrorone, Botswana
| | | | - Christine Patch
- Genomics England, London, UK
- Wellcome Connecting Science, Cambridge, UK
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Muller SHA, Kalkman S, van Thiel GJMW, Mostert M, van Delden JJM. The social licence for data-intensive health research: towards co-creation, public value and trust. BMC Med Ethics 2021; 22:110. [PMID: 34376204 PMCID: PMC8353823 DOI: 10.1186/s12910-021-00677-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background The rise of Big Data-driven health research challenges the assumed contribution of medical research to the public good, raising questions about whether the status of such research as a common good should be taken for granted, and how public trust can be preserved. Scandals arising out of sharing data during medical research have pointed out that going beyond the requirements of law may be necessary for sustaining trust in data-intensive health research. We propose building upon the use of a social licence for achieving such ethical governance. Main text We performed a narrative review of the social licence as presented in the biomedical literature. We used a systematic search and selection process, followed by a critical conceptual analysis. The systematic search resulted in nine publications. Our conceptual analysis aims to clarify how societal permission can be granted to health research projects which rely upon the reuse and/or linkage of health data. These activities may be morally demanding. For these types of activities, a moral legitimation, beyond the limits of law, may need to be sought in order to preserve trust. Our analysis indicates that a social licence encourages us to recognise a broad range of stakeholder interests and perspectives in data-intensive health research. This is especially true for patients contributing data. Incorporating such a practice paves the way towards an ethical governance, based upon trust. Public engagement that involves patients from the start is called for to strengthen this social licence. Conclusions There are several merits to using the concept of social licence as a guideline for ethical governance. Firstly, it fits the novel scale of data-related risks; secondly, it focuses attention on trustworthiness; and finally, it offers co-creation as a way forward. Greater trust can be achieved in the governance of data-intensive health research by highlighting strategic dialogue with both patients contributing the data, and the public in general. This should ultimately contribute to a more ethical practice of governance. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00677-5.
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Affiliation(s)
- Sam H A Muller
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands.
| | - Shona Kalkman
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Ghislaine J M W van Thiel
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Menno Mostert
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CX, Utrecht, The Netherlands
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Sajo MEJV, Teves JMY, Corachea AJM, Diaz LA, Chan AFO, Valparaiso AP, Dy Echo AVV, Macalindong SS, Uy GLB, Dofitas RB, Habana MAE, Gerona RR, Irwin JC, Giudice LC, Velarde MC. A Pilot Cancer-Phenome Biobanking System in a Low-Resource Southeast Asian Setting: The Philippine General Hospital Biobank Experience. Biopreserv Biobank 2020; 18:180-188. [PMID: 32202927 DOI: 10.1089/bio.2019.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Biobanking has become an indispensable tool for translational research and health innovations. While the field of biobanking has progressed and evolved globally, biobanking in developing Association of Southeast Asian Nations (ASEAN) countries such as the Philippines remains underrepresented because of several challenges often encountered in these low- and middle-income countries. Recently, the Philippine government has undertaken enormous efforts to advancing research and development in the country, and one of the current research pursuits is the establishment of biobanks, with the hope of attaining more discoveries and innovations in the future. Given that cancer remains a leading cause of death in the Philippines, the Philippine government supported the establishment of a cancer biobank at the Philippine General Hospital (PGH). In this study, we present a specific use case of biobanking activity at the PGH Biobank, to build a cohort of biospecimens from Filipino patients with breast, endometrial, and ovarian cancer. This initiative is part of a biomonitoring study (1) to assess environmental exposures and possible risk factors in the Philippine population and (2) to develop a system of culturing human cells from Filipino patients for subsequent in vitro studies. We discuss issues faced and the solutions developed during the implementation of the biobank. Strong research collaboration, a funding source, basic infrastructure, and appropriate technology helped initiate this pilot biobank in the Philippines. Overall, the experiences of establishing the PGH Biobank may help other institutions in low-resource countries to set up cancer biobanks.
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Affiliation(s)
- Ma Easter Joy V Sajo
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Joji Marie Y Teves
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Allen Joy M Corachea
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Leomir A Diaz
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Alison Faye O Chan
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | - Apple P Valparaiso
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Ana Victoria V Dy Echo
- Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Shiela S Macalindong
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Gemma Leonora B Uy
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Rodney B Dofitas
- Department of General Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Ma Antonia E Habana
- Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roy R Gerona
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Juan C Irwin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Michael C Velarde
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City, Philippines
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Elias B, Hanlon-Dearman A, Head B, Hicks GG. Translating to the Community (T2C): a protocol paper describing the development of Canada's first social epigenetic FASD biobank. Biochem Cell Biol 2018; 96:275-287. [PMID: 29544064 DOI: 10.1139/bcb-2017-0278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Translating to the Community (T2C) is a social biorepository designed to advance new diagnostic tools and realign community-clinical processes, with the aim to mitigate the short- and long-term impacts of fetal alcohol spectrum disorder (FASD) as well as prenatal alcohol exposure and its co-morbidities and behaviors. In this paper, we describe the evolution of this repository as a new translational partnership to advance a precision-medicine approach to FASD. Key to its evolution was a partnership between academic researchers, Indigenous communities, families, and a regional diagnostic clinic. We further describe the rationale for social biobanking, the type of banking, ethical engagement of families, communities, and clinics, their roles in repository design, governance, translation, and research activities, types of data collected from families, and how the study data are managed, reported, and accessed. The repository design includes biological samples, social-contextual health-survey data, and clinical data (which are linkable to administrative data) from community and clinical cohorts of diagnosed children, children prenatally exposed but not diagnosed, children suspected to have had a prenatal exposure, and related siblings, biological parents, and unrelated children and their parents. From these cohorts and families, potential studies drawing on this data will shed light on various risk factors, social and biological pathways, and service utilization issues, with the aim to implement primary and secondary prevention and intervention strategies.
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Affiliation(s)
- Brenda Elias
- a Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Ana Hanlon-Dearman
- b Department of Paediatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W3, Canada; Manitoba FASD Centre/FASD Network, Winnipeg, MB R3E 3G1, Canada
| | - Betty Head
- c Cree Nation Tribal Health Centre, Star Program, The Pas, MB R9A 1M5, Canada
| | - Geoffrey G Hicks
- d Department of Biochemistry & Medical Genetics, Regenerative Medicine Program, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
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7
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Murtagh MJ, Minion JT, Turner A, Wilson RC, Blell M, Ochieng C, Murtagh B, Roberts S, Butters OW, Burton PR. The ECOUTER methodology for stakeholder engagement in translational research. BMC Med Ethics 2017; 18:24. [PMID: 28376776 PMCID: PMC5379503 DOI: 10.1186/s12910-017-0167-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 01/08/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes (as a patient or member of the public). Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others (the many 'publics' of engagement) brings them closer to the research but also brings the research closer to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. METHODS In practice, engagement faces numerous challenges and is often time-consuming, expensive and 'thorny' work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER (Employing COnceptUal schema for policy and Translation Engagement in Research) methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, "How could it be otherwise?" ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of 'keeping open' the possible considerations that might emerge and including reflexive use of qualitative analytic methods. RESULTS This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to 'open up' engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: (1) engagement and knowledge exchange; (2) analysis of mindmap contributions; (3) development of a conceptual schema (i.e. a map of concepts and their relationship); and (4) feedback, refinement and development of recommendations. CONCLUSION ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it.
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Affiliation(s)
- Madeleine J. Murtagh
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Centre for Policy, Ethics and Life Sciences (PEALS), Newcastle University, Newcastle, UK
| | - Joel T. Minion
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Andrew Turner
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rebecca C. Wilson
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mwenza Blell
- Department of Sociology, University of Cambridge, Cambridge, UK
| | - Cynthia Ochieng
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Barnaby Murtagh
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Urban Cow Productions, London, UK
| | - Stephanie Roberts
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Oliver W. Butters
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul R Burton
- Data2Knowledge (D2K) Research Group, School of Social and Community Medicine, University of Bristol, Bristol, UK
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O'Doherty KC, Christofides E, Yen J, Bentzen HB, Burke W, Hallowell N, Koenig BA, Willison DJ. If you build it, they will come: unintended future uses of organised health data collections. BMC Med Ethics 2016; 17:54. [PMID: 27600117 PMCID: PMC5011895 DOI: 10.1186/s12910-016-0137-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/25/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Health research increasingly relies on organized collections of health data and biological samples. There are many types of sample and data collections that are used for health research, though these are collected for many purposes, not all of which are health-related. These collections exist under different jurisdictional and regulatory arrangements and include: 1) Population biobanks, cohort studies, and genome databases 2) Clinical and public health data 3) Direct-to-consumer genetic testing 4) Social media 5) Fitness trackers, health apps, and biometric data sensors Ethical, legal, and social challenges of such collections are well recognized, but there has been limited attention to the broader societal implications of the existence of these collections. DISCUSSION Although health research conducted using these collections is broadly recognized as beneficent, secondary uses of these data and samples may be controversial. We examine both documented and hypothetical scenarios of secondary uses of health data and samples. In particular, we focus on the use of health data for purposes of: Forensic investigations Civil lawsuits Identification of victims of mass casualty events Denial of entry for border security and immigration Making health resource rationing decisions Facilitating human rights abuses in autocratic regimes CONCLUSIONS Current safeguards relating to the use of health data and samples include research ethics oversight and privacy laws. These safeguards have a strong focus on informed consent and anonymization, which are aimed at the protection of the individual research subject. They are not intended to address broader societal implications of health data and sample collections. As such, existing arrangements are insufficient to protect against subversion of health databases for non-sanctioned secondary uses, or to provide guidance for reasonable but controversial secondary uses. We are concerned that existing debate in the scholarly literature and beyond has not sufficiently recognized the secondary data uses we outline in this paper. Our main purpose, therefore, is to raise awareness of the potential for unforeseen and unintended consequences, in particular negative consequences, of the increased availability and development of health data collections for research, by providing a comprehensive review of documented and hypothetical non-health research uses of such data.
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Affiliation(s)
- Kieran C O'Doherty
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Emily Christofides
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Jeffery Yen
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Heidi Beate Bentzen
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian Research Center for Computers and Law, Faculty of Law, University of Oslo, Oslo, Norway
- Norwegian Cancer Genomics Consortium, Oslo, Norway
| | - Wylie Burke
- Department of Bioethics & Humanities, University of Washington, Seattle, USA
| | - Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Barbara A Koenig
- UCSF Bioethics, Institute for Health & Aging, University of California, San Francisco, USA
| | - Donald J Willison
- Institute of Health Policy Management and Evaluation | Joint Centre for Bioethics, University of Toronto, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Nicol D, Critchley C, McWhirter R, Whitton T. Understanding public reactions to commercialization of biobanks and use of biobank resources. Soc Sci Med 2016; 162:79-87. [PMID: 27343817 DOI: 10.1016/j.socscimed.2016.06.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 05/22/2016] [Accepted: 06/15/2016] [Indexed: 01/25/2023]
Abstract
Biobanks will be essential to facilitate the translation of genomic research into real improvements to healthcare. Biobanking is a long-term commitment, requiring public support as well as appropriate regulatory, social and ethical guidelines to realize this promise. There is a growing body of research that explores the necessary conditions to ensure public trust in biomedical research, particularly in the context of biobanking. Trust is, however, a complex relationship. More analysis of public perceptions, attitudes and reactions is required to understand the primary triggers that influence gain and loss of trust. Further, the outcomes of these analyses require detailed consideration to determine how to promote trustworthy institutions and practices. This article uses national survey data, combined with the results of a community consultation that took place in Tasmania, Australia in 2013, to analyze the specific issue of public reactions to commercialization of biobanks and their outputs. This research will enhance the ability of biobanks to respond preemptively to public concerns about commercialization by establishing and maintaining governance frameworks that are responsive to those concerns. The results reveal that it is possible to counter the 'natural prejudice' that many people have against commercialization through independent governance of biobank resources and transparency with regard to commercial involvement. Indeed, most participants agreed that they would rather have a biobank with commercial involvement than none at all. This analysis provides nuanced conclusions about public reactions towards commercialization and equips researchers and biobank operators with data on which to base policies and make governance decisions in order to tackle participant concerns respectfully and responsively.
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Affiliation(s)
- Dianne Nicol
- Centre for Law and Genetics, Faculty of Law, University of Tasmania, Private Bag 89, Hobart, TAS, 7001, Australia.
| | - Christine Critchley
- Centre for Law and Genetics, Faculty of Law, University of Tasmania, Private Bag 89, Hobart, TAS, 7001, Australia; Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Mail H31, P.O. Box 218, Hawthorn, VIC, 3122, Australia.
| | - Rebekah McWhirter
- Centre for Law and Genetics, Faculty of Law, University of Tasmania, Private Bag 89, Hobart, TAS, 7001, Australia; Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
| | - Tess Whitton
- Centre for Law and Genetics, Faculty of Law, University of Tasmania, Private Bag 89, Hobart, TAS, 7001, Australia; Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
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10
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Murtagh MJ, Turner A, Minion JT, Fay M, Burton PR. International Data Sharing in Practice: New Technologies Meet Old Governance. Biopreserv Biobank 2016; 14:231-40. [PMID: 27200470 DOI: 10.1089/bio.2016.0002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The social structures that govern data/sample release aim to safeguard the confidentiality and privacy of cohort research participants (without whom there would be no data or samples) and enable the realization of societal benefit through optimizing the scientific use of those cohorts. Within collaborations involving multiple cohorts and biobanks, however, the local, national, and supranational institutional and legal guidelines for research (which produce a multiplicity of data access governance structures and guidelines) risk impeding the very science that is the raison d'etre of these consortia. We present an ethnographic study, which examined the epistemic and nonepistemic values driving decisions about data access and their consequences in the context of the pilot of an integrated approach to co-analysis of data. We demonstrate how the potential analytic flexibility offered by this approach was lost under contemporary data access governance. We identify three dominant values: protecting the research participant, protecting the study, and protecting the researcher. These values were both supported by and juxtaposed against a "public good" argument, and each was used as a rationale to both promote and inhibit sharing of data. While protection of the research participants was central to access permissions, decisions were also attentive to the desire of researchers to see their efforts in building population biobanks and cohorts realized in the form of scientific outputs. We conclude that systems for governing and enabling data access in large consortia need to (1) protect disclosure of research participant information or identity, (2) ensure the specific expectations of research participants are met, (3) embody systems of review that are transparent and not compromised by the specific interests of one particular group of stakeholders, and (4) facilitate data access procedures that are timely and efficient. Practical solutions are urgently needed. New approaches to data access governance should be trialed (and formally evaluated) with input from and discussion with stakeholders.
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Affiliation(s)
- Madeleine J Murtagh
- Data to Knowledge Research Group, School of Social and Community Medicine, University of Bristol , Bristol, United Kingdom
| | - Andrew Turner
- Data to Knowledge Research Group, School of Social and Community Medicine, University of Bristol , Bristol, United Kingdom
| | - Joel T Minion
- Data to Knowledge Research Group, School of Social and Community Medicine, University of Bristol , Bristol, United Kingdom
| | - Michaela Fay
- Data to Knowledge Research Group, School of Social and Community Medicine, University of Bristol , Bristol, United Kingdom
| | - Paul R Burton
- Data to Knowledge Research Group, School of Social and Community Medicine, University of Bristol , Bristol, United Kingdom
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11
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Lucena-Aguilar G, Sánchez-López AM, Barberán-Aceituno C, Carrillo-Ávila JA, López-Guerrero JA, Aguilar-Quesada R. DNA Source Selection for Downstream Applications Based on DNA Quality Indicators Analysis. Biopreserv Biobank 2016; 14:264-70. [PMID: 27158753 PMCID: PMC4991598 DOI: 10.1089/bio.2015.0064] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
High-quality human DNA samples and associated information of individuals are necessary for biomedical research. Biobanks act as a support infrastructure for the scientific community by providing a large number of high-quality biological samples for specific downstream applications. For this purpose, biobank methods for sample preparation must ensure the usefulness and long-term functionality of the products obtained. Quality indicators are the tool to measure these parameters, the purity and integrity determination being those specifically used for DNA. This study analyzes the quality indicators in DNA samples derived from 118 frozen human tissues in optimal cutting temperature (OCT) reactive, 68 formalin-fixed paraffin-embedded (FFPE) tissues, 119 frozen blood samples, and 26 saliva samples. The results obtained for DNA quality are discussed in association with the usefulness for downstream applications and availability of the DNA source in the target study. In brief, if any material is valid, blood is the most approachable option of prospective collection of samples providing high-quality DNA. However, if diseased tissue is a requisite or samples are available, the recommended source of DNA would be frozen tissue. These conclusions will determine the best source of DNA, according to the planned downstream application. Furthermore our results support the conclusion that a complete procedure of DNA quantification and qualification is necessary to guarantee the appropriate management of the samples, avoiding low confidence results, high costs, and a waste of samples.
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Affiliation(s)
- Gema Lucena-Aguilar
- 1 Andalusian Public Health System Biobank, Armilla, Spain .,2 Instituto de Investigación Biosanitaria de Granada , Armilla, Spain
| | - Ana María Sánchez-López
- 1 Andalusian Public Health System Biobank, Armilla, Spain .,2 Instituto de Investigación Biosanitaria de Granada , Armilla, Spain
| | | | - José Antonio Carrillo-Ávila
- 1 Andalusian Public Health System Biobank, Armilla, Spain .,2 Instituto de Investigación Biosanitaria de Granada , Armilla, Spain
| | - José Antonio López-Guerrero
- 3 Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología , Valencia, Spain .,4 Biobank, Fundación Instituto Valenciano de Oncología , Valencia, Spain
| | - Rocío Aguilar-Quesada
- 1 Andalusian Public Health System Biobank, Armilla, Spain .,2 Instituto de Investigación Biosanitaria de Granada , Armilla, Spain
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12
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Stephens N, Dimond R. Closure of a human tissue biobank: individual, institutional, and field expectations during cycles of promise and disappointment. NEW GENETICS AND SOCIETY 2015; 34:417-436. [PMID: 26740793 PMCID: PMC4685593 DOI: 10.1080/14636778.2015.1107469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/09/2015] [Indexed: 05/04/2023]
Abstract
Biobanks are increasingly being established to act as mediators between patient-donors and researchers. In practice, some of these will close. This paper details the experiences of one such bank. We report interviews with the bank's staff and oversight group during the period when the bank ceased biobanking activity, reconfigured as a disseminator of best practice, before then closing altogether. The paper makes three distinct contributions: (i) to provide a detailed account of the establishment, operational challenges, and eventual closure of the bank, which makes clear the rapid turnover in a cycle of promise and disappointment; (ii) to explore this in terms of a novel analytical focus upon field, institutional, and individual expectations; and (iii) to use this typology to demonstrate how, even after the bank's closure, aspects of its work were reconfigured and reused in new contexts. This provides a unique empirical analysis of the under-reported issue of biobank closure.
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Affiliation(s)
- Neil Stephens
- Cesagene, School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII, CardiffCF10 3WT, UK
- Corresponding author.
| | - Rebecca Dimond
- Cesagene, School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII, CardiffCF10 3WT, UK
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13
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Standard biobanking conditions prevent evaporation of body fluid samples. Clin Chim Acta 2015; 442:141-5. [PMID: 25661086 DOI: 10.1016/j.cca.2015.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 11/21/2022]
Abstract
Pre-analytical variation in biobanking procedures, e.g., long-term storage, could confound biomarker outcomes. We investigated evaporation in various body fluids at different storage temperatures and storage durations. Biobank sample tubes (Sarstedt 72.694.007) filled with water in different volumes (50, 100, 250, 500, 750, 1000, 1250, 1500μl) were stored at different temperatures (-80°C, -20°C, 4°C, room temperature (RT)) for 4.5years and weighed at regular intervals. Next, saliva, serum, plasma, and CSF were stored in different volumes (50, 250, 500, 1000μl) at different temperatures (-80°C, -20°C, 4°C, RT) for 2years. An extra set of CSF was stored in tubes with safe-lock cap (Eppendorf 0030 120.086) instead of a screw cap with o-ring. No evaporation of water stored in biobanking tubes at -80°C or -20°C occurred over 4.5years. Storage of saliva, serum, plasma, and CSF at -80°C or -20°C, monitored over 2years, protected these samples from evaporation too. At 4°C, evaporation was minor, approximately 1.5% (50μl) or 0% (1ml) yearly, where at RT it ranged from 38% (50μl) to 2% (1ml). Differences were observed neither between different body fluids, nor between tube caps. Our data provide support for long-term biobanking conform current biobanking guidelines, encouraging retrospective use of clinical cohorts.
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Sanner JE, Yu E, Udtha M, Holtzclaw Williams P. Nursing and Genetic Biobanks. Nurs Clin North Am 2013; 48:637-48. [DOI: 10.1016/j.cnur.2013.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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15
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Beyond ELSIs. Pharmacogenomics 2013. [DOI: 10.1016/b978-0-12-391918-2.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Harris JR, Burton P, Knoppers BM, Lindpaintner K, Bledsoe M, Brookes AJ, Budin-Ljøsne I, Chisholm R, Cox D, Deschênes M, Fortier I, Hainaut P, Hewitt R, Kaye J, Litton JE, Metspalu A, Ollier B, Palmer LJ, Palotie A, Pasterk M, Perola M, Riegman PHJ, van Ommen GJ, Yuille M, Zatloukal K. Toward a roadmap in global biobanking for health. Eur J Hum Genet 2012; 20:1105-11. [PMID: 22713808 PMCID: PMC3477856 DOI: 10.1038/ejhg.2012.96] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Biobanks can have a pivotal role in elucidating disease etiology, translation, and advancing public health. However, meeting these challenges hinges on a critical shift in the way science is conducted and requires biobank harmonization. There is growing recognition that a common strategy is imperative to develop biobanking globally and effectively. To help guide this strategy, we articulate key principles, goals, and priorities underpinning a roadmap for global biobanking to accelerate health science, patient care, and public health. The need to manage and share very large amounts of data has driven innovations on many fronts. Although technological solutions are allowing biobanks to reach new levels of integration, increasingly powerful data-collection tools, analytical techniques, and the results they generate raise new ethical and legal issues and challenges, necessitating a reconsideration of previous policies, practices, and ethical norms. These manifold advances and the investments that support them are also fueling opportunities for biobanks to ultimately become integral parts of health-care systems in many countries. International harmonization to increase interoperability and sustainability are two strategic priorities for biobanking. Tackling these issues requires an environment favorably inclined toward scientific funding and equipped to address socio-ethical challenges. Cooperation and collaboration must extend beyond systems to enable the exchange of data and samples to strategic alliances between many organizations, including governmental bodies, funding agencies, public and private science enterprises, and other stakeholders, including patients. A common vision is required and we articulate the essential basis of such a vision herein.
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Affiliation(s)
- Jennifer R Harris
- Department of Genes and Environment, Division of Epidemiology, The Norwegian Institute of Public Health, Oslo, Norway.
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17
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Harnessing Omics Sciences, Population Databases, and Open Innovation Models for Theranostics-Guided Drug Discovery and Development. Drug Dev Res 2012. [DOI: 10.1002/ddr.21035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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18
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Mischak H, Ioannidis JPA, Argiles A, Attwood TK, Bongcam-Rudloff E, Broenstrup M, Charonis A, Chrousos GP, Delles C, Dominiczak A, Dylag T, Ehrich J, Egido J, Findeisen P, Jankowski J, Johnson RW, Julien BA, Lankisch T, Leung HY, Maahs D, Magni F, Manns MP, Manolis E, Mayer G, Navis G, Novak J, Ortiz A, Persson F, Peter K, Riese HH, Rossing P, Sattar N, Spasovski G, Thongboonkerd V, Vanholder R, Schanstra JP, Vlahou A. Implementation of proteomic biomarkers: making it work. Eur J Clin Invest 2012; 42:1027-36. [PMID: 22519700 PMCID: PMC3464367 DOI: 10.1111/j.1365-2362.2012.02674.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While large numbers of proteomic biomarkers have been described, they are generally not implemented in medical practice. We have investigated the reasons for this shortcoming, focusing on hurdles downstream of biomarker verification, and describe major obstacles and possible solutions to ease valid biomarker implementation. Some of the problems lie in suboptimal biomarker discovery and validation, especially lack of validated platforms with well-described performance characteristics to support biomarker qualification. These issues have been acknowledged and are being addressed, raising the hope that valid biomarkers may start accumulating in the foreseeable future. However, successful biomarker discovery and qualification alone does not suffice for successful implementation. Additional challenges include, among others, limited access to appropriate specimens and insufficient funding, the need to validate new biomarker utility in interventional trials, and large communication gaps between the parties involved in implementation. To address this problem, we propose an implementation roadmap. The implementation effort needs to involve a wide variety of stakeholders (clinicians, statisticians, health economists, and representatives of patient groups, health insurance, pharmaceutical companies, biobanks, and regulatory agencies). Knowledgeable panels with adequate representation of all these stakeholders may facilitate biomarker evaluation and guide implementation for the specific context of use. This approach may avoid unwarranted delays or failure to implement potentially useful biomarkers, and may expedite meaningful contributions of the biomarker community to healthcare.
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Affiliation(s)
- Harald Mischak
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Murtagh MJ, Demir I, Jenkings KN, Wallace SE, Murtagh B, Boniol M, Bota M, Laflamme P, Boffetta P, Ferretti V, Burton PR. Securing the data economy: translating privacy and enacting security in the development of DataSHIELD. Public Health Genomics 2012; 15:243-53. [PMID: 22722688 DOI: 10.1159/000336673] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Contemporary bioscience is seeing the emergence of a new data economy: with data as its fundamental unit of exchange. While sharing data within this new 'economy' provides many potential advantages, the sharing of individual data raises important social and ethical concerns. We examine ongoing development of one technology, DataSHIELD, which appears to elide privacy concerns about sharing data by enabling shared analysis while not actually sharing any individual-level data. We combine presentation of the development of DataSHIELD with presentation of an ethnographic study of a workshop to test the technology. DataSHIELD produced an application of the norm of privacy that was practical, flexible and operationalizable in researchers' everyday activities, and one which fulfilled the requirements of ethics committees. We demonstrated that an analysis run via DataSHIELD could precisely replicate results produced by a standard analysis where all data are physically pooled and analyzed together. In developing DataSHIELD, the ethical concept of privacy was transformed into an issue of security. Development of DataSHIELD was based on social practices as well as scientific and ethical motivations. Therefore, the 'success' of DataSHIELD would, likewise, be dependent on more than just the mathematics and the security of the technology.
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Affiliation(s)
- M J Murtagh
- Data to Knowledge for Practice, University of Leicester, Leicester, UK.
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20
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Murtagh MJ, Burges Watson DL, Jenkings KN, Lie MLS, Mackintosh JE, Ford GA, Thomson RG. Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitative study. PLoS One 2012; 7:e37066. [PMID: 22675477 PMCID: PMC3365903 DOI: 10.1371/journal.pone.0037066] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 04/17/2012] [Indexed: 12/11/2022] Open
Abstract
Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. ‘Drip feeding’ information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation.
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Affiliation(s)
- Madeleine J Murtagh
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Burges Watson DL, Sanoff R, Mackintosh JE, Saver JL, Ford GA, Price C, Starkman S, Eckstein M, Conwit R, Grace A, Murtagh MJ. Evidence from the scene: paramedic perspectives on involvement in out-of-hospital research. Ann Emerg Med 2012; 60:641-50. [PMID: 22387089 DOI: 10.1016/j.annemergmed.2011.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 11/21/2011] [Accepted: 12/05/2011] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE In the context of calls to develop better systems for out-of-hospital clinical research, we seek to understand paramedics' perceptions of involvement in research and the barriers and facilitators to that involvement. METHODS This was a qualitative study using semistructured focus groups with 58 United Kingdom paramedics and interviews with 30 US firefighter-paramedics. The study focused on out-of-hospital research (trials of out-of-hospital treatment for stroke), whereby paramedics identified potential study subjects or obtained consent and administered study treatment in the field. Data were analyzed with a thematic and discourse approach. RESULTS Three key themes emerged as significant facilitators and barriers to paramedic involvement in research: patient benefit, professional identity and responsibility, and time. Paramedics showed willingness and capacity to engage in research but also some reticence because of the perceived sacrifice of autonomy and challenge to their identity. Paramedics work in a time-sensitive environment and were concerned that research would increase time taken in the field. CONCLUSION Awareness of these perspectives will help with development of out-of-hospital research protocols and potentially facilitate greater participation.
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