1
|
Jaffe K, Slat S, Chen L, Macleod C, Bohnert A, Lagisetty P. Perceptions around medications for opioid use disorder among a diverse sample of U.S. adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209361. [PMID: 38703949 DOI: 10.1016/j.josat.2024.209361] [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] [Received: 06/15/2023] [Revised: 03/04/2024] [Accepted: 03/27/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) including methadone (MMT), buprenorphine (BUP), and naltrexone (NTX) are safe and effective. However, there are significant negative perceptions surrounding MOUD, creating barriers to uptake. While research on MOUD stigma has largely focused on provider and patient experiences, fewer studies have explored MOUD perceptions among the general public. Given that MOUD stigma expressed by social ties surrounding individuals with OUD can influence treatment choices, we assessed MOUD perceptions among U.S. adults to determine how beliefs impacted treatment preference. We further explored how MOUD perceptions may be amplified among racialized groups with histories of experiencing drug-related discrimination. METHODS The study collected survey data from a diverse sample of U.S. adults (n = 1508) between October 2020 and January 2021. The survey measured knowledge of MOUD and non-medication treatments, relative agreement with common MOUD perceptions, and treatment preferences. Multinomial logistic regression analysis tested associations with treatment preference, stratified by race/ethnicity. RESULTS Descriptive results indicated that across groups, many respondents (66.8 %) had knowledge of MOUD, but believed MOUD was a "substitute" for opioids and had some degree of concern about misuse. Multivariable results showed knowledge of non-medication treatments was positively associated with MOUD preference among White (MMT OR = 3.16, 95 % CI = 1.35-7.39; BUP OR = 2.69, CI = 1.11-6.47), Black (MMT OR = 3.91, CI = 1.58-9.69), and Latino/a (MMT OR = 5.12, CI = 1.99-13.2; BUP OR = 3.85, CI = 1.5-9.87; NTX OR = 4.51, CI = 1.44-14.06) respondents. Among White respondents, we identified positive associations between MOUD experience and buprenorphine preference (OR = 4.33, CI = 1.17-16.06); non-medication treatment experience and preference for buprenorphine (OR = 2.86, CI = 1.03-7.94) and naltrexone (OR = 3.17, CI = 1.08-9.28). Concerns around misuse of methadone were negatively associated with methadone preference among White (OR = 0.65, CI = 0.43-0.98) and Latino/a (OR = 0.49, CI = 0.34-0.7), and concerns around misuse of buprenorphine was negatively associated with preference for MOUD among White (MMT OR = 0.62, CI = 0.39-0.99; BUP OR = 0.48, CI = 0.3-0.77; NTX OR = 0.6, CI = 0.36-0.99) and Latino/a (BUP OR = 0.59, CI = 0.39-0.89) respondents. CONCLUSIONS This analysis offers critical insights into treatment perceptions beyond the patient population, finding that negative beliefs around MOUD are common and negatively associated with preferences for medication-based treatment. These findings highlight implications for public support of evidence-based treatment and lay the groundwork for future interventions addressing public stigma toward MOUD.
Collapse
Affiliation(s)
- Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA
| | - Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Liying Chen
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Colin Macleod
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| |
Collapse
|
2
|
Walshe J, Elphinstone B, Nicol D, Taylor M. A systematic literature review of the 'commercialisation effect' on public attitudes towards biobank and genomic data repositories. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2024; 33:548-567. [PMID: 38389329 DOI: 10.1177/09636625241230864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Initiatives that collect and share genomic data to advance health research are widespread and accelerating. Commercial interests in these efforts, while vital, may erode public trust and willingness to provide personal genomic data, upon which these initiatives depend. Understanding public attitudes towards providing genomic data for health research in the context of commercial involvement is critical. A PRISMA-guided search of six online academic databases identified 113 quantitative and qualitative studies using primary data pertaining to public attitudes towards commercial actors in the management, collection, access, and use of biobank and genomic data. The presence of commercial interests yields interrelated public concerns around consent, privacy and data security, trust in science and scientists, benefit sharing, and the ownership and control of health data. Carefully considered regulatory and data governance and access policies are therefore required to maintain public trust and support for genomic health initiatives.
Collapse
|
3
|
Jaffe K, Patel S, Chen L, Slat S, Bohnert A, Lagisetty P. Impact of Perceived Access and Treatment Knowledge on Medication Preferences for Opioid Use Disorder. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241254591. [PMID: 38828548 DOI: 10.1177/29767342241254591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Medications for opioid use disorders (MOUDs) are effective, but most people with opioid use disorder (OUD) do not receive treatment. Prior research has explored patients' structural barriers to access and perceptions of MOUD. Little research has considered treatment knowledge and perceptions outside of the patient population. Members of the public without OUD themselves (eg, family, friends) can significantly influence treatment decisions of persons with OUD. Considering these gaps, we conducted an original survey with a diverse sample of US adults to explore knowledge and preferences toward OUD treatments. METHODS We conducted an online survey with 1505 White, Black, and Latino/a Americans including a small percentage (8.5%) with self-reported lifetime OUD. The survey used vignettes to describe hypothetical patients with OUD, provide basic treatment information (ie, methadone, buprenorphine, naltrexone, nonmedication treatment), and then assessed treatment preferences. Using multivariable logistic regression, we examined associations between covariates of interest (eg, perceived access, knowledge, demographics) and preference for MOUD versus nonmedication treatment. RESULTS There were 523 White, 502 Black, and 480 Latino/a respondents. Across racial/ethnic subsamples, respondents had the greatest knowledge of nonmedication treatments, with Black (72.7%) and Latino/a (70.2%) respondents having significantly greater knowledge compared to White respondents (61.8%). However, after viewing the vignette, a greater proportion of respondents chose methadone (35.8%) or buprenorphine (34.8%) as their first-choice treatment for hypothetical patients. Multivariable logistic regression suggested that among Black respondents, those with knowledge of nonmedication treatment were more likely to choose MOUD than those without knowledge (odds ratio = 2.41, 95% confidence interval = 1.34-4.34). Perceived treatment access did not affect treatment choice. CONCLUSIONS Across racial groups, knowledge and perceived access to nonmedication treatment was greater than for MOUD, but many still selected MOUD as a first-choice treatment. Significant findings emphasized the importance of treatment knowledge around decision-making, highlighting opportunities for tailored education efforts to improve uptake of evidence-based treatment.
Collapse
Affiliation(s)
- Kaitlyn Jaffe
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Shivam Patel
- Department of Urology, Beaumont Hospital, Royal Oak, MI, USA
| | - Liying Chen
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Slat
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Amy Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Martyn M, Forbes E, Lee L, Kanga-Parabia A, Weerasuriya R, Lynch E, Gleeson P, Gaff C. Secondary use of genomic data: patients' decisions at point of testing and perspectives to inform international data sharing. Eur J Hum Genet 2024; 32:717-724. [PMID: 38528053 PMCID: PMC11153578 DOI: 10.1038/s41431-023-01531-5] [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] [Received: 04/27/2023] [Revised: 09/14/2023] [Accepted: 12/19/2023] [Indexed: 03/27/2024] Open
Abstract
International sharing of genomic data files arising from clinical testing of patients is essential to further improve genomic medicine. Whilst the general public are reluctant to donate DNA for research, the choices patients actually make about sharing their clinical genomic data for future re-use (research or clinical) are unknown. We ascertained the data-sharing choices of 1515 patients having genomic testing for inherited conditions or cancer treatment from clinical consent forms. To understand the experiences and preferences of these patients, surveys were administered after test consent (RR 73%). Almost all patients (98%) consented to share their data. Survey respondents' decision recall was high (90%), but poorer if English was an additional language (p < 0.001). Parents deciding on behalf of children were over-represented amongst data-sharing decliners (p = 0.047) and decliners were more likely to believe that stored data could be easily reidentified (p < 0.001). A quarter of respondents did not know if reidentification would be easy and 44% of them were concerned about this possibility. Of those willing to share data overseas (60%), 23% indicated the recipient researcher's country would affect their decision. Most respondents (89%) desired some ongoing control over research use of their data. Four preliminary data-sharing profiles emerged; their further development could inform tailored patient resources. Our results highlight considerations for establishment of systems to make clinical genomic data files available for reanalysis locally and across borders. Patients' willingness to share their data - and value of the resulting research - should encourage clinical laboratories to consider sharing data systematically for secondary uses.
Collapse
Affiliation(s)
- Melissa Martyn
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Emily Forbes
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
| | - Ling Lee
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Anaita Kanga-Parabia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, 3052, Australia
| | - Rona Weerasuriya
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
| | - Elly Lynch
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, 3052, Australia
| | - Penny Gleeson
- Deakin Law school, Deakin University, Burwood, VIC, 3125, Australia
| | - Clara Gaff
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia.
| |
Collapse
|
5
|
Cascini F, Pantovic A, Al-Ajlouni YA, Puleo V, De Maio L, Ricciardi W. Health data sharing attitudes towards primary and secondary use of data: a systematic review. EClinicalMedicine 2024; 71:102551. [PMID: 38533128 PMCID: PMC10963197 DOI: 10.1016/j.eclinm.2024.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
Background To receive the best care, people share their health data (HD) with their health practitioners (known as sharing HD for primary purposes). However, during the past two decades, sharing for other (i.e., secondary) purposes has become of great importance in numerous fields, including public health, personalized medicine, research, and development. We aimed to conduct the first comprehensive overview of all studies that investigated people's HD sharing attitudes-along with associated barriers/motivators and significant influencing factors-for all data types and across both primary and secondary uses. Methods We searched PubMed, MEDLINE, PsycINFO, Web of Science, EMBASE, and CINAHL for relevant studies published in English between database inception and February 28, 2023, using a predefined set of keywords. Studies were included, regardless of their design, if they reported outcomes related to attitudes towards sharing HD. We extracted key data from the included studies, including the type of HD involved and findings related to: HD sharing attitudes (either in general or depending on type of data/user); barriers/motivators/benefits/concerns of the study participants; and sociodemographic and other variables that could impact HD sharing behaviour. The qualitative synthesis was conducted by dividing the studies according to the data type (resulting in five subgroups) as well as the purpose the data sharing was focused on (primary, secondary or both). The Newcastle-Ottawa Scale (NOS) was used to assess the quality of non-randomised studies. This work was registered with PROSPERO, CRD42023413822. Findings Of 2109 studies identified through our search, 116 were included in the qualitative synthesis, yielding a total of 228,501 participants and various types of HD represented: person-generated HD (n = 17 studies and 10,771 participants), personal HD in general (n = 69 studies and 117,054 participants), Biobank data (n = 7 studies and 27,073 participants), genomic data (n = 13 studies and 54,716 participants), and miscellaneous data (n = 10 studies and 18,887 participants). The majority of studies had a moderate level of quality (83 [71.6%] of 116 studies), but varying levels of quality were observed across the included studies. Overall, studies suggest that sharing intentions for primary purposes were observed to be high regardless of data type, and it was higher than sharing intentions for secondary purposes. Sharing for secondary purposes yielded variable findings, where both the highest and the lowest intention rates were observed in the case of studies that explored sharing biobank data (98% and 10%, respectively). Several influencing factors on sharing intentions were identified, such as the type of data recipient, data, consent. Further, concerns related to data sharing that were found to be mutual for all data types included privacy, security, and data access/control, while the perceived benefits included those related to improvements in healthcare. Findings regarding attitudes towards sharing varied significantly across sociodemographic factors and depended on data type and type of use. In most cases, these findings were derived from single studies and therefore warrant confirmations from additional studies. Interpretation Sharing health data is a complex issue that is influenced by various factors (the type of health data, the intended use, the data recipient, among others) and these insights could be used to overcome barriers, address people's concerns, and focus on spreading awareness about the data sharing process and benefits. Funding None.
Collapse
Affiliation(s)
- Fidelia Cascini
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
- Directorate General for the Digitisation of the Health Information System and Statistics, Ministry of Health, Italy
| | - Ana Pantovic
- Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | | | - Valeria Puleo
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
| | - Lucia De Maio
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
| | - Walter Ricciardi
- Department of Life Sciences and Public Health, Section of Hygiene and Public Health, Università Cattolica del Sacro Cuore, L. go Francesco Vito 1, Rome, 00168, Italy
| |
Collapse
|
6
|
Baines R, Stevens S, Austin D, Anil K, Bradwell H, Cooper L, Maramba ID, Chatterjee A, Leigh S. Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review. J Med Internet Res 2024; 26:e50421. [PMID: 38441944 PMCID: PMC10951832 DOI: 10.2196/50421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses. OBJECTIVE This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses. METHODS A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach. RESULTS Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level. CONCLUSIONS There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized.
Collapse
Affiliation(s)
- Rebecca Baines
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Sebastian Stevens
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
| | - Daniela Austin
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Hannah Bradwell
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Leonie Cooper
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Arunangsu Chatterjee
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon Leigh
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
- Warwick Medical School, University of Warwick, Conventry, United Kingdom
| |
Collapse
|
7
|
Lynch F, Meng Y, Best S, Goranitis I, Savulescu J, Gyngell C, Vears DF. Australian public perspectives on genomic data governance: responsibility, regulation, and logistical considerations. Eur J Hum Genet 2024; 32:295-301. [PMID: 37165103 PMCID: PMC10923910 DOI: 10.1038/s41431-023-01381-1] [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] [Received: 11/01/2022] [Revised: 03/13/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023] Open
Abstract
Genomic sequencing generates huge volumes of data, which may be collected or donated to form large genomic databases. Such information can be stored for future use, either for the data donor themselves or by researchers to help improve our understanding of the genetic basis of disease. Creating datasets of this magnitude and diversity is only possible if patients, their families, and members of the public worldwide share their data. However, there is no consensus on the best technical approach to data sharing that also minimises risks to individuals and exploration of stakeholders' views on aspects of genomic data governance models-the ways genomic data is stored, managed, shared and used-has been minimal. To address this need, we conducted focus groups with 39 members of the Australian public exploring their views and preferences for different aspects of genomic data governance models. We found that consent and control were essential to participants, as they wanted the option to choose who had access to their data and for what purposes. Critically, participants wanted a trustworthy body to enforce regulation of data storage, sharing and usage. While participants recognised the importance of data accessibility, they also expressed a strong desire for data security. Finally, financial responsibility for data storage raised concerns for inequity as well as organisations and individuals using data in ethically contentious ways to generate profit. Our findings highlight some of the trade-offs that need to be considered in the development of genomic data governance systems.
Collapse
Affiliation(s)
- Fiona Lynch
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Yan Meng
- The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Stephanie Best
- The University of Melbourne, Parkville, VIC, 3052, Australia
- Peter MacCallum Cancer Centre, Parkville, VIC, 3052, Australia
- Victorian Comprehensive Cancer Centre, Parkville, VIC, 3052, Australia
- Australian Genomics Health Alliance, Parkville, VIC, Australia
| | - Ilias Goranitis
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- The University of Melbourne, Parkville, VIC, 3052, Australia
- Australian Genomics Health Alliance, Parkville, VIC, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- The University of Melbourne, Parkville, VIC, 3052, Australia
- Chen Su Lan Centennial Professor in Medical Ethics, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christopher Gyngell
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
- The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Danya F Vears
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
- The University of Melbourne, Parkville, VIC, 3052, Australia.
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, 3000, Belgium.
| |
Collapse
|
8
|
Etchegary H, Darmonkov G, Simmonds C, Pullman D, Rahman P. Public attitudes towards genomic data sharing: results from a provincial online survey in Canada. BMC Med Ethics 2023; 24:81. [PMID: 37805493 PMCID: PMC10560413 DOI: 10.1186/s12910-023-00967-0] [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] [Received: 01/23/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND While genomic data sharing can facilitate important health research and discovery benefits, these must be balanced against potential privacy risks and harms to individuals. Understanding public attitudes and perspectives on data sharing is important given these potential risks and to inform genomic research and policy that aligns with public preferences and needs. METHODS A cross sectional online survey measured attitudes towards genomic data sharing among members of the general public in an Eastern Canadian province. RESULTS Results showed a moderate comfort level with sharing genomic data, usually into restricted scientific databases with controlled access. Much lower comfort levels were observed for sharing data into open or publicly accessible databases. While respondents largely approved of sharing genomic data for health research permitted by a research ethics board, many general public members were concerned with who would have access to their data, with higher rates of approval for access from clinical or academic actors, but much more limited approval of access from commercial entities or governments. Prior knowledge about sequencing and about research ethics boards were both related to data sharing attitudes. CONCLUSIONS With evolving regulations and guidelines for genomics research and data sharing, it is important to consider the perspectives of participants most impacted by these changes. Participant information materials and informed consent documents must be explicit about the safeguards in place to protect genomic data and the policies governing the sharing of data. Increased public awareness of the role of research ethics boards and of the need for genomic data sharing more broadly is also needed.
Collapse
Affiliation(s)
- Holly Etchegary
- Faculty of Medicine, Memorial University, St. John's, NL, A1B 3V6, Canada.
| | - Georgia Darmonkov
- Faculty of Medicine, Memorial University, St. John's, NL, A1B 3V6, Canada
| | - Charlene Simmonds
- Research Initiatives and Services, Memorial University, St. John's, NL, A1B 3V6, Canada
| | - Daryl Pullman
- Faculty of Medicine, Memorial University, St. John's, NL, A1B 3V6, Canada
| | - Proton Rahman
- Faculty of Medicine, Memorial University, St. John's, NL, A1B 3V6, Canada
- Eastern Regional Health Authority, Memorial University and Rheumatologist, St. John's, NL, A1B 3V6, Canada
| |
Collapse
|
9
|
Middleton A, Adams A, Aidid H, Atutornu J, Boraschi D, Borra J, Bircan T, Burch C, Costa A, Dickinson A, Enticknap A, Galloway C, Gale F, Garlick E, Haydon E, Henriques S, Mitchell M, Milne R, Monaghan J, Morley KI, Muella Santos M, Olivares Boldu L, Olumogba F, Orviss K, Parry V, Patch C, Robarts L, Shingles S, Smidt C, Tomlin B, Parkinson S. Public engagement with genomics. Wellcome Open Res 2023; 8:310. [PMID: 37928209 PMCID: PMC10624956 DOI: 10.12688/wellcomeopenres.19473.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
As detailed in its flagship report, Genome UK, the UK government recognises the vital role that broad public engagement across whole populations plays in the field of genomics. However, there is limited evidence about how to do this at scale. Most public audiences do not feel actively connected to science, are oftenunsure of the relevance to their lives and rarely talk to their family and friends about; we term this dis-connection a 'disengaged public audience'. We use a narrative review to explore: (i) UK attitudes towards genetics and genomics and what may influence reluctance to engage with these topics; (ii) innovative public engagement approaches that have been used to bring diverse public audiences into conversations about the technology. Whilst we have found some novel engagement methods that have used participatory arts, film, social media and deliberative methods, there is no clear agreement on best practice. We did not find a consistently used, evidence-based strategy for delivering public engagement about genomics across diverse and broad populations, nor a specific method that is known to encourage engagement from groups that have historically felt (in terms of perception) and been (in reality) excluded from genomic research. We argue there is a need for well-defined, tailor-made engagement strategies that clearly articulate the audience, the purpose and the proposed impact of the engagement intervention. This needs to be coupled with robust evaluation frameworks to build the evidence-base for population-level engagement strategies.
Collapse
Affiliation(s)
- Anna Middleton
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Hugbaad Aidid
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Jerome Atutornu
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
- School of Health and Sport Sciences, University of Suffolk, Ipswich, England, UK
| | - Daniela Boraschi
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Tuba Bircan
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Claudette Burch
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | | | | | - Catherine Galloway
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Emma Garlick
- Wellcome Connecting Science, Hinxton, England, UK
| | - Em Haydon
- Wellcome Connecting Science, Hinxton, England, UK
| | - Sasha Henriques
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
- Clinical Genetics Department, Guy's and St Thomas' Hospital, London, England, UK
| | - Marion Mitchell
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Richard Milne
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Katherine I Morley
- RAND Europe, Cambridge, England, UK
- Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | - Vivienne Parry
- Genomics England, Queen Mary University of London, London, England, UK
| | | | | | - Sam Shingles
- Wellcome Connecting Science, Hinxton, England, UK
| | - Cindy Smidt
- Wellcome Connecting Science, Hinxton, England, UK
| | - Ben Tomlin
- Wellcome Connecting Science, Hinxton, England, UK
| | | |
Collapse
|
10
|
Benevento M, Mandarelli G, Carravetta F, Ferorelli D, Caterino C, Nicolì S, Massari A, Solarino B. Measuring the willingness to share personal health information: a systematic review. Front Public Health 2023; 11:1213615. [PMID: 37546309 PMCID: PMC10397406 DOI: 10.3389/fpubh.2023.1213615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background In the age of digitalization and big data, personal health information is a key resource for health care and clinical research. This study aimed to analyze the determinants and describe the measurement of the willingness to disclose personal health information. Methods The study conducted a systematic review of articles assessing willingness to share personal health information as a primary or secondary outcome. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. English and Italian peer-reviewed research articles were included with no restrictions for publication years. Findings were narratively synthesized. Results The search strategy found 1,087 papers, 89 of which passed the screening for title and abstract and the full-text assessment. Conclusion No validated measurement tool has been developed for willingness to share personal health information. The reviewed papers measured it through surveys, interviews, and questionnaires, which were mutually incomparable. The secondary use of data was the most important determinant of willingness to share, whereas clinical and socioeconomic variables had a slight effect. The main concern discouraging data sharing was privacy, although good data anonymization and the high perceived benefits of sharing may overcome this issue.
Collapse
Affiliation(s)
- Marcello Benevento
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | | | | | - Davide Ferorelli
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Cristina Caterino
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Simona Nicolì
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Antonella Massari
- Department of Economics, Management and Business Law, University of Bari, Bari, Italy
| | - Biagio Solarino
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| |
Collapse
|
11
|
Warren V, Critchley C, McWhirter R, Walshe J, Nicol D. Context matters in genomic data sharing: a qualitative investigation into responses from the Australian public. BMC Med Genomics 2023; 15:275. [PMID: 37005651 PMCID: PMC10068139 DOI: 10.1186/s12920-023-01452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/01/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Understanding public attitudes to genomic data sharing is widely seen as key in shaping effective governance. However, empirical research in this area often fails to capture the contextual nuances of diverse sharing practices and regulatory concerns encountered in real-world genomic data sharing. This study aimed to investigate factors affecting public attitudes to data sharing through responses to diverse genomic data sharing scenarios. METHODS A set of seven empirically validated genomic data sharing scenarios reflecting a range of current practices in Australia was used in an open-ended survey of a diverse sample of the Australian public (n = 243). Qualitative responses were obtained for each of the scenarios. Respondents were each allocated one scenario and asked five questions on: whether (and why/not) they would share data; what sharing would depend on; benefits and risks of sharing; risks they were willing to accept if sharing was certain to result in benefits; and what could increase their comfort about sharing and any potential risk. A thematic analysis was used to examine responses, coded and validated by two blinded coders. RESULTS Participants indicated an overall high willingness to share genomic information, although this willingness varied considerably between different scenarios. A strong perception of benefits was reported as the foremost explanation for willingness to share across all scenarios. The high degree of convergence in the perception of benefits and the types of benefits identified by participants across all the scenarios suggests that the differentiation in intention to share may lie in perceptions of risk, which showed distinct patterns within and between the different scenarios. Some concerns were shared strongly across all scenarios, particularly benefit sharing, future use, and privacy. CONCLUSIONS Qualitative responses provide insight into popular assumptions regarding existing protections, conceptions of privacy, and which trade-offs are generally acceptable. Our results indicate that public attitudes and concerns are heterogeneous and influenced by the context in which sharing takes place. The convergence of key themes such as benefits and future uses point to core concerns that must be centred in regulatory responses to genomic data sharing.
Collapse
Affiliation(s)
- Vanessa Warren
- School of Law, University of Tasmania, Sandy Bay, TAS, Australia.
| | - Christine Critchley
- School of Law, University of Tasmania, Sandy Bay, TAS, Australia
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rebekah McWhirter
- School of Law, University of Tasmania, Sandy Bay, TAS, Australia
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Jarrod Walshe
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Dianne Nicol
- School of Law, University of Tasmania, Sandy Bay, TAS, Australia
| |
Collapse
|
12
|
Mayeur C, Mertes H, Van Hoof W. Do genomic passports leave us more vulnerable or less vulnerable? Perspectives from an online citizen engagement. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:83. [PMID: 36909259 PMCID: PMC9985078 DOI: 10.1057/s41599-023-01580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Since genomics is becoming commonplace in healthcare for the diagnosis, treatment, and prevention, the prospect of generating a genomic passport for all citizens is gaining traction. While this would have many advantages, it raises ethical issues requiring societal debate alongside academic reflection. Hence, Sciensano-the Belgian scientific Institute of Public Health-organised an online citizen engagement on genomic information usage, including a question on a genomic passport for all. The inductive thematic analysis of participants' contributions highlighted vulnerability as a fundamental concern, while this has not received sufficient attention so far in genomics. Participants expressed their vulnerability in two ways. First, the genomic passport would inform them about their ontological vulnerability. By revealing their constitutional weaknesses (predisposition to diseases), it reminds them that everyone is unavoidably and perennially at risk of being harmed. Second, the misuse of the genomic passport can add situational vulnerabilities (e.g., discrimination causing psychological and economic harm). Moreover, the fundamental uncertainty in genomics-how will such sensitive information be used, and how will the science evolve?-exacerbates these vulnerabilities. This article ends with recommendations to alleviate these vulnerabilities in genomics now and in the future in which the genomic passport may become a reality.
Collapse
|
13
|
Thorpe R, Jensen K, Masser B, Raivola V, Kakkos A, von Wielligh K, Wong J. Donor and non-donor perspectives on receiving information from routine genomic testing of donor blood. Transfusion 2023; 63:331-338. [PMID: 36478364 PMCID: PMC10107456 DOI: 10.1111/trf.17215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Genomic testing is already used by blood collection agencies (BCAs) to identify rare blood types and ensure the best possible matching of blood. With ongoing technological developments, broader applications, such as the identification of genetic markers relevant to blood donor health, will become feasible. However, the perspectives of blood donors (and potential blood donors) on routine genomic testing of donor blood are under-researched. STUDY DESIGN AND METHODS Eight online Focus Groups were conducted: four with donors and four with non-donors. Participants were presented with three hypothetical scenarios about the current and possible future applications of genomic testing: Performing rare blood type testing; identifying donors with genetic markers associated with iron metabolism; and identifying donors with genetic markers associated with bowel cancer. RESULTS Testing to identify rare blood types was perceived to be an appropriate application for the BCA to undertake, while identifying markers associated with iron metabolism and cancer genetic markers were only partially supported. Participants raised concerns about the boundaries of acceptable testing and the implications of testing for privacy, data security, and health insurance. Perspectives of donors and non-donors on all scenarios were similar. DISCUSSION The principles of who benefits from genomic testing and the perceived role of BCAs were key in shaping participants' perspectives. Participants generally agreed that testing should be directly related to blood donation or be of benefit to the recipient or donor. Findings indicate that consent and communication are key to the acceptability of current and expanded genomic testing.
Collapse
Affiliation(s)
- Rachel Thorpe
- Clinical Services and Research, Australia Red Cross Lifeblood, West Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kyle Jensen
- Research and Development, Australia Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Barbara Masser
- Research and Development, Australia Red Cross Lifeblood, Kelvin Grove, Queensland, Australia.,School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Department of Public Health and Primary Care, University of Cambridge, National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, Cambridge, UK
| | - Vera Raivola
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, Kuopio, Finland.,Finnish Red Cross Blood Service, Helsinki, Finland
| | - Athina Kakkos
- Clinical Services and Research, Australia Red Cross Lifeblood, West Melbourne, Victoria, Australia
| | - Kobie von Wielligh
- Clinical Services and Research, Australia Red Cross Lifeblood, West Melbourne, Victoria, Australia
| | - Jonathan Wong
- Clinical Services and Research, Australia Red Cross Lifeblood, West Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Yang JH, Kim H, Lee I. Public perceptions and attitudes of the national project of bio-big data: A nationwide survey in the Republic of Korea. Front Genet 2023; 14:1081812. [PMID: 36911391 PMCID: PMC9995590 DOI: 10.3389/fgene.2023.1081812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
Background: The National Project of Bio-Big Data (NPBBD) is a South Korean bio-big data collection project, expected to include health, genomic, and lifelog data of one million Koreans. The Ethical, Legal, and Social Implications study is a parallel study active since 2020. As part of the study, a public survey was conducted to evaluate public attitudes towards engagement schemes, such as public committees and web portals for communication between the public and researchers. Methods: An online survey was conducted from March 3-9, 2021, using structured questionnaires addressed to 1,000 adults aged 20-59 years. Results: Several respondents reported a positive attitude towards participation (43.6% "somewhat," 14.3% "definitely"), whereas approximately one-third (36.5%) reported a neutral attitude. Positive factors that may affect the willingness of the respondents to participate included receiving health information (25.1%), contributing to research on cancer and rare diseases (21.9%), and advancing personalized medicine (21.5%). Conversely, negative factors were mainly associated with concerns regarding the risk of data leakage (22.8%), discrimination (21.1%), lack of information (13.5%), possibility of knowing the risk of being diagnosed with an incurable diseases (12.5%), and possibility of using data in industry (11.3%). In terms of project governance, respondents tended to recognize the importance of public participation in incorporating public opinion into the project design. Conclusion: These results have implications for the participant recruitment process, public engagement strategies, and the scope of user (academics/industry, domestic/overseas) accessibility to the database.
Collapse
Affiliation(s)
- Ji Hyun Yang
- Division of Medical Law and Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, South Korea.,Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, South Korea
| | - Hannah Kim
- Division of Medical Law and Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, South Korea.,Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, South Korea
| | - Ilhak Lee
- Division of Medical Law and Ethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, South Korea.,Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, South Korea
| |
Collapse
|
15
|
Ni H, Jordan E, Cao J, Kinnamon DD, Gottlieb SS, Hofmeyer M, Jimenez J, Judge DP, Kransdorf E, Morris AA, Owens A, Shah P, Tang WHW, Wang J, Hershberger RE. Knowledge of Genome Sequencing and Trust in Medical Researchers Among Patients of Different Racial and Ethnic Groups With Idiopathic Dilated Cardiomyopathy. JAMA Cardiol 2023; 8:33-42. [PMID: 36383367 PMCID: PMC9669924 DOI: 10.1001/jamacardio.2022.4132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
Importance Cardiovascular disease contributes outsized mortality in patients from underrepresented racial and ethnic groups. Understanding levels of trust in medical researchers and knowledge of genome sequencing may help identify barriers to research participation and develop strategies to educate patients about the role of genetics in cardiovascular disease. Objective To assess racial and ethnic differences in trust in medical researchers and genome-sequencing knowledge among patients with idiopathic dilated cardiomyopathy and determine the association between trust in medical researchers and genome-sequencing knowledge. Design, Setting, and Participants This cross-sectional study conducted by a consortium of 25 US heart failure programs included patients with idiopathic dilated cardiomyopathy defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes. Enrollment occurred from June 7, 2016, to March 15, 2020. Main Outcomes and Measures Percent distributions, means, and associations of genome-sequencing knowledge scores and research trust scores for Hispanic, non-Hispanic Black (hereafter referred to as Black), and non-Hispanic White participants (hereafter referred to as White). Results Among 1121 participants, mean (SD) age was 51.6 (13.6) years with 41.4% Black, 8.5% Hispanic, and 43.4% female. After accounting for site effects, the level of genome-sequencing knowledge was lower in Hispanic and Black participants compared with White participants (mean score difference, -2.6; 95% CI, -3.9 to -1.2 and mean score difference, -2.9; 95% CI, -3.6 to -2.2, respectively). The level of trust in researchers was lowest in Black participants (mean score, 27.7), followed by Hispanic participants (mean score, 29.4) and White participants (mean score, 33.9). Racial and ethnic differences remained after adjusting for education, age at enrollment, duration of dilated cardiomyopathy, and health status. A higher level of trust was associated with a higher level of genome-sequencing knowledge within different racial and ethnic groups. Conclusions and Relevance In this cross-sectional study, large racial and ethnic differences in levels of genome-sequencing knowledge and trust in medical researchers were observed among patients with dilated cardiomyopathy. Findings from this study can inform future studies that aim to enhance the uptake of genomic knowledge and level of trust in medical researchers.
Collapse
Affiliation(s)
- Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | | | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, Florida
| | | | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| |
Collapse
|
16
|
Parvinen L, Alamäki A, Hallikainen H, Mäki M. Exploring the challenges of and solutions to sharing personal genomic data for use in healthcare. Health Informatics J 2023; 29:14604582231152185. [PMID: 36651319 DOI: 10.1177/14604582231152185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Boosted by the COVID-19 pandemic, as well as the tightened General Data Protection Regulation (GDPR) legislation within the European Union (EU), individuals have become increasingly concerned about privacy. This is also reflected in how willing individuals are to consent to sharing personal data, including their health data. To understand this behaviour better, this study focuses on willingness to consent in relation to genomic data. The study explores how the provision of educational information relates to willingness to consent, as well as differences in privacy concerns, information sensitivity and the perceived trade-off value between individuals willing versus unwilling to consent to sharing their genomic data. Of the respondents, 65% were initially willing to consent, but after educational information 89% were willing to consent and only 11% remained unwilling to consent. Educating individuals about potential health benefits can thus help to correct the beliefs that originally led to the unwillingness to share genomic data.
Collapse
Affiliation(s)
- Lasse Parvinen
- Faculty of Science and Engineering, Laboratory of Industrial Management Finland, 278232Åbo Akademi University, Turku, Finland
| | - Ari Alamäki
- 52909Haaga-Helia University of Applied Sciences, Helsinki, Finland
| | | | - Marko Mäki
- 52909Haaga-Helia University of Applied Sciences, Helsinki, Finland
| |
Collapse
|
17
|
Lynch F, Meng Y, Best S, Goranitis I, Savulescu J, Gyngell C, Vears DF. Australian public perspectives on genomic data storage and sharing: Benefits, concerns and access preferences. Eur J Med Genet 2023; 66:104676. [PMID: 36473622 DOI: 10.1016/j.ejmg.2022.104676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Diagnostic genomic sequencing generates unprecedented amounts of data. In addition to its primary use, this data could be used for a wide range of secondary purposes, including research and informing future healthcare for the data donor. These opportunities may require data to be shared with third parties. Although effective data sharing relies on public support, there are barriers which may prevent people from choosing to donate their genomic data and surprisingly few studies explore these barriers in depth. To address this need, this study aimed to qualitatively explore the Australian public's views and preferences for storing and sharing genomic data. Online focus groups were recorded, transcribed, and analysed using inductive content analysis. A total of 7 focus groups were conducted with 39 members of the Australian public ranging from 18 to 67 years of age. Participants were mostly supportive of genomic data being stored and shared for secondary purposes, recognising the potential benefits for individual health and wider medical research. However, some concerns were identified. Participants felt genomic data was particularly sensitive information, and raised the potential for discrimination, stigma, and other malicious uses of such data. Concerns for privacy and security of the data were also prevalent. Trustworthiness of data users was important when considering who genomic data should be shared with. Although participants were supportive of data being freely available to health professionals and researchers, they were opposed to insurance companies and employers accessing the data. There was greater controversy around sharing data with law enforcement and pharmaceutical companies. Participants recognised both benefits and harms to sharing with law enforcement. They were also cognizant of the dual purpose of pharmaceutical companies as both research and profit-driven organisations. Finally, participants expressed varying perspectives about sharing genomic data with family members, yet most agreed that explicit consent from the data donor should be required to share their information with relatives. This study highlighted several of the Australian public's perceived barriers and motivators for the storage and sharing of genomic data. Participants recognised both the benefits of collecting, storing and sharing such data widely but also the potential for harm from data misuse. While public acceptance of such endeavours is required to maximise the volume of data made available, the concerns around data access and security need to be addressed before this can occur. These findings also highlight the nuance and ethical complexity of decisions about who we should allow to access donated genomic data. These perspectives will be essential in helping to shape the way large-scale genomic data storage and sharing is developed and implemented in Australia, and internationally.
Collapse
Affiliation(s)
- Fiona Lynch
- Murdoch Children's Research Institute, Parkville, 3052, Australia; The University of Melbourne, Parkville, 3052, Australia
| | - Yan Meng
- The University of Melbourne, Parkville, 3052, Australia
| | - Stephanie Best
- The University of Melbourne, Parkville, 3052, Australia; Peter MacCallum Cancer Centre, Parkville, 3052, Australia; Victorian Comprehensive Cancer Centre, Parkville, 3052, Australia; Australian Genomics Health Alliance, Australia
| | - Ilias Goranitis
- Murdoch Children's Research Institute, Parkville, 3052, Australia; The University of Melbourne, Parkville, 3052, Australia; Australian Genomics Health Alliance, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, Parkville, 3052, Australia; The University of Melbourne, Parkville, 3052, Australia; Chen Su Lan Centennial Professor in Medical Ethics, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Gyngell
- Murdoch Children's Research Institute, Parkville, 3052, Australia; The University of Melbourne, Parkville, 3052, Australia
| | - Danya F Vears
- Murdoch Children's Research Institute, Parkville, 3052, Australia; The University of Melbourne, Parkville, 3052, Australia; Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, Leuven, 3000, Belgium.
| |
Collapse
|
18
|
Ahram M, Abdelgawad F, ElHafeez SA, Abdelhafiz AS, Ibrahim ME, Elgamri A, Mohammed Z, El-Rhazi K, Elsebaie E, Gamel E, Shahouri M, Mostafa NT, Adarmouch L, Silverman H. Perceptions, attitudes, and willingness of the public in low- and middle-income countries of the Arab region to participate in biobank research. BMC Med Ethics 2022; 23:122. [PMID: 36457067 PMCID: PMC9713115 DOI: 10.1186/s12910-022-00855-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022] Open
Abstract
Population-based genomics studies have proven successful in identifying genetic variants associated with diseases. High-quality biospecimens linked with informative health data from diverse segments of the population have made such research possible. However, the success of biobank research depends on the willingness of the public to participate in this type of research. We aimed to explore the factors associated with the willingness of the public to participate in biobank research from four low- and middle-income countries in the Arab region (Egypt, Jordan, Morocco, and Sudan). We used a previously validated questionnaire to assess several constructs that included the public's perceptions, attitudes, and willingness to participate in biobank research. We recruited 967 participants. More than half did not have prior awareness of biobanks. Participants' willingness to donate biospecimens and health data was less than 10%. Our results also showed that participants harbored concerns with trust, privacy, and with data-sharing involving international researchers. Predictors of willingness to participate in biobank research included no previous involvement in research and positive attitudes toward biobanks. Finally, our study showed several differences between the four countries regarding several of the investigated constructs. We conclude there should be additional efforts to raise public awareness and enhance perceptions of the public in biobanking research to enhance trust. We further recommend qualitative research to explore the underlying factors that contribute to the public's concerns with international data sharing that would enhance global health.
Collapse
Affiliation(s)
- Mamoun Ahram
- grid.9670.80000 0001 2174 4509School of Medicine, The University of Jordan, Amman, Jordan
| | - Fatma Abdelgawad
- grid.7776.10000 0004 0639 9286Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Samar Abd ElHafeez
- grid.7155.60000 0001 2260 6941High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | - Maha Emad Ibrahim
- grid.33003.330000 0000 9889 5690Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Alya Elgamri
- Faculty of Dentistry, University of Khartoum, Cairo, Egypt
| | - Zeinab Mohammed
- grid.411662.60000 0004 0412 4932Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Karima El-Rhazi
- Faculty of Medicine of Fez, Sidi Mohamed Ben Abellah University, Fez, Morocco
| | - Eman Elsebaie
- grid.7776.10000 0004 0639 9286Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ehsan Gamel
- grid.9763.b0000 0001 0674 6207Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | | | | | - Latifa Adarmouch
- grid.411840.80000 0001 0664 9298Faculty of Medicine, Cadi Ayyad University, Marrakesh, Morocco
| | - Henry Silverman
- grid.411024.20000 0001 2175 4264University of Maryland School of Medicine, Baltimore, MD USA
| |
Collapse
|
19
|
Hastings Ward J, Middleton R, McCormick D, White H, Kherroubi Garcia I, Simmonds S, Chandramouli L, Hart A. Research participants: critical friends, agents for change. Eur J Hum Genet 2022; 30:1309-1313. [PMID: 36195706 PMCID: PMC9712391 DOI: 10.1038/s41431-022-01199-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | - Helen White
- Participant Panel at Genomics England, London, UK
| | | | | | | | - Andrew Hart
- Participant Panel at Genomics England, London, UK
| |
Collapse
|
20
|
Brall C, Berlin C, Zwahlen M, Vayena E, Egger M, Ormond KE. Public preferences towards data management and governance in Swiss biobanks: results from a nationwide survey. BMJ Open 2022; 12:e060844. [PMID: 36028266 PMCID: PMC9422864 DOI: 10.1136/bmjopen-2022-060844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This article aims to measure the willingness of the Swiss public to participate in personalised health research, and their preferences regarding data management and governance. SETTING Results are presented from a nationwide survey of members of the Swiss public. PARTICIPANTS 15 106 randomly selected Swiss residents received the survey in September 2019. The response rate was 34.1% (n=5156). Respondent age ranged from 18 to 79 years, with fairly uniform spread across sex and age categories between 25 and 64 years. PRIMARY AND SECONDARY OUTCOME MEASURES Willingness to participate in personalised health research and opinions regarding data management and governance. RESULTS Most respondents preferred to be contacted and reconsented for each new project using their data (39%, 95% CI: 37.4% to 40.7%), or stated that their preference depends on the project type (29.4%, 95% CI: 27.9% to 31%). Additionally, a majority (52%, 95% CI: 50.3% to 53.8%) preferred their data or samples be stored anonymously or in coded form (43.4%, 95% CI: 41.7% to 45.1%). Of those who preferred that their data be anonymised, most also indicated a wish to be recontacted for each new project (36.8%, 95% CI: 34.5% to 39.2%); however, these preferences are in conflict. Most respondents desired to personally own their data. Finally, most Swiss respondents trust their doctors, along with researchers at universities, to protect their data. CONCLUSION Insight into public preference can enable Swiss biobanks and research institutions to create management and governance strategies that match the expectations and preferences of potential participants. Models allowing participants to choose how to interact with the process, while more complex, may increase individual willingness to provide data to biobanks.
Collapse
Affiliation(s)
- Caroline Brall
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kelly E Ormond
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
21
|
Corman A, Canaway R, Culnane C, Teague V. Public comprehension of privacy protections applied to health data shared for research: an Australian cross-sectional study. Int J Med Inform 2022; 167:104859. [DOI: 10.1016/j.ijmedinf.2022.104859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
|
22
|
Lessons Learned from the Pilot Phase of a Population-Wide Genomic Screening Program: Building the Base to Reach a Diverse Cohort of 100,000 Participants. J Pers Med 2022; 12:jpm12081228. [PMID: 36013178 PMCID: PMC9410232 DOI: 10.3390/jpm12081228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Genomic information is increasingly relevant for disease prevention and risk management at the individual and population levels. Screening healthy adults for Tier 1 conditions of hereditary breast and ovarian cancer, Lynch syndrome, and familial hypercholesterolemia using a population-based approach can help identify the 1−2% of the US population at increased risk of developing diseases associated with these conditions and tailor prevention strategies. Our objective is to report findings from an implementation science study that evaluates multi-level facilitators and barriers to implementation of the In Our DNA SC population-wide genomic screening initiative. Methods: We established an IMPACTeam (IMPlementAtion sCience for In Our DNA SC Team) to evaluate the pilot phase using principles of implementation science. We used a parallel convergent mixed methods approach to assess the Reach, Implementation, and Effectiveness outcomes from the RE-AIM implementation science framework during the pilot phase of In Our DNA SC. Quantitative assessment included the examination of frequencies and response rates across demographic categories using chi-square tests. Qualitative data were audio-recorded and transcribed, with codes developed by the study team based on the semi-structured interview guide. Results: The pilot phase (8 November 2021, to 7 March 2022) included recruitment from ten clinics throughout South Carolina. Reach indicators included enrollment rate and representativeness. A total of 23,269 potential participants were contacted via Epic’s MyChart patient portal with 1976 (8.49%) enrolled. Black individuals were the least likely to view the program invitation (28.9%) and take study-related action. As a result, there were significantly higher enrollment rates among White (10.5%) participants than Asian (8.71%) and Black (3.46%) individuals (p < 0.0001). Common concerns limiting reach and participation included privacy and security of results and the impact participation would have on health or life insurance. Facilitators included family or personal history of a Tier 1 condition, prior involvement in genetic testing, self-interest, and altruism. Assessment of implementation (i.e., adherence to protocols/fidelity to protocols) included sample collection rate (n = 1104, 55.9%) and proportion of samples needing recollection (n = 19, 1.7%). There were no significant differences in sample collection based on demographic characteristics. Implementation facilitators included efficient collection processes and enthusiastic clinical staff. Finally, we assessed the effectiveness of the program, finding low dropout rates (n = 7, 0.35%), the identification of eight individuals with Tier 1 conditions (0.72% positive), and high rates of follow-up genetic counseling (87.5% completion). Conclusion: Overall, Asian and Black individuals were less engaged, with few taking any study-related actions. Strategies to identify barriers and promoters for the engagement of diverse populations are needed to support participation. Once enrolled, individuals had high rates of completing the study and follow-up engagement with genetic counselors. Findings from the pilot phase of In Our DNA SC offer opportunities for improvement as we expand the program and can provide guidance to organizations seeking to begin efforts to integrate population-wide genomic screening.
Collapse
|
23
|
Amorim M, Silva S, Machado H, Teles EL, Baptista MJ, Maia T, Nwebonyi N, de Freitas C. Benefits and Risks of Sharing Genomic Data for Research: Comparing the Views of Rare Disease Patients, Informal Carers and Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148788. [PMID: 35886636 PMCID: PMC9319916 DOI: 10.3390/ijerph19148788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 01/25/2023]
Abstract
Assessing public and patients’ expectations and concerns about genomic data sharing is essential to promote adequate data governance and engagement in rare diseases genomics research. This cross-sectional study compared the views of 159 rare disease patients, 478 informal carers and 63 healthcare professionals in Northern Portugal about the benefits and risks of sharing genomic data for research, and its associated factors. The three participant groups expressed significantly different views. The majority of patients (84.3%) and informal carers (87.4%) selected the discovery of a cure for untreatable diseases as the most important benefit. In contrast, most healthcare professionals revealed a preference for the development of new drugs and treatments (71.4%), which was the second most selected benefit by carers (48.3%), especially by the more educated (OR (95% CI): 1.58 (1.07–2.34)). Lack of security and control over information access and the extraction of information exceeding research objectives were the two most often selected risks by patients (72.6% and 50.3%, respectively) and carers (60.0% and 60.6%, respectively). Conversely, professionals were concerned with genomic data being used to discriminate citizens (68.3%), followed by the extraction of information exceeding research objectives (54.0%). The latter risk was more frequently expressed by more educated carers (OR (95% CI): 1.60 (1.06–2.41)) and less by those with blue-collar (OR (95% CI): 0.44 (0.25–0.77) and other occupations (OR (95% CI): 0.44 (0.26–0.74)). Developing communication strategies and consent approaches tailored to participants’ expectations and needs can benefit the inclusiveness of genomics research that is key for patient-centred care.
Collapse
Affiliation(s)
- Mariana Amorim
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
| | - Susana Silva
- Centro em Rede de Investigação em Antropologia, Universidade do Minho, 4710-057 Braga, Portugal;
- Instituto de Ciências Sociais, Universidade do Minho, 4710-057 Braga, Portugal;
| | - Helena Machado
- Instituto de Ciências Sociais, Universidade do Minho, 4710-057 Braga, Portugal;
| | - Elisa Leão Teles
- Centro de Referência de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
| | - Maria João Baptista
- Centro de Referência de Cardiopatias Congénitas, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
- Departamento de Ginecologia, Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Tiago Maia
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
| | - Ngozi Nwebonyi
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
| | - Cláudia de Freitas
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- Correspondence:
| |
Collapse
|
24
|
Buchbinder M, Juengst E, Rennie S, Blue C, Rosen DL. Advancing a Data Justice Framework for Public Health Surveillance. AJOB Empir Bioeth 2022; 13:205-213. [PMID: 35442141 PMCID: PMC10777676 DOI: 10.1080/23294515.2022.2063997] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bioethical debates about privacy, big data, and public health surveillance have not sufficiently engaged the perspectives of those being surveilled. The data justice framework suggests that big data applications have the potential to create disproportionate harm for socially marginalized groups. Using examples from our research on HIV surveillance for individuals incarcerated in jails, we analyze ethical issues in deploying big data in public health surveillance. METHODS We conducted qualitative, semi-structured interviews with 24 people living with HIV who had been previously incarcerated in county jails about their perspectives on and experiences with HIV surveillance, as part of a larger study to characterize ethical considerations in leveraging big data techniques to enhance continuity of care for incarcerated people living with HIV. RESULTS Most participants expressed support for the state health department tracking HIV testing results and viral load data. Several viewed HIV surveillance as a violation of privacy, and several had actively avoided contact from state public health outreach workers. Participants were most likely to express reservations about surveillance when they viewed the state's motives as self-interested. Perspectives highlight the mistrust that structurally vulnerable people may have in the state's capacity to act as an agent of welfare. Findings suggest that adopting a nuanced, context-sensitive view on surveillance is essential. CONCLUSIONS Establishing trustworthiness through interpersonal interactions with public health personnel is important to reversing historical legacies of harm to racial minorities and structurally vulnerable groups. Empowering stakeholders to participate in the design and implementation of data infrastructure and governance is critical for advancing a data justice agenda, and can offset privacy concerns. The next steps in advancing the data justice framework in public health surveillance will be to innovate ways to represent the voices of structurally vulnerable groups in the design and governance of big data initiatives.
Collapse
Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, UNC—Chapel Hill
| | - Eric Juengst
- Department of Social Medicine, Center for Bioethics, UNC—Chapel Hill
| | - Stuart Rennie
- Department of Social Medicine, Center for Bioethics, UNC—Chapel Hill
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, UNC—Chapel Hill
| | - David L. Rosen
- Division of Infectious Diseases, Department of Medicine, UNC—Chapel Hill
| |
Collapse
|
25
|
Koplin JJ, Gyngell C, Savulescu J, Vears DF. Moving from 'fully' to 'appropriately' informed consent in genomics: The PROMICE framework. BIOETHICS 2022; 36:655-665. [PMID: 35390218 PMCID: PMC9321597 DOI: 10.1111/bioe.13027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 06/01/2023]
Abstract
Genomic sequencing technologies (GS) pose novel challenges not seen in older genetic technologies, making traditional standards for fully informed consent difficult or impossible to meet. This is due to factors including the complexity of the test and the broad range of results it may identify. Meaningful informed consent is even more challenging to secure in contexts involving significant time constraints and emotional distress, such as when rapid genomic testing (RGS) is performed in neonatal intensive care units. In this article, we propose that informed consent matters not for its own sake, but because obtaining it furthers a range of morally important goals, such as promoting autonomy, well-being, and trust in medicine. These goals form the basis of a new framework [PROmoting Morally Important Consent Ends (PROMICE)] for assessing the ethical appropriateness of various informed consent models. We illustrate this framework with two examples: (a) a tiered and layered consent model for obtaining consent for GS, and (b) consent for RGS in critically ill newborns. We conclude that appropriately-rather than fully-informed consent provides the correct standard for genomic medicine and research.
Collapse
Affiliation(s)
- Julian J. Koplin
- Biomedical Ethics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| | - Christopher Gyngell
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Julian Savulescu
- Biomedical Ethics Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
- Faculty of Philosophy, Oxford Uehiro Centre for Practical EthicsOxford UniversityOxfordUK
| | - Danya F. Vears
- Melbourne Law SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| |
Collapse
|
26
|
Igumbor JO, Bosire EN, Vicente-Crespo M, Igumbor EU, Olalekan UA, Chirwa TF, Kinyanjui SM, Kyobutungi C, Fonn S. Considerations for an integrated population health databank in Africa: lessons from global best practices. Wellcome Open Res 2022; 6:214. [PMID: 35224211 PMCID: PMC8844538 DOI: 10.12688/wellcomeopenres.17000.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The rising digitisation and proliferation of data sources and repositories cannot be ignored. This trend expands opportunities to integrate and share population health data. Such platforms have many benefits, including the potential to efficiently translate information arising from such data to evidence needed to address complex global health challenges. There are pockets of quality data on the continent that may benefit from greater integration. Integration of data sources is however under-explored in Africa. The aim of this article is to identify the requirements and provide practical recommendations for developing a multi-consortia public and population health data-sharing framework for Africa. Methods: We conducted a narrative review of global best practices and policies on data sharing and its optimisation. We searched eight databases for publications and undertook an iterative snowballing search of articles cited in the identified publications. The Leximancer software
© enabled content analysis and selection of a sample of the most relevant articles for detailed review. Themes were developed through immersion in the extracts of selected articles using inductive thematic analysis. We also performed interviews with public and population health stakeholders in Africa to gather their experiences, perceptions, and expectations of data sharing. Results: Our findings described global stakeholder experiences on research data sharing. We identified some challenges and measures to harness available resources and incentivise data sharing. We further highlight progress made by the different groups in Africa and identified the infrastructural requirements and considerations when implementing data sharing platforms. Furthermore, the review suggests key reforms required, particularly in the areas of consenting, privacy protection, data ownership, governance, and data access. Conclusions: The findings underscore the critical role of inclusion, social justice, public good, data security, accountability, legislation, reciprocity, and mutual respect in developing a responsive, ethical, durable, and integrated research data sharing ecosystem.
Collapse
Affiliation(s)
- Jude O Igumbor
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
| | - Edna N Bosire
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
| | - Marta Vicente-Crespo
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa.,African Population and Health Research Centre, Nairobi, Kenya
| | - Ehimario U Igumbor
- Nigeria Centre for Disease Control, Abuja, Nigeria.,School of Public Health, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Uthman A Olalekan
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tobias F Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
| | | | | | - Sharon Fonn
- School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
| |
Collapse
|
27
|
Samuel G, Broekstra R, Gille F, Lucassen A. Public Trust and Trustworthiness in Biobanking: The Need for More Reflexivity. Biopreserv Biobank 2022; 20:291-296. [PMID: 35172119 DOI: 10.1089/bio.2021.0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Low levels of public trust in biobanks are perceived to be a deterrent to participation and a threat to their sustainability. Acting in a "trustworthy" manner is seen to be one approach to ensuring public trust in biobanks. Striving to improve public trust in biobanks and prioritizing the need for institutional trustworthiness are both vital endeavors. However, there has been little discussion in the context of biobanking about the meaning of these two concepts, and the relationship between them. In this article, we argue that it is important to examine this, to ensure clarity around their meaning, as well as their relationship with each other as they apply to biobanking. We conclude by making a series of recommendations for biobanks.
Collapse
Affiliation(s)
- Gabrielle Samuel
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Reinder Broekstra
- Clinical Ethics and Law Southampton (CELS), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Felix Gille
- Digital Society Initiative, University of Zurich, Zurich, Switzerland.,Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Anneke Lucassen
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.,Clinical Ethics and Law Southampton (CELS), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
28
|
Akyüz K, Chassang G, Goisauf M, Kozera Ł, Mezinska S, Tzortzatou O, Mayrhofer MT. Biobanking and risk assessment: a comprehensive typology of risks for an adaptive risk governance. LIFE SCIENCES, SOCIETY AND POLICY 2021; 17:10. [PMID: 34903285 PMCID: PMC8666836 DOI: 10.1186/s40504-021-00117-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/01/2021] [Indexed: 05/03/2023]
Abstract
Biobanks act as the custodians for the access to and responsible use of human biological samples and related data that have been generously donated by individuals to serve the public interest and scientific advances in the health research realm. Risk assessment has become a daily practice for biobanks and has been discussed from different perspectives. This paper aims to provide a literature review on risk assessment in order to put together a comprehensive typology of diverse risks biobanks could potentially face. Methodologically set as a typology, the conceptual approach used in this paper is based on the interdisciplinary analysis of scientific literature, the relevant ethical and legal instruments and practices in biobanking to identify how risks are assessed, considered and mitigated. Through an interdisciplinary mapping exercise, we have produced a typology of potential risks in biobanking, taking into consideration the perspectives of different stakeholders, such as institutional actors and publics, including participants and representative organizations. With this approach, we have identified the following risk types: economic, infrastructural, institutional, research community risks and participant's risks. The paper concludes by highlighting the necessity of an adaptive risk governance as an integral part of good governance in biobanking. In this regard, it contributes to sustainability in biobanking by assisting in the design of relevant risk management practices, where they are not already in place or require an update. The typology is intended to be useful from the early stages of establishing such a complex and multileveled biomedical infrastructure as well as to provide a catalogue of risks for improving the risk management practices already in place.
Collapse
Affiliation(s)
- Kaya Akyüz
- BBMRI-ERIC, Graz, Austria.
- Department of Science and Technology Studies, University of Vienna, Vienna, Austria.
| | - Gauthier Chassang
- BBMRI-ERIC, Graz, Austria
- CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Melanie Goisauf
- BBMRI-ERIC, Graz, Austria
- Department of Science and Technology Studies, University of Vienna, Vienna, Austria
| | | | - Signe Mezinska
- BBMRI-ERIC, Graz, Austria
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Olga Tzortzatou
- BBMRI-ERIC, Graz, Austria
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | | |
Collapse
|
29
|
Motives for withdrawal of participation in biobanking and participants' willingness to allow linkages of their data. Eur J Hum Genet 2021; 30:367-377. [PMID: 34803164 PMCID: PMC8904772 DOI: 10.1038/s41431-021-00997-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/12/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Data repositories, like research biobanks, seek to optimise the number of responding participants while simultaneously attempting to increase the amount of data donated per participant. Such efforts aim to increase the repository’s value for its uses in medical research to contribute to improve health care, especially when data linkage is permitted by participants. We investigated individuals’ motives for participating in such projects and potential reasons for their withdrawal from participation in a population-based biobank. In addition, we analysed how these motives were related to various characteristics of the participants and their willingness to permit data linkage to their personal data for research. These questions were explored using a sample of participants in the Dutch Lifelines biobank (n = 2615). Our results indicated that motives for participation and withdrawal were premised on benefits or harm to society and to the individuals themselves. Although general values and trust both played key roles in participation, potential withdrawal and willingness to permit data linkage, they were differentially associated with motives for participation and withdrawal. These findings support and nuance previous findings by highlighting the distinctiveness and complexity of decision making regarding participation in or withdrawal from data donation. We suggest some new directions for improving recruitment, retention and safeguarding strategies in biobanking. In addition, our data provide initial evidence regarding how factors may relate with the probability that individuals will agree to data linkages, when controlling for their unique effects. Future research should further investigate how perceptions of harm and benefits may influence decision making on withdrawal of participation.
Collapse
|
30
|
Li X, Tao B, Dai HN, Imran M, Wan D, Li D. Is blockchain for Internet of Medical Things a panacea for COVID-19 pandemic? PERVASIVE AND MOBILE COMPUTING 2021; 75:101434. [PMID: 34121966 PMCID: PMC8184358 DOI: 10.1016/j.pmcj.2021.101434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/11/2021] [Accepted: 06/02/2021] [Indexed: 05/14/2023]
Abstract
The outbreak of the COVID-19 pandemic has deeply influenced the lifestyle of the general public and the healthcare system of the society. As a promising approach to address the emerging challenges caused by the epidemic of infectious diseases like COVID-19, Internet of Medical Things (IoMT) deployed in hospitals, clinics, and healthcare centers can save the diagnosis time and improve the efficiency of medical resources though privacy and security concerns of IoMT stall the wide adoption. In order to tackle the privacy, security, and interoperability issues of IoMT, we propose a framework of blockchain-enabled IoMT by introducing blockchain to incumbent IoMT systems. In this paper, we review the benefits of this architecture and illustrate the opportunities brought by blockchain-enabled IoMT. We also provide use cases of blockchain-enabled IoMT on fighting against the COVID-19 pandemic, including the prevention of infectious diseases, location sharing and contact tracing, and the supply chain of injectable medicines. We also outline future work in this area.
Collapse
Affiliation(s)
- Xuran Li
- Shandong Key Laboratory of Medical Physics and Image Processing, School of Physics and Electronics, Shandong Normal University, Jinan, Shandong, China
| | - Bishenghui Tao
- Faculty of Information Technology, Macau University of Science and Technology, Macau SAR, China
| | - Hong-Ning Dai
- Department of Computing and Decision Sciences, Lingnan University, Hong Kong SAR, China
| | - Muhammad Imran
- College of Applied Computer Science, King Saud University, Riyadh, Saudi Arabia
| | - Dehuan Wan
- Guangdong University of Finance, Guangzhou, China
| | - Dengwang Li
- Shandong Key Laboratory of Medical Physics and Image Processing, School of Physics and Electronics, Shandong Normal University, Jinan, Shandong, China
| |
Collapse
|
31
|
Gille F, Brall C. Limits of data anonymity: lack of public awareness risks trust in health system activities. LIFE SCIENCES, SOCIETY AND POLICY 2021; 17:7. [PMID: 34304736 PMCID: PMC8310702 DOI: 10.1186/s40504-021-00115-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Public trust is paramount for the well functioning of data driven healthcare activities such as digital health interventions, contact tracing or the build-up of electronic health records. As the use of personal data is the common denominator for these healthcare activities, healthcare actors have an interest to ensure privacy and anonymity of the personal data they depend on. Maintaining privacy and anonymity of personal data contribute to the trustworthiness of these healthcare activities and are associated with the public willingness to trust these activities with their personal data. An analysis of online news readership comments about the failed care.data programme in England revealed that parts of the public have a false understanding of anonymity in the context of privacy protection of personal data as used for healthcare management and medical research. Some of those commenting demanded complete anonymity of their data to be willing to trust the process of data collection and analysis. As this demand is impossible to fulfil and trust is built on a false understanding of anonymity, the inability to meet this demand risks undermining public trust. Since public concerns about anonymity and privacy of personal data appear to be increasing, a large-scale information campaign about the limits and possibilities of anonymity with respect to the various uses of personal health data is urgently needed to help the public to make better informed choices about providing personal data.
Collapse
Affiliation(s)
- Felix Gille
- Department of Health Sciences and Technology, Ethics and Policy Lab, ETH Zürich, Zürich, Switzerland.
| | - Caroline Brall
- Department of Health Sciences and Technology, Ethics and Policy Lab, ETH Zürich, Zürich, Switzerland
| |
Collapse
|
32
|
Romano V, Milne R, Mascalzoni D. Italian public’s views on sharing genetic information and medical information: findings from the ‘Your DNA, Your Say’ study. Wellcome Open Res 2021; 6:180. [PMID: 35233468 PMCID: PMC8855014 DOI: 10.12688/wellcomeopenres.16909.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The collection and sharing of genomic and health data underpins global efforts to develop genomic medicine services. ‘Your DNA, Your Say’ is a cross-sectional survey with the goal of gathering lay public attitudes toward the access and sharing of deoxyribonucleic acid (DNA) information and medical information. It suggests significant international variation in the willingness to share information, and in trust in the actors associated with the collection and use of this information. This paper explores these questions in the Italian context. Methods: The Italian Your DNA, Your Say campaign led to the collection of 1229 valid questionnaires. The sample was analysed using standard descriptive statistics. We described the sample in terms of gender, age ranges and self-reported religiosity, and split the sample amongst the five typically studied Italian macro-areas to explore regional variation. We analysed the relationship between these factors and trust and willingness to share medical and DNA information. Results: The majority of the sample, across all socio-demographics, were willing to share DNA and health information with all entities considered except for-profit researchers. Respondents tended not to trust institutions beyond their own doctor. There was no difference between Italian regions. Conclusions: Despite the generally positive attitude towards sharing, we suggest that the lack of trust in non-profit researchers and the government needs to be better understood to inform public communication projects around genomics in the future and to enhance awareness of DNA and medical information in Italy.
Collapse
Affiliation(s)
- Virginia Romano
- Center for Research, Ethics and Bioethics, Uppsala University, Uppsala, Sweden, SE-751 05, Sweden
- Medical Ethics, Lund University, Lund, Sweden, 22362, Sweden
| | - Richard Milne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK, UK
- Society and Ethics Research, Wellcome Connecting Science, Wellcome Genome Campus, Hinxton, UK, CB 10 1SA, UK
| | - Deborah Mascalzoni
- Center for Research, Ethics and Bioethics, Uppsala University, Uppsala, Sweden, SE-751 05, Sweden
- Institute of Biomedicine, Eurac Research, Bolzano, Italy, 39100, Italy
| |
Collapse
|
33
|
Savić-Kallesøe S, Middleton A, Milne R. Public trust and genomic medicine in Canada and the UK. Wellcome Open Res 2021; 6:124. [PMID: 34235273 PMCID: PMC8215560 DOI: 10.12688/wellcomeopenres.16831.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Genomic medicine could improve precise risk stratification, early prevention, and personalised treatment across a broad spectrum of disease. As this reality approaches, questions on the importance of public trust arise. The success of genomic medicine initiatives is influenced by the public's trust and willingness to engage. Specific social actors influential in the public's trust have been identified by the "Your DNA, Your Say" study, including doctors, researchers, and governments. This paper aims to identify and examine which specific social actors, if any, in Canada and the United Kingdom (UK) are the most trustworthy and influential to engage the public in genomic medicine research. Methods: Using data from the 'Your DNA, Your Say' study, logistic regression models and Pearson's chi-square tests were conducted to explore trust in social actors across Canada and the UK. Results: The results demonstrate Canada and the UK significantly differ in public trust and willingness to donate. Non-profit researchers, domestic doctors, and personal doctors were identified to be the most influential and trustworthy social actors in Canada and the UK. Conclusions: The comparative results indicate that both countries would benefit from engaging the public through doctors and non-profit researchers. The UK could additionally support public trust by engaging with the public through the National Health Service. However, the results suggest that whilst public trust is significant, it may be neither necessary nor sufficient in influencing willingness to donate. Future research could do well to investigate how the importance of public trust compares in countries with lower public trust.
Collapse
Affiliation(s)
- Sarah Savić-Kallesøe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Anna Middleton
- Society and Ethics Research, Wellcome Connecting Science, Cambridge, CB10 1SA, UK
- Faculty of Education, University of Cambridge, Cambridge, CB2 8PQ, UK
| | - Richard Milne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
- Society and Ethics Research, Wellcome Connecting Science, Cambridge, CB10 1SA, UK
| |
Collapse
|
34
|
Milne R, Morley KI, Almarri MA, Anwer S, Atutornu J, Baranova EE, Bevan P, Cerezo M, Cong Y, Costa A, Critchley C, Fernow J, Goodhand P, Hasan Q, Hibino A, Houeland G, Howard HC, Hussain SZ, Malmgren CI, Izhevskaya VL, Jędrzejak A, Jinhong C, Kimura M, Kleiderman E, Leach B, Liu K, Mascalzoni D, Mendes Á, Minari J, Nicol D, Niemiec E, Patch C, Pollard J, Prainsack B, Rivière M, Robarts L, Roberts J, Romano V, Sheerah HA, Smith J, Soulier A, Steed C, Stefànsdóttir V, Tandre C, Thorogood A, Voigt TH, Wang N, West AV, Yoshizawa G, Middleton A. Demonstrating trustworthiness when collecting and sharing genomic data: public views across 22 countries. Genome Med 2021; 13:92. [PMID: 34034801 PMCID: PMC8147072 DOI: 10.1186/s13073-021-00903-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/04/2021] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Public trust is central to the collection of genomic and health data and the sustainability of genomic research. To merit trust, those involved in collecting and sharing data need to demonstrate they are trustworthy. However, it is unclear what measures are most likely to demonstrate this. METHODS We analyse the 'Your DNA, Your Say' online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle- and high-income countries, gathered in 15 languages. We examine how participants perceived the relative value of measures to demonstrate the trustworthiness of those using donated DNA and/or medical information. We examine between-country variation and present a consolidated ranking of measures. RESULTS Providing transparent information about who will benefit from data access was the most important measure to increase trust, endorsed by more than 50% of participants across 20 of 22 countries. It was followed by the option to withdraw data and transparency about who is using data and why. Variation was found for the importance of measures, notably information about sanctions for misuse of data-endorsed by 5% in India but almost 60% in Japan. A clustering analysis suggests alignment between some countries in the assessment of specific measures, such as the UK and Canada, Spain and Mexico and Portugal and Brazil. China and Russia are less closely aligned with other countries in terms of the value of the measures presented. CONCLUSIONS Our findings highlight the importance of transparency about data use and about the goals and potential benefits associated with data sharing, including to whom such benefits accrue. They show that members of the public value knowing what benefits accrue from the use of data. The study highlights the importance of locally sensitive measures to increase trust as genomic data sharing continues globally.
Collapse
Affiliation(s)
- Richard Milne
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK.
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK.
| | - Katherine I Morley
- RAND Europe, Cambridge, CB4 1YG, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Mohamed A Almarri
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
- Department of Forensic Science and Criminology, Dubai Police GHQ, Dubai, United Arab Emirates
| | | | - Jerome Atutornu
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Elena E Baranova
- Russian Medical Academy of Continuous Professional Education, Moscow, 119049, Russia
| | - Paul Bevan
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
| | - Maria Cerezo
- EMBL-EBI, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Yali Cong
- Medical Ethics Program, Peking University Health Science Center, Beijing, 100191, China
| | - Alessia Costa
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Christine Critchley
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, 3122, Australia
- Centre for Law and Genetics, University of Tasmania, Hobart, 7001, Australia
| | - Josepine Fernow
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Peter Goodhand
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, M5G 0A3, Canada
| | - Qurratulain Hasan
- Department of Genetics & Molecular Medicine, Kamineni Hospitals, Hyderabad, 500 068, India
- SAAZ Genetics, Hyderabad, 500033, India
| | - Aiko Hibino
- Faculty of Humanities and Social Sciences, Hirosaki University, Hirosaki, 036-8560, Japan
| | - Gry Houeland
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Heidi C Howard
- Medical Ethics, Lund Universitet, Sölvegatan, 19, Lund, Sweden
| | | | - Charlotta Ingvoldstad Malmgren
- Department of Public Health and Caring Scienec, Uppsala University, 751 22, Uppsala, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Solna, Sweden
| | | | | | - Cao Jinhong
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Megumi Kimura
- Institute of Innovation Research, Hitotsubashi University, Tokyo, 186-8603, Japan
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, H3A 0G1, Canada
| | | | - Keying Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
- School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Deborah Mascalzoni
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
- EURAC, Institute of Biomedicine, 39100, Bolzano, Italy
| | - Álvaro Mendes
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
| | - Jusaku Minari
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, 606-8507, Japan
| | - Dianne Nicol
- Centre for Law and Genetics, University of Tasmania, Hobart, 7001, Australia
| | - Emilia Niemiec
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Christine Patch
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
- Genomics England, Queen Mary University of London, London, EC1M 6BQ, UK
| | | | - Barbara Prainsack
- Department of Political Science, University of Vienna, 1010, Vienna, Austria
- Department of Global Health & Social Medicine, King's College London, London, WC2R 2LS, UK
| | | | - Lauren Robarts
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Jonathan Roberts
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Virginia Romano
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
- EURAC, Institute of Biomedicine, 39100, Bolzano, Italy
| | - Haytham A Sheerah
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - James Smith
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
| | - Alexandra Soulier
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Claire Steed
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
| | - Vigdis Stefànsdóttir
- Landspitali, the National University Hospital of Iceland, 101, Reykjavík, Iceland
| | - Cornelia Tandre
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, H3A 0G1, Canada
| | - Torsten H Voigt
- Institute of Sociology, RWTH Aachen University, 52062, Aachen, Germany
| | - Nan Wang
- Medical Ethics Program, Peking University Health Science Center, Beijing, 100191, China
| | - Anne V West
- Indiana University Maurer School of Law, Bloomington, 47405, USA
| | - Go Yoshizawa
- Work Research Institute (AFI), Oslo Metropolitan University, 0130, Oslo, Norway
| | - Anna Middleton
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
- Faculty of Education, University of Cambridge, Cambridge, CB2 8PQ, UK
| |
Collapse
|
35
|
Savić-Kallesøe S, Middleton A, Milne R. Public trust and genomic medicine in Canada and the UK. Wellcome Open Res 2021; 6:124. [PMID: 34235273 PMCID: PMC8215560 DOI: 10.12688/wellcomeopenres.16831.1] [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] [Accepted: 05/12/2021] [Indexed: 04/03/2024] Open
Abstract
Background: Genomic medicine could improve precise risk stratification, early prevention, and personalised treatment across a broad spectrum of disease. As this reality approaches, questions on the importance of public trust arise. The success of genomic medicine initiatives is influenced by the public's trust and willingness to engage. Specific social actors influential in the public's trust have been identified by the "Your DNA, Your Say" study, including doctors, researchers, and governments. This paper aims to identify and examine which specific social actors, if any, in Canada and the United Kingdom (UK) are the most trustworthy and influential to engage the public in genomic medicine. Methods: Using data from the 'Your DNA, Your Say' study, logistic regression models and Pearson's chi-square tests were conducted to explore trust in social actors across Canada and the UK. Results: The results demonstrate Canada and the UK significantly differ in public trust and willingness to donate. Non-profit researchers, domestic doctors, and personal doctors were identified to be the most influential and trustworthy social actors in Canada and the UK. Conclusions: The comparative results indicate that both countries would benefit from engaging the public through doctors and non-profit researchers. The UK could additionally support public trust by engaging with the public through the National Health Service. However, the results suggest that whilst public trust is significant, it may be neither necessary nor sufficient in influencing willingness to donate. Future research could do well to investigate how the importance of public trust compares in countries with lower public trust.
Collapse
Affiliation(s)
- Sarah Savić-Kallesøe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Anna Middleton
- Society and Ethics Research, Wellcome Connecting Science, Cambridge, CB10 1SA, UK
- Faculty of Education, University of Cambridge, Cambridge, CB2 8PQ, UK
| | - Richard Milne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
- Society and Ethics Research, Wellcome Connecting Science, Cambridge, CB10 1SA, UK
| |
Collapse
|
36
|
Mayeur C, Saelaert M, Van Hoof W. The Belgian DNA Debate: An Online Deliberative Platform on the Ethical, Legal, and Social Issues of Genomics. Public Health Genomics 2021; 24:149-159. [PMID: 33951658 DOI: 10.1159/000515356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/13/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Genomics is increasingly being implemented in the society. To fully realise this implementation, citizens should be consulted about their perspectives on genomics and its associated ethical, legal, and social issues (ELSI) to enable them to co-create with experts a society-supported framework in genomics. METHODS A Belgian online DNA debate was organised, where 1,127 citizens contributed to its deliberative platform. RESULTS Contributors expressed a dual attitude towards the societal use of genomic information throughout 5 main themes. Firstly, contributors considered DNA to have a significant but nondeterministic impact on identity. The second theme describes how genomic information may guide people's behaviour but has unfavourable effects such as psychological distress. The third theme covers the tension between a genomics-based responsibility and the rejection of genetic discrimination. The fourth theme depicts how genomic information may be useful for the common good and society at large but how, nevertheless, it should be people's free choice to use this information. In the fifth theme, contributors expressed both willingness to share their data and caution towards the harm and abuses this may engender. Finally, contributors formulated some recommendations for the responsible implementation of genomics. DISCUSSION AND CONCLUSION The attitude of contributors towards the societal use of genomic information and its ELSI aligns with a soft precautionary approach, in which prudence and the weighing of different values should result in protective measures against potential risks and harms. Further societal implementation of genomics should include these values and concerns.
Collapse
|
37
|
Perceptions of 'Precision' and 'Personalised' Medicine in Singapore and Associated Ethical Issues. Asian Bioeth Rev 2021; 13:179-194. [PMID: 33959200 PMCID: PMC8079483 DOI: 10.1007/s41649-021-00165-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/17/2022] Open
Abstract
Governments are investing in precision medicine (PM) with the aim of improving healthcare through the use of genomic analyses and data analytics to develop tailored treatment approaches for individual patients. The success of PM is contingent upon clear public communications that engender trust and secure the social licence to collect and share large population-wide data sets because specific consent for each data re-use is impractical. Variation in the terminology used by different programmes used to describe PM may hinder clear communication and threaten trust. Language is used to create common understanding and expectations regarding precision medicine between researchers, clinicians and the volunteers. There is a need to better understand public interpretations of PM-related terminology. This paper reports on a qualitative study involving 24 focus group participants in the multi-lingual context of Singapore. The study explored how Singaporeans interpret and understand the terms ‘precision medicine’ and ‘personalised medicine’, and which term they felt more aptly communicates the concept and goals of PM. Results suggest that participants were unable to readily link the terms with this area of medicine and initially displayed preferences for the more familiar term of ‘personalised’. The use of visual aids to convey key concepts resonated with participants, some of whom then indicated preferences for the term ‘precision’ as being a more accurate description of PM research. These aids helped to facilitate dialogue around the ethical and social value, as well as the risks, of PM. Implications for programme developers and policy makers are discussed.
Collapse
|
38
|
Chavarria-Soley G, Francis-Cartin F, Jimenez-Gonzalez F, Ávila-Aguirre A, Castro-Gomez MJ, Robarts L, Middleton A, Raventós H. Attitudes of Costa Rican individuals towards donation of personal genetic data for research. Per Med 2021; 18:141-152. [PMID: 33576268 PMCID: PMC8010325 DOI: 10.2217/pme-2020-0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: We explore attitudes from the public in Costa Rica regarding willingness to donate DNA data for research. Materials & methods: A total of 224 Costa Rican individuals answered the anonymous online survey 'Your DNA, Your Say'. It covers attitudes toward DNA and medical data donation, trust in research professionals and concerns about consequences of reidentification. Results & conclusion: Most individuals (89%) are willing to donate their information for research purposes. When confronted with different potential uses of their data, participants are significantly less likely to donate data to for-profit researchers (34% willingness to donate). The most frequently cited concerns regarding donation of genetic data relate to possible discrimination by health/life insurance companies and employers. For the participants in the survey, the most trusted professionals are their own medical doctor and nonprofit researchers from their country. This is the first study regarding attitudes toward genetic data donation in Costa Rica.
Collapse
Affiliation(s)
- Gabriela Chavarria-Soley
- Escuela de Biología/Universidad de Costa Rica/San José, Costa Rica.,Centro de Investigación en Biología Celular y Molecular/Universidad de Costa Rica/San José, Costa Rica
| | - Fernanda Francis-Cartin
- Escuela de Biología/Universidad de Costa Rica/San José, Costa Rica.,Centro de Investigación en Biología Celular y Molecular/Universidad de Costa Rica/San José, Costa Rica
| | - Fabiola Jimenez-Gonzalez
- Centro de Investigación en Biología Celular y Molecular/Universidad de Costa Rica/San José, Costa Rica
| | - Alejandro Ávila-Aguirre
- Centro de Investigación en Biología Celular y Molecular/Universidad de Costa Rica/San José, Costa Rica
| | - Maria Jose Castro-Gomez
- Centro de Investigación en Biología Celular y Molecular/Universidad de Costa Rica/San José, Costa Rica
| | - Lauren Robarts
- Society & Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Anna Middleton
- Society & Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge, UK.,Faculty of Education, University of Cambridge
| | - Henriette Raventós
- Escuela de Biología/Universidad de Costa Rica/San José, Costa Rica.,Centro de Investigación en Biología Celular y Molecular/Universidad de Costa Rica/San José, Costa Rica
| |
Collapse
|
39
|
Participant mothers' attitudes toward genetic analysis in a birth cohort study. J Hum Genet 2021; 66:671-679. [PMID: 33495570 PMCID: PMC8225506 DOI: 10.1038/s10038-020-00894-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 01/21/2023]
Abstract
To conduct a long-term birth cohort study that includes genetic analysis, it is crucial to understand the attitudes of participants to genetic analysis and then take appropriate approaches for addressing their ambiguous and negative attitudes. This study aimed to explore participants’ attitudes toward genetic analysis and associated background factors among mothers who were enrolled in a large Japanese birth cohort. A questionnaire was sent to participants’ households, and the responses of 1762 mothers (34.0%) were used for the study. The majority of mothers recognized genetic analysis for themselves and their children and sharing of genetic data as beneficial. A low knowledge level of genomic terminology was associated with ambiguous attitudes toward genetic analysis and data sharing. Education level was positively associated with the recognition of the benefits of genetic analysis. Concern about handling genetic information was associated with the unacceptability of data sharing. Trust was associated with the approval of genetic analysis. Most mothers preferred that genetic analysis results be returned. These findings suggest the need for multiple efforts to maximize participants’ acceptance of genetic analysis, such as utilizing an educational approach to encourage familiarity with genetics/genomics, optimizing explanations for different educational levels, and explicitly disclosing the handling policy for genetic information.
Collapse
|
40
|
Mayeur C, van Hoof W. Citizens' conceptions of the genome: Related values and practical implications in a citizen forum on the use of genomic information. Health Expect 2021; 24:468-477. [PMID: 33453142 PMCID: PMC8077069 DOI: 10.1111/hex.13187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The development of large data sets, including genomic data, coupled with rapid advances in personalized medicine where citizens increasingly face complex choices about the use of their genomic information implies that citizens are essential stakeholders in genomics. They should be engaged in the ethical, legal and societal issues to produce a framework that fosters trust and allows them to guide the technology based on their values. OBJECTIVE This article highlights that citizens' conceptions of the human genome inform about and make sense of their main values regarding the use of genomic information, which is critical for policymakers, experts and stakeholders to understand to maintain the public support in genomics. METHOD Through an inductive thematic approach, we reanalysed data collected for the Belgian citizen forum, which aimed to produce recommendations for the Ministry of Public Health and other stakeholders. RESULTS Citizens expressed four conceptions of the genome that determined which uses of genomic information they supported: the most intimate part of individuals; 'I am more than my genome'; the individual's property vs the common good; and uncertainty and fear. CONCLUSION Diversity in their conceptions reveals remaining conflicts of values among citizens, mainly regarding a conception of the genome as an individual property or a common good. However, despite differing conceptions, shared values emerged such as solidarity, privacy, no genetic discrimination and the right to an open future, where individual and common interests coexist. PATIENT OR PUBLIC CONTRIBUTION The panel of the citizen forum consisted of 32 citizens.
Collapse
Affiliation(s)
- Chloé Mayeur
- Department of Public Health and Monitoring, Cancer Center, Sciensano, Brussels, Belgium
| | - Wannes van Hoof
- Department of Public Health and Monitoring, Cancer Center, Sciensano, Brussels, Belgium
| |
Collapse
|
41
|
Mann SP, Treit PV, Geyer PE, Omenn GS, Mann M. Ethical Principles, Constraints and Opportunities in Clinical Proteomics. Mol Cell Proteomics 2021; 20:100046. [PMID: 33453411 PMCID: PMC7950205 DOI: 10.1016/j.mcpro.2021.100046] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Recent advances in mass spectrometry (MS)-based proteomics have vastly increased the quality and scope of biological information that can be derived from human samples. These advances have rendered current workflows increasingly applicable in biomedical and clinical contexts. As proteomics is poised to take an important role in the clinic, associated ethical responsibilities increase in tandem with impacts on the health, privacy, and wellbeing of individuals. We conducted and here report a systematic literature review of ethical issues in clinical proteomics. We add our perspectives from a background of bioethics, the results of our accompanying paper extracting individual-sensitive results from patient samples, and the literature addressing similar issues in genomics. The spectrum of potential issues ranges from patient re-identification to incidental findings of clinical significance. The latter can be divided into actionable and unactionable findings. Some of these have the potential to be employed in discriminatory or privacy-infringing ways. However, incidental findings may also have great positive potential. A plasma proteome profile, for instance, could inform on the general health or disease status of an individual regardless of the narrow diagnostic question that prompted it. We suggest that early discussion of ethical issues in clinical proteomics can ensure that eventual healthcare practices and regulations reflect the considered judgment of the community and anticipate opportunities and problems that may arise as the technology matures.
Collapse
Affiliation(s)
- Sebastian Porsdam Mann
- Department of Media, Cognition and Communication, University of Copenhagen, Copenhagen, Denmark; Uehiro Center for Practical Ethics, University of Oxford, Oxford, UK; New address: Faculty of Law, University of Oxford, Oxford, UK.
| | - Peter V Treit
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Philipp E Geyer
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany; NNF Center for Protein Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; New address: OmicEra Diagnostics GmbH, Planegg, Germany
| | - Gilbert S Omenn
- Departments of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, and School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany; NNF Center for Protein Research, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
42
|
Haas MA, Teare H, Prictor M, Ceregra G, Vidgen ME, Bunker D, Kaye J, Boughtwood T. 'CTRL': an online, Dynamic Consent and participant engagement platform working towards solving the complexities of consent in genomic research. Eur J Hum Genet 2021; 29:687-698. [PMID: 33408362 PMCID: PMC8115139 DOI: 10.1038/s41431-020-00782-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
The complexities of the informed consent process for participating in research in genomic medicine are well-documented. Inspired by the potential for Dynamic Consent to increase participant choice and autonomy in decision-making, as well as the opportunities for ongoing participant engagement it affords, we wanted to trial Dynamic Consent and to do so developed our own web-based application (web app) called CTRL (control). This paper documents the design and development of CTRL, for use in the Australian Genomics study: a health services research project building evidence to inform the integration of genomic medicine into mainstream healthcare. Australian Genomics brought together a multi-disciplinary team to develop CTRL. The design and development process considered user experience; security and privacy; the application of international standards in data sharing; IT, operational and ethical issues. The CTRL tool is now being offered to participants in the study, who can use CTRL to keep personal and contact details up to date; make consent choices (including indicate preferences for return of results and future research use of biological samples, genomic and health data); follow their progress through the study; complete surveys, contact the researchers and access study news and information. While there are remaining challenges to implementing Dynamic Consent in genomic research, this study demonstrates the feasibility of building such a tool, and its ongoing use will provide evidence about the value of Dynamic Consent in large-scale genomic research programs.
Collapse
Affiliation(s)
- Matilda A Haas
- Australian Genomics Health Alliance, Parkville, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Harriet Teare
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK
| | - Megan Prictor
- Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | | | - Miranda E Vidgen
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - David Bunker
- Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK.,Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | - Tiffany Boughtwood
- Australian Genomics Health Alliance, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
| |
Collapse
|
43
|
Ratan R, Earle K, Rosenthal S, Hua Chen VH, Gambino A, Goggin G, Stevens H, Li B, Lee KM. The (digital) medium of mobility is the message: Examining the influence of e-scooter mobile app perceptions on e-scooter use intent. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2021. [DOI: 10.1016/j.chbr.2021.100076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
|
44
|
Broekstra R, Aris-Meijer J, Maeckelberghe E, Stolk R, Otten S. Demographic and prosocial intrapersonal characteristics of biobank participants and refusers: the findings of a survey in the Netherlands. Eur J Hum Genet 2021; 29:11-19. [PMID: 32737438 PMCID: PMC7852517 DOI: 10.1038/s41431-020-0701-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/03/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022] Open
Abstract
Research in genetics relies heavily on voluntary contributions of personal data. We aimed to acquire insights into the differences between participants and refusers of participation in a Dutch population-based biobank. Accordingly, we assessed the demographic and prosocial intrapersonal characteristics of respondents who participated (n = 2615) or refused to participate (n = 404) in the Lifelines biobank and databank. Our results indicated that health-related values critically influence participation decisions. The participation threshold for Lifelines was determined by an absence of health-related values and of trust in government. Therefore, considering these factors in communication and recruitment strategies could enhance participation in biomedical research. No indications were found of a stronger general prosociality of participants or their trust in researchers beyond the context of biobanking. This emphasizes the contextual understanding of the decision of participation in biobanking. Our findings may contribute to improving recruitment strategies by incorporating relevant values and/or highlighting prosocial benefits. Moreover, they foreground the need to address trust issues in collaborations between data repositories and commercial companies. Future research should explore how prosocial intrapersonal characteristics drive participation and withdrawal decisions and relate to contextual attributes.
Collapse
Affiliation(s)
- Reinder Broekstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of Social Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.
| | - Judith Aris-Meijer
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Els Maeckelberghe
- Wenckebach Institute for Medical Education and Training, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald Stolk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sabine Otten
- Department of Social Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
45
|
Sharing genomic data from clinical testing with researchers: public survey of expectations of clinical genomic data management in Queensland, Australia. BMC Med Ethics 2020; 21:119. [PMID: 33213438 PMCID: PMC7678081 DOI: 10.1186/s12910-020-00563-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/12/2020] [Indexed: 12/31/2022] Open
Abstract
Background There has been considerable investment and strategic planning to introduce genomic testing into Australia’s public health system. As more patients’ genomic data is being held by the public health system, there will be increased requests from researchers to access this data. It is important that public policy reflects public expectations for how genomic data that is generated from clinical tests is used. To inform public policy and discussions around genomic data sharing, we sought public opinions on using genomic data contained in medical records for research purposes in the Australian state of Queensland. Methods A total of 1494 participants completed an online questionnaire between February and May 2019. Participants were adults living in Australia. The questionnaire explored participant preferences for sharing genomic data or biological samples with researchers, and concerns about genomic data sharing. Results Most participants wanted to be given the choice to have their genomic data from medical records used in research. Their expectations on whether and how often they needed to be approached for permission on using their genomic data, depended on whether the data was identifiable or anonymous. Their willingness to sharing data for research purposes depended on the type of information being shared, what type of research would be undertaken and who would be doing the research. Participants were most concerned with genomics data sharing that could lead to discrimination (insurance and employment), data being used for marketing, data security, or commercial use. Conclusions Most participants were willing to share their genomic data from medical records with researchers, as long as permission for use was sought. However, the existing policies related to this process in Queensland do not reflect participant expectations for how this is achieved, particularly with anonymous genomics data. This inconsistency may be addressed by process changes, such as inclusion of research in addition to clinical consent or general research data consent programs.
Collapse
|
46
|
Strategic vision for improving human health at The Forefront of Genomics. Nature 2020; 586:683-692. [PMID: 33116284 DOI: 10.1038/s41586-020-2817-4] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022]
Abstract
Starting with the launch of the Human Genome Project three decades ago, and continuing after its completion in 2003, genomics has progressively come to have a central and catalytic role in basic and translational research. In addition, studies increasingly demonstrate how genomic information can be effectively used in clinical care. In the future, the anticipated advances in technology development, biological insights, and clinical applications (among others) will lead to more widespread integration of genomics into almost all areas of biomedical research, the adoption of genomics into mainstream medical and public-health practices, and an increasing relevance of genomics for everyday life. On behalf of the research community, the National Human Genome Research Institute recently completed a multi-year process of strategic engagement to identify future research priorities and opportunities in human genomics, with an emphasis on health applications. Here we describe the highest-priority elements envisioned for the cutting-edge of human genomics going forward-that is, at 'The Forefront of Genomics'.
Collapse
|
47
|
Middleton A, Milne R, Almarri MA, Anwer S, Atutornu J, Baranova EE, Bevan P, Cerezo M, Cong Y, Critchley C, Fernow J, Goodhand P, Hasan Q, Hibino A, Houeland G, Howard HC, Hussain SZ, Malmgren CI, Izhevskaya VL, Jędrzejak A, Jinhong C, Kimura M, Kleiderman E, Leach B, Liu K, Mascalzoni D, Mendes Á, Minari J, Wang N, Nicol D, Niemiec E, Patch C, Pollard J, Prainsack B, Rivière M, Robarts L, Roberts J, Romano V, Sheerah HA, Smith J, Soulier A, Steed C, Stefànsdóttir V, Tandre C, Thorogood A, Voigt TH, West AV, Yoshizawa G, Morley KI. Global Public Perceptions of Genomic Data Sharing: What Shapes the Willingness to Donate DNA and Health Data? Am J Hum Genet 2020; 107:743-752. [PMID: 32946764 PMCID: PMC7536612 DOI: 10.1016/j.ajhg.2020.08.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022] Open
Abstract
Analyzing genomic data across populations is central to understanding the role of genetic factors in health and disease. Successful data sharing relies on public support, which requires attention to whether people around the world are willing to donate their data that are then subsequently shared with others for research. However, studies of such public perceptions are geographically limited and do not enable comparison. This paper presents results from a very large public survey on attitudes toward genomic data sharing. Data from 36,268 individuals across 22 countries (gathered in 15 languages) are presented. In general, publics across the world do not appear to be aware of, nor familiar with, the concepts of DNA, genetics, and genomics. Willingness to donate one's DNA and health data for research is relatively low, and trust in the process of data's being shared with multiple users (e.g., doctors, researchers, governments) is also low. Participants were most willing to donate DNA or health information for research when the recipient was specified as a medical doctor and least willing to donate when the recipient was a for-profit researcher. Those who were familiar with genetics and who were trusting of the users asking for data were more likely to be willing to donate. However, less than half of participants trusted more than one potential user of data, although this varied across countries. Genetic information was not uniformly seen as different from other forms of health information, but there was an association between seeing genetic information as special in some way compared to other health data and increased willingness to donate. The global perspective provided by our "Your DNA, Your Say" study is valuable for informing the development of international policy and practice for sharing genomic data. It highlights that the research community not only needs to be worthy of trust by the public, but also urgent steps need to be taken to authentically communicate why genomic research is necessary and how data donation, and subsequent sharing, is integral to this.
Collapse
Affiliation(s)
- Anna Middleton
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Faculty of Education, University of Cambridge, Cambridge CB2 8PQ, UK.
| | - Richard Milne
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | | | | | - Jerome Atutornu
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Elena E Baranova
- Russian Medical Academy of Continuous Professional Education, Moscow 119049, Russia
| | - Paul Bevan
- Wellcome Sanger Institute, Cambridge CB10 1SA, UK
| | - Maria Cerezo
- EMBL-EBI, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Yali Cong
- Medical Ethics Program, Peking University Health Science Center, Beijing 100191, China
| | - Christine Critchley
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC 3122, Australia; Centre for Law and Genetics, University of Tasmania, Hobart, TAS 7001, Australia
| | - Josepine Fernow
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Peter Goodhand
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, ON M5G 0A3, Canada
| | - Qurratulain Hasan
- Department of Genetics & Molecular Medicine, Kamineni Hospitals, Hyderabad 500 068, India; SAAZ Genetics, Hyderabad 500033, India
| | - Aiko Hibino
- Faculty of Humanities and Social Sciences, Hirosaki University, Hirosaki 036-8560, Japan
| | - Gry Houeland
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Heidi C Howard
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden; Medical Ethics, Lund Universitet, Lund SE-221 00, Sweden
| | | | - Charlotta Ingvoldstad Malmgren
- Department of Public Health and Caring Science, Uppsala University, Uppsala 751 22, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna 171 76, Sweden
| | | | | | - Cao Jinhong
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China
| | - Megumi Kimura
- Institute of Innovation Research, Hitotsubashi University, Tokyo 186-8603, Japan
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada
| | | | - Keying Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Deborah Mascalzoni
- EURAC, Institute of Biomedicine, Bolzano 39100, Italy; Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Álvaro Mendes
- UnIGENe and CGPP (Centre for Predictive and Preventive Genetics), IBMC (Institute for Molecular and Cell Biology), i3S (Instituto de Investigação e Inovação em Saúde), Universidade do Porto, Porto 4200-135, Portugal
| | - Jusaku Minari
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto 606-8507, Japan
| | - Nan Wang
- Medical Ethics Program, Peking University Health Science Center, Beijing 100191, China
| | - Dianne Nicol
- Centre for Law and Genetics, University of Tasmania, Hobart, TAS 7001, Australia
| | - Emilia Niemiec
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Christine Patch
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK; Genomics England, Queen Mary University of London, London EC1M 6BQ, UK
| | | | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna 1010, Austria; Department of Global Health & Social Medicine, King's College London, London WC2R 2LS, UK
| | | | - Lauren Robarts
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Jonathan Roberts
- Society and Ethics Research Group, Connecting Science, Wellcome Genome Campus, Cambridge CB10 1SA, UK
| | - Virginia Romano
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden; EURAC, Institute of Biomedicine, Bolzano 39100, Italy
| | - Haytham A Sheerah
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - James Smith
- Wellcome Sanger Institute, Cambridge CB10 1SA, UK
| | - Alexandra Soulier
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Claire Steed
- Wellcome Sanger Institute, Cambridge CB10 1SA, UK
| | - Vigdís Stefànsdóttir
- Landspitali, the National University Hospital of Iceland, Reykjavík 101, Iceland
| | - Cornelia Tandre
- Centre for Ethics & Bioethics, Uppsala University, Uppsala SE-751 22, Sweden
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada
| | - Torsten H Voigt
- Institute of Sociology, RWTH Aachen University, Aachen 52062, Germany
| | - Anne V West
- Indiana University Maurer School of Law, Bloomington, IN 47405, USA
| | - Go Yoshizawa
- Work Research Institute (AFI), Oslo Metropolitan University, Oslo 0130, Norway
| | - Katherine I Morley
- RAND Europe, Cambridge CB4 1YG, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| |
Collapse
|
48
|
The Skeleton in the Closet: Faults and Strengths of Public Versus Private Genetic Biobanks. Biomolecules 2020; 10:biom10091273. [PMID: 32899386 PMCID: PMC7564942 DOI: 10.3390/biom10091273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 01/30/2023] Open
Abstract
Direct-to-consumer (DTC) genetic testing has been a major ethical controversy related to clinical utility, the availability of pre- and post-genetic counseling, privacy concerns, and the risk of discrimination and stigmatization. The development of direct-to-consumer genetic testing cannot leave aside some considerations on how the samples are managed once the analyses have been completed and the customer has received a response. The possibility that these samples are maintained by the structure for future research uses, explains the definition, which has been proposed in the literature, of these structures such as private genetic biobanks. The most relevant aspects that may impact ethical aspects, allowing a comparison between the public and private dimensions of genetic biobanks, are mainly transparency and participant/donor trust. The article aims to analyze the main line of ethical debate related to the mentioned practices and to explore whether market-based and consumer rights regarding DTC genetic testing can be counterbalanced by healthcare system developments based on policies that encourage the donation of samples in the context of public biobanks. A platform for dialogue, both technical–scientific and ethical, is indispensable between the public sector, the private sector and citizens to truly maximize both transparency and public trust in both contexts.
Collapse
|
49
|
Paprica PA, Sutherland E, Smith A, Brudno M, Cartagena RG, Crichlow M, Courtney BK, Loken C, McGrail KM, Ryan A, Schull MJ, Thorogood A, Virtanen C, Yang K. Essential requirements for establishing and operating data trusts: practical guidance co-developed by representatives from fifteen canadian organizations and initiatives. Int J Popul Data Sci 2020; 5:1353. [PMID: 33644412 PMCID: PMC7894384 DOI: 10.23889/ijpds.v5i1.1353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Increasingly, the label "data trust" is being applied to repeatable mechanisms or approaches to sharing data in a timely, fair, safe, and equitable way. However, there is an absence of practical guidance regarding how to establish and operate a data trust. AIM AND APPROACH In December 2019, the Canadian Institute for Health Information and the Vector Institute for Artificial Intelligence convened a working meeting of 19 people representing 15 Canadian organizations/initiatives involved in data sharing, most of which focus on public sector health data. The objective was to identify essential requirements for the establishment and operation of data trusts in the Canadian context. Preliminary requirements were discussed during the meeting and then refined as authors contributed to this manuscript. RESULTS Twelve minimum specification requirements ("min specs") for data trusts were identified. The foundational min spec is that data trusts must meet all legal requirements, including legal authority to collect, hold or share data. In addition, there was agreement that data trusts must have (i) an accountable governing body to ensure that the data trust achieves its stated purpose and is transparent, (ii) comprehensive data management including clear processes and qualified individuals responsible for the collection, storage, access, disclosure and use of data, (iii) training and accountability requirements for all data users and (iv) ongoing public and stakeholder engagement. CONCLUSIONS Practical guidance for the establishment and operation of data trusts was articulated in the form of 12 min specs requirements. The 12 min specs are a starting point. Future work to refine and strengthen them with members of the public, companies, and additional research data stakeholders from within and outside of Canada, is recommended.
Collapse
Affiliation(s)
- P. Alison Paprica
- University of Toronto, Institute of Health Policy, Management and Evaluation, 155 College Street, Toronto, ON, M5T 3M6, Canada
- Vector Institute, Suite 710, 661 University Ave, Toronto, ON, M5G 1M1, Canada
- Health Data Research Network Canada, 01-2206 East Mall, Vancouver BC, V6T 1Z3, Canada
- ICES, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Eric Sutherland
- Canadian Institute for Health Information, Suite 600, 495 Richmond Road, Ottawa, ON, K2A 4H6, Canada
| | - Andrea Smith
- Vector Institute, Suite 710, 661 University Ave, Toronto, ON, M5G 1M1, Canada
| | - Michael Brudno
- HPC4Health, 686 Bay St. Toronto, ON, M5G 0A4, Canada
- University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada
- Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- University of Toronto, Department of Computer Science, 214 College St, Toronto, ON, M5T 3A1, Canada
| | | | - Monique Crichlow
- Compute Ontario, Suite 1140, 661 University Avenue, Toronto, ON, M5G 1M1, Canada
| | - Brian K. Courtney
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Chris Loken
- Compute Ontario, Suite 1140, 661 University Avenue, Toronto, ON, M5G 1M1, Canada
| | - Kimberlyn M. McGrail
- Population Data BC, University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- UBC Centre for Health Services and Policy Research, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
- University of British Columbia, Faculty of Medicine, School of Population and Public Health, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alex Ryan
- MaRS Discovery District MaRS Centre, South Tower 101 College Street, Suite 100 Toronto, ON, M5G 1L7, Canada
| | - Michael J. Schull
- Health Data Research Network Canada, 01-2206 East Mall, Vancouver BC, V6T 1Z3, Canada
- ICES, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Adrian Thorogood
- McGill University, Centre of Genomics and Policy, Suite 5200, 740, avenue Dr. Penfield, Montreal, QC, H3A 0G1, Canada
- Global Alliance for Genomics and Health, MaRS Centre, West Tower, Suite 510, 661 University Avenue, Toronto, ON, M5G 0A3, Canada
| | - Carl Virtanen
- HPC4Health, 686 Bay St. Toronto, ON, M5G 0A4, Canada
- University Health Network, 190 Elizabeth St., Toronto, ON, M5G 2C4, Canada
| | - Kathleen Yang
- Canadian Institute for Health Information, Suite 600, 495 Richmond Road, Ottawa, ON, K2A 4H6, Canada
| |
Collapse
|
50
|
Broekstra R, Maeckelberghe ELM, Aris-Meijer JL, Stolk RP, Otten S. Motives of contributing personal data for health research: (non-)participation in a Dutch biobank. BMC Med Ethics 2020; 21:62. [PMID: 32711531 PMCID: PMC7382031 DOI: 10.1186/s12910-020-00504-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/14/2020] [Indexed: 01/13/2023] Open
Abstract
Background Large-scale, centralized data repositories are playing a critical and unprecedented role in fostering innovative health research, leading to new opportunities as well as dilemmas for the medical sciences. Uncovering the reasons as to why citizens do or do not contribute to such repositories, for example, to population-based biobanks, is therefore crucial. We investigated and compared the views of existing participants and non-participants on contributing to large-scale, centralized health research data repositories with those of ex-participants regarding the decision to end their participation. This comparison could yield new insights into motives of participation and non-participation, in particular the behavioural change of withdrawal. Methods We conducted 36 in-depth interviews with ex-participants, participants, and non-participants of a three-generation, population-based biobank in the Netherlands. The interviews focused on the respondents’ decision-making processes relating to their participation in a large-scale, centralized repository for health research data. Results The decision of participants and non-participants to contribute to the biobank was motivated by a desire to help others. Whereas participants perceived only benefits relating to their participation and were unconcerned about potential risks, non-participants and ex-participants raised concerns about the threat of large-scale, centralized public data repositories and public institutes, such as social exclusion or commercialization. Our analysis of ex-participants’ perceptions suggests that intrapersonal characteristics, such as levels of trust in society, participation conceived as a social norm, and basic societal values account for differences between participants and non-participants. Conclusions Our findings indicate the fluidity of motives centring on helping others in decisions to participate in large-scale, centralized health research data repositories. Efforts to improve participation should focus on enhancing the trustworthiness of such data repositories and developing layered strategies for communication with participants and with the public. Accordingly, personalized approaches for recruiting participants and transmitting information along with appropriate regulatory frameworks are required, which have important implications for current data management and informed consent procedures.
Collapse
Affiliation(s)
- R Broekstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, FA 40, 9700, RB, Groningen, The Netherlands. .,Department of Social Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.
| | - E L M Maeckelberghe
- University Medical Center Groningen, Institute for Medical Education, University of Groningen, Groningen, The Netherlands
| | - J L Aris-Meijer
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, FA 40, 9700, RB, Groningen, The Netherlands
| | - R P Stolk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, FA 40, 9700, RB, Groningen, The Netherlands
| | - S Otten
- Department of Social Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|