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Papadopoulos K, Struckmann V, von Wyl V, Gille F. Citizen Views on an Opt-Out Approach to National Electronic Health Records in Germany: A Small-Scale Qualitative Study. Int J Public Health 2024; 69:1607288. [PMID: 39022444 PMCID: PMC11251894 DOI: 10.3389/ijph.2024.1607288] [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: 03/18/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives Electronic health records (German: elektronische Patientenakte - ePA) are an important healthcare tool. However, in Germany, current participation remains low for their national ePA. To rectify this, the German government recently adopted an opt-out approach to their national ePA system. The objective of this study is to investigate and provide a brief overview of German public attitudes towards this approach to inform policymakers with evidence-based insights. Methods Four public focus groups were conducted with 12 German citizens to discuss their opinions on the German governments new opt-out approach to the ePA. Results Three major thematic categories were identified (Contributors to Opt-Out Implementation, Barriers to Opt-Out Implementation, and Contingent Factors) to describe citizen views on the opt-out approach for the ePA. Conclusion The public is generally supportive of an opt-out approach to ePAs in Germany, as they see the benefits ePAs can provide to German society; but they are skeptical on how successful this approach might be due to extant issues that policymakers must be aware of in order to successfully implement an opt-out approach for Germany's national ePA system.
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Affiliation(s)
- Kimon Papadopoulos
- Digital Society Initiative (DSI) and Institute for Implementation Science in Healthcare, University of Zurich, Zürich, Switzerland
| | | | - Viktor von Wyl
- Digital Society Initiative (DSI) and Institute for Implementation Science in Healthcare, University of Zurich, Zürich, Switzerland
| | - Felix Gille
- Digital Society Initiative (DSI) and Institute for Implementation Science in Healthcare, University of Zurich, Zürich, Switzerland
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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.
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Afraz A, Montazeri M, Shahrbabaki ME, Ahmadian L, Jahani Y. The viewpoints of parents of children with mental disorders regarding the confidentiality and security of their children's information in the Iranian national electronic health record system. Int J Med Inform 2024; 183:105334. [PMID: 38218129 DOI: 10.1016/j.ijmedinf.2023.105334] [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: 09/30/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Electronic health records help collect and communicate patient information among healthcare providers. The confidentiality of information, especially for patients with mental disorders, is paramount due to its profound impacts on individuals' lives' social and personal aspects. This study aimed to investigate the viewpoints and concerns of parents of children with mental disorders regarding the confidentiality and security of their children's information in the Iranian National Electronic Health Record System (IEHRS). METHODS This is a survey study on parents or guardians of children with mental disorders who visited Kerman's specialised child psychiatry treatment centres. The data collection tool was a researcher-made questionnaire with 28 questions organised in seven sections, including demographic information of parents, children's medical history, Internet use, knowledge about IEHRS, the necessity of data collection, IEHRS security concerns, and privacy concerns. The data were analysed in SPSS 24 software using descriptive statistics and logistic and ordinal regressions to assess the relationship between parents' demographic characteristics and their viewpoints regarding information security and confidentiality concerns. RESULTS The results showed that more than 85 % of the parents believed that the security of their children's information in IEHRS was moderate to high. More than two-thirds (71 %) of the parents also believed that IEHRS should tighten its privacy policies. Most participants (87 %) were concerned about their children's information security in IEHRS. In this study, the parents' concerns about the privacy and security of information in IEHRS were not significantly associated with their age, gender, or knowledge about IEHRS. CONCLUSIONS Most parents of children with mental disorders were concerned about the security and confidentiality of their children's information in IEHRS. Thus, health policymakers should maintain a high level of security and establish appropriate privacy and confidentiality rules in IEHRS. In addition, they should be transparent about the system's security mechanisms and confidentiality regulations to win public trust.
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Affiliation(s)
- Ali Afraz
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahdieh Montazeri
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahin Eslami Shahrbabaki
- Neuroscience Research Center, Department of Psychiatry, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.
| | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Papadopoulos K, von Wyl V, Gille F. What is public trust in national electronic health record systems? A scoping review of qualitative research studies from 1995 to 2021. Digit Health 2024; 10:20552076241228024. [PMID: 38288130 PMCID: PMC10823845 DOI: 10.1177/20552076241228024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024] Open
Abstract
Objective Public trust in national electronic health record systems is essential for the successful implementation within a healthcare system. Research investigating public trust in electronic health records is limited, leading to a lack of conceptual clarity. In response, the objective of this study is to gain a clearer understanding on the conceptualizations of public trust in electronic health records, which can support the implementation of national electronic health record systems. Methods Guided by the PRISMA-ScR checklist, a scoping review of 27 qualitative studies on public trust in electronic health records found between January 2022 and June 2022 was conducted using an inclusive search method. In an iterative process, conceptual themes were derived describing the promoters and outcomes of public trust in electronic health records. Results Five major conceptual themes with 15 sub-themes were present across the literature. Comprehension, autonomy, and data protection promote public trust in electronic health record; while personal and system benefits are the outcomes once public trust in electronic health records exists. Additional findings highlight the pivotal role of healthcare actors for the public trust building process. Conclusions The results underscore comprehension, autonomy, and data protection as important themes that help ascertain and solidify public trust in electronic health records. As well, health system actors have the capacity to promote or hinder national electronic health record implementation, depending on their actions and how the public perceives those actions. The findings can assist researchers, policymakers, and other health system actors in attaining a better understanding of the intricacies of public trust in electronic health records.
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Affiliation(s)
- Kimon Papadopoulos
- Digital Society Initiative (DSI), University of Zürich, Zurich, Switzerland
- Institute for Implementation Science in Health Care (IfIS), University of Zürich, Zurich, Switzerland
| | - Viktor von Wyl
- Digital Society Initiative (DSI), University of Zürich, Zurich, Switzerland
- Institute for Implementation Science in Health Care (IfIS), University of Zürich, Zurich, Switzerland
| | - Felix Gille
- Digital Society Initiative (DSI), University of Zürich, Zurich, Switzerland
- Institute for Implementation Science in Health Care (IfIS), University of Zürich, Zurich, Switzerland
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5
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McCormick JB, Hopkins M, Lehman EB, Green MJ. Mining the Data: Exploring Rural Patients' Attitudes about the Use of Their Personal Information in Research. AJOB Empir Bioeth 2022; 13:89-106. [PMID: 35271430 PMCID: PMC10038193 DOI: 10.1080/23294515.2022.2040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study examines rural patients' perceived importance of knowing or being consulted about researchers' access and use of their personal data (identifiable and de-identified health information, and identifiable and de-identified non-health information) across five scenarios. This study also examines their views on stewardship or governance of their personal information by researchers in their healthcare systems. METHODS We conducted a survey by mail. Data were analyzed using descriptive statistics. Multivariable regression analyses were conducted across each scenario and type of personal data with the same variables included in each model. RESULTS The majority of participants said it was "very important/absolutely essential" to know the purpose of the study, to be asked every time, and to know the policies governing researcher access and use of their identifiable health information. Just over two-thirds of respondents thought it "very important/absolutely essential" to know who serves on the data governance committee and to have a community member serve. Distrust in healthcare organizations was positively correlated with the scenarios while willingness to give permission to donate leftover biological specimens was negatively correlated. CONCLUSION Our study findings indicate that the type of personal information being accessed and used generally matters to 1,407 patients living in rural Pennsylvania. We also demonstrate that knowing their healthcare organizations' governance policies and practices for managing their personal data is important to many rural Pennsylvania patients. Biomedical researchers need to recognize and attend to those differences as much as possible in order to expand opportunities for and participation in research by residents of these rural communities. Supplemental data for this article is available online at.
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Affiliation(s)
- Jennifer B McCormick
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Margaret Hopkins
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Jordanian views regarding sharing of medical data for research: A cross-sectional study during COVID-19 pandemic. PLoS One 2022; 17:e0265695. [PMID: 35312726 PMCID: PMC8936458 DOI: 10.1371/journal.pone.0265695] [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] [Received: 01/01/2022] [Accepted: 03/06/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In the current study, the views of Jordanian regarding sharing medical reports for research purposes were investigated during the COVID-19 pandemic. In addition, motivators and barriers regarding sharing of medical records were examined. METHODS This observational survey-based cross-sectional study was conducted using an electronic questionnaire during the COVID-19 pandemic (second half of 2020). The questionnaire link was disseminated through two social media platforms (WhatsApp and Facebook), targeting Jordanian adults (age >18 years). RESULTS In this study, 1,194 participants agreed to complete the study survey. Results showed that 58.3% of them (n = 696) reported to be willing to share their medical data. while 17.6% of the participants (n = 210) showed hesitancy to share their medical information. The most important motivators as perceived by the study participants were helping other patients who have similar health conditions (n = 995, 83.3%). Moreover, fearing from stigma (n = 753, 63.1%), and the lack of confidence in data security and privacy (n = 728, 61.0%) were among the main barriers preventing participants from sharing their information. Finally, results showed that participants with higher educational level (bachelor or higher) (OR = 0.299, P<0.001), or those living in center of Jordan (OR = 0.270, P<0.001) showed a lower tendency to share their medical data. While participants those who have shared data before showed a higher tendency to share their medical data (OR = 2.524, P<0.001). CONCLUSION In this study, many of the participants had a positive attitude towards sharing biomedical data for scientific research during the COVID-19 pandemic, many had doubts in the control over their data. Thus, policymakers and data users should address the concerns and values of patients and understand their preferences in favor of an ethically scrupulous use of data in research.
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Piasecki J, Walkiewicz-Żarek E, Figas-Skrzypulec J, Kordecka A, Dranseika V. Ethical issues in biomedical research using electronic health records: a systematic review. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:633-658. [PMID: 34146228 PMCID: PMC8214390 DOI: 10.1007/s11019-021-10031-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 05/14/2023]
Abstract
Digitization of a health record changes its accessibility. An electronic health record (EHR) can be accessed by multiple authorized users. Health information from EHRs contributes to learning healthcare systems' development. The objective of this systematic review is to answer a question: What are ethical issues concerning research using EHRs in the literature? We searched Medline Ovid, Embase and Scopus for publications concerning ethical issues of research use of EHRs. We employed the constant comparative method to retrieve common ethical themes. We descriptively summarized empirical studies. The study reveals the breadth, depth, and complexity of ethical problems associated with research use of EHRs. The central ethical question that emerges from the review is how to manage access to EHRs. Managing accessibility consists of interconnected and overlapping issues: streamlining research access to EHRs, minimizing risk, engaging and educating patients, as well as ensuring trustworthy governance of EHR data. Most of the ethical problems concerning EHR-based research arise from rapid cultural change. The framing of concepts of privacy, as well as individual and public dimensions of beneficence, are changing. We are currently living in the middle of this transition period. Human emotions and mental habits, as well as laws, are lagging behind technological developments. In the medical tradition, individual patient's health has always been in the center. Transformation of healthcare care, its digitalization, seems to have some impacts on our perspective of health care ethics, research ethics and public health ethics.
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Affiliation(s)
- Jan Piasecki
- Department of Philosophy and Bioethics, Faculty of Health Sciences, Medical College, Jagiellonian University, Michalowskiego 12, 31-126, Krakow, Poland.
| | | | | | - Anna Kordecka
- HTA Registry Sp. z o.o. Sp. K, Herzoga 15, 30-252, Krakow, Poland
| | - Vilius Dranseika
- Department of Philosophy and Bioethics, Faculty of Health Sciences, Medical College, Jagiellonian University, Michalowskiego 12, 31-126, Krakow, Poland
- Institute of Philosophy, Vilnius University, 9/1 Universiteto, 01513, Vilnius, Lithuania
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Wendler D. The Ethics of Mandatory Retention of Clinical Biospecimens for Research. J Gen Intern Med 2021; 36:2818-2819. [PMID: 33501544 PMCID: PMC8390568 DOI: 10.1007/s11606-020-06468-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Affiliation(s)
- David Wendler
- Section on Research Ethics, Department of Bioethics, National Institutes of Health, Bethesda, MD, USA.
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Jackson BR, Ye Y, Crawford JM, Becich MJ, Roy S, Botkin JR, de Baca ME, Pantanowitz L. The Ethics of Artificial Intelligence in Pathology and Laboratory Medicine: Principles and Practice. Acad Pathol 2021; 8:2374289521990784. [PMID: 33644301 PMCID: PMC7894680 DOI: 10.1177/2374289521990784] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022] Open
Abstract
Growing numbers of artificial intelligence applications are being developed and applied to pathology and laboratory medicine. These technologies introduce risks and benefits that must be assessed and managed through the lens of ethics. This article describes how long-standing principles of medical and scientific ethics can be applied to artificial intelligence using examples from pathology and laboratory medicine.
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Affiliation(s)
- Brian R. Jackson
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, UT, USA
| | - Ye Ye
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael J. Becich
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Somak Roy
- Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey R. Botkin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Pritchard AE, Zabel TA, Jacobson LA, Jones E, Holingue C, Kalb LG. Caregiver Perspectives on Informed Consent for a Pediatric Learning Healthcare System Model of Care. AJOB Empir Bioeth 2020; 12:92-100. [PMID: 33104494 DOI: 10.1080/23294515.2020.1836066] [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: 10/23/2022]
Abstract
BACKGROUND Data is needed to provide insight into the issue of preference around consent for use of pediatric clinical data for research. This study evaluated caregivers' preferences concerning use of their child's clinical information. METHODS Caregivers of children (n = 101; response rate 81.5% of n = 124) presenting for psychological evaluation at an urban medical center viewed a video regarding how the information contained in their child's medical record could be used for research. RESULTS An anonymous survey following the video indicated that: 1) >90% of caregivers felt comfortable with their child's information being used; 2) >90% of caregivers felt their child's privacy would be adequately protected; 3) 98% of caregivers reported themselves to be as or more likely to return to the institution after viewing the video; 4) 60% of caregivers felt no additional consent procedures beyond viewing the video were needed, while 20% preferred an opt-out and 20% preferred a traditional consent procedure. Caregiver demographic variables were largely unrelated to consent preferences. DISCUSSION Overall, caregivers reported strong support for use of their child's clinical data for research purposes.
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Affiliation(s)
- A E Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - T A Zabel
- Clinical Research and Quality Improvement, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - L A Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - E Jones
- Research Operations, Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - C Holingue
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - L G Kalb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hammack-Aviran CM, Brelsford KM, McKenna KC, Graham RD, Lampron ZM, Beskow LM. Research Use of Electronic Health Records: Patients' Views on Alternative Approaches to Permission. AJOB Empir Bioeth 2020; 11:172-186. [PMID: 32338567 DOI: 10.1080/23294515.2020.1755383] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: The increased use of electronic health records (EHRs) has resulted in new opportunities for research, but also raises concerns regarding privacy, confidentiality, and patient awareness. Because public trust is essential to the success of the research enterprise, patient perspectives are essential to the development and implementation of ethical approaches to the research use of EHRs. Yet, little is known about patients' views and expectations regarding various approaches to seeking permission for research use of their EHR data. Methods: We conducted semi-structured interviews with 120 patients in four counties in diverse regions of the southeastern United States: Appalachia, the Mississippi Delta, and the Piedmont area of North Carolina. We asked participants to consider, from multiple stakeholder perspectives, the advantages and disadvantages of three approaches to notifying patients of, or obtaining permission for, research use of their EHR data; whether they believed it would be acceptable if their healthcare organization used each approach; and which approach would be most appropriate. Results: Nearly all participants said General Notification, Broad Permission, and Categorical Permission would each be acceptable approaches to notification of, or permission for, EHR research. Over half identified Broad Permission as the most appropriate approach. Across all of these discussions, major themes included the importance of clarity, simplicity, and usability of patient-facing materials, as well as the level of transparency, trustworthiness, and respect for patients the approach conveys. Conclusions: Our findings help to inform the development and implementation of ethical approaches to the research use of EHRs by identifying key patient considerations regarding various approaches to permission and suggesting potential actions for healthcare organizations and researchers.
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Affiliation(s)
- Catherine M Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen M Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin C McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ross D Graham
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zachary M Lampron
- Department of Pragmatic Health Systems Research, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Cardillo L, Cahill F, Wylie H, Williams A, Zylstra J, Davies A, Fullwood L, Van Hemelrijck M. Patients' perspectives on opt-out consent for observational research: systematic review and focus group. ACTA ACUST UNITED AC 2019; 27:1321-1329. [PMID: 30525978 DOI: 10.12968/bjon.2018.27.22.1321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: observational research is increasingly important in clinical decision-making. Opt-out consent has been proposed as a more practical way to obtain participants' consent for such research. The authors evaluated patients' views on opt-out consent for observational research by identifying perceived benefits and barriers. METHODS: following a systematic literature review of research on participants' perspectives on opt-out consent, a focus group interview was conducted with oncological patients and their family members. RESULTS: the review identified 13 articles detailing perspectives on opt-out consent. Perceived advantages included benefitting medicine and future generations. These findings were confirmed in the focus group. The main reported barriers to opt-out consent are concerns regarding privacy and the sharing of data with third parties. Participants also demonstrated concerns on insufficient education on opt-out consent. CONCLUSION: participants demonstrated willingness to participate in observational studies utilising opt-out consent. Special focus should be placed on outlining existing safeguards in research.
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Affiliation(s)
- Luca Cardillo
- Medical Student, King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research
| | - Fidelma Cahill
- Research Nurse, King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research
| | - Harriet Wylie
- Clinical Trial Coordinator, King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research
| | - Ambi Williams
- Research Manager, King's College London, School of Cancer and Pharmaceutical Sciences
| | - Janine Zylstra
- Clinical Research Manager, Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London
| | - Andrew Davies
- Consultant oesophagogastric and general surgeon, Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London
| | | | - Mieke Van Hemelrijck
- Reader in Cancer Epidemiology, King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research
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13
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Stockdale J, Cassell J, Ford E. "Giving something back": A systematic review and ethical enquiry into public views on the use of patient data for research in the United Kingdom and the Republic of Ireland. Wellcome Open Res 2019; 3:6. [PMID: 30854470 PMCID: PMC6402072 DOI: 10.12688/wellcomeopenres.13531.2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Use of patients' medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public views of patient data used in research, critically analysing such views though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform ethical and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a framework analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share patient data for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns about the potential risks to their privacy. The first of these concerns related to a party's competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which decision makers should address when evaluating proposals for the secondary use of data.
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Affiliation(s)
- Jessica Stockdale
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Department of Philosophy, School of History, Art History and Philosophy, University of Sussex, Brighton, UK
| | - Jackie Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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14
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Rothwell E, Botkin JR, Cheek-O'Donnell S, Wong B, Case GA, Johnson E, Matheson T, Wilson A, Robinson NR, Rawlings J, Horejsi B, Lopez AM, Byington CL. An empirical assessment of the short-term impacts of a reading of Deborah Zoe Laufer's drama Informed Consent on attitudes and intentions to participate in genetic research. AJOB Empir Bioeth 2018; 9:69-76. [PMID: 29513089 PMCID: PMC6092928 DOI: 10.1080/23294515.2018.1449771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study assessed the short-term impact of the play "Informed Consent" by Deborah Zoe Laufer (a fictionalized look at the controversy over specimens collected from the Havasupai Tribe for diabetes research in 1989) on perceptions of trust, willingness to donate biospecimens, and attitudes toward harm and privacy among the medical and undergraduate students, faculty, and the public in the Intermountain West. METHODS Surveys were administered before and after a staged reading of the play by professional actors. Survey items included the short form Trust in Medical Researchers, and single-item questions about group identity, ethics of genetic testing in children, and willingness to donate biospecimens. In addition, respondents were given the option to answer open-ended questions through e-mail. RESULTS Out of the 481 who attended the play, 421 completed both the pre and post surveys, and 166 participants completed open-ended questions online approximately 1 week after the play. Across all participants, there were significant declines for trust in medical researchers and for the survey item "is it ethical for investigators to test children for adult onset diseases" (p < .001 for both) following the play. There was a significant increase in agreement to improve group identity protections (p < .001) and there were no differences on willingness to donate biospecimens to research (p = .777). Qualitative data provided extensive contextual data supporting these perspectives. DISCUSSION This is one of the first studies to document short-term impacts of a theatrical performance on both attitudes and behavioral intentions toward research ethics and clinical research participation. Future research should continue to explore the impact of theatrical performances among public and investigators on the ethical issues and complexities in clinical research.
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Affiliation(s)
| | | | | | - Bob Wong
- a University of Utah , Salt Lake City , Utah , USA
| | | | - Erin Johnson
- a University of Utah , Salt Lake City , Utah , USA
| | | | - Alena Wilson
- a University of Utah , Salt Lake City , Utah , USA
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15
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Gehlert S, Mozersky J. Seeing Beyond the Margins: Challenges to Informed Inclusion of Vulnerable Populations in Research. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2018; 46:30-43. [PMID: 30093794 PMCID: PMC6077979 DOI: 10.1177/1073110518766006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although the importance of including vulnerable populations in medical research is widely accepted, identifying how to achieve such inclusion remains a challenge. Ensuring that the language of informed consent is comprehensible to this group is no less of a challenge. Although a variety of interventions show promise for increasing the comprehensibility of informed consent and increasing a climate of exchange, consensus is lacking on which interventions should be used in which situations and current regulations provide little guidance. We argue that the notion of individual autonomy — a foundational principle of informed consent — may be too narrow for some vulnerable populations by virtue of its failure to acknowledge their unique histories and current circumstances. It has a different meaning for members of structured groups like American Indians than for unstructured groups, such as African Americans, whose complicated histories foster group identity. Ensuring broad participation in research and selecting appropriate methods for obtaining informed consent — namely, methods aligned with the source of vulnerability and level of risk — require new ways of thinking that might produce guidelines for matching informed consent models and processes with subpopulations.
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Affiliation(s)
- Sarah Gehlert
- Sarah Gehlert, Ph.D., is the E. Desmond Lee Professor of Racial and Ethnic Diversity at Washington University in St. Louis. She holds an M.A. in Anthropology and an M.S.W. from the University of Missouri-Columbia and a Ph.D. in Social Work from Washington University (St. Louis). Jessica Mozersky, Ph.D., is an Assistant Professor at Washington University in St. Louis. She holds an M.B.E. from the University of Pennsylvania and a Ph.D. in Anthropology from University College London's Interdisciplinary Institute for Human Genetics and Health
| | - Jessica Mozersky
- Sarah Gehlert, Ph.D., is the E. Desmond Lee Professor of Racial and Ethnic Diversity at Washington University in St. Louis. She holds an M.A. in Anthropology and an M.S.W. from the University of Missouri-Columbia and a Ph.D. in Social Work from Washington University (St. Louis). Jessica Mozersky, Ph.D., is an Assistant Professor at Washington University in St. Louis. She holds an M.B.E. from the University of Pennsylvania and a Ph.D. in Anthropology from University College London's Interdisciplinary Institute for Human Genetics and Health
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16
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Vermeulen E, Rebers S, Aaronson NK, Brandenburg AP, van Leeuwen FE, Schmidt MK. Patients' Attitudes Towards the Return of Incidental Findings After Research with Residual Tissue: A Mixed Methods Study. Genet Test Mol Biomarkers 2018; 22:178-186. [PMID: 29461872 DOI: 10.1089/gtmb.2017.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS To investigate the attitudes of patients toward the return of individual research results from scientific research with residual tissue. METHODS AND FINDINGS We recruited 1319 patients from 6 Dutch hospitals. In total, 673 patients (51% response rate) completed the questionnaire and 146 were interviewed. Based on the questionnaire data, the majority of respondents (92%) wanted to be informed of incidental findings about both a curable (92%) and an incurable (76%) disease. Respondents' wishes to be informed about incidental findings did not vary significantly as a function of patient demographics or type of disease. The interview data show that respondents wished to be informed about incidental findings because they considered it to be normal practice; they expected the information to be of benefit for their health. Information should be provided by their physician. Yet, most respondents (84%) would consent to research even if they would not be informed about incidental findings, primarily because they recognized that there might be practical problems in providing such information, and because they valued scientific research highly. CONCLUSIONS We conclude that, while the majority of patients want to be informed about incidental findings, they also recognize that this may be difficult.
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Affiliation(s)
- Eric Vermeulen
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,2 VSOP, Dutch Alliance for Rare and Genetic Diseases, Soest, the Netherlands
| | - Susanne Rebers
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,3 Division of Molecular Pathology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
| | - Neil K Aaronson
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
| | - Alexander P Brandenburg
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,4 KWF-Dutch Cancer Society , Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
| | - Marjanka K Schmidt
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,3 Division of Molecular Pathology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
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Stockdale J, Cassell J, Ford E. "Giving something back": A systematic review and ethical enquiry of public opinions on the use of patient data for research in the United Kingdom and the Republic of Ireland. Wellcome Open Res 2018; 3:6. [PMID: 30854470 PMCID: PMC6402072 DOI: 10.12688/wellcomeopenres.13531.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Use of medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public opinion and understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public opinions of medical data use in research, critically analysing such opinions though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform ethical and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the wider public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a Framework Analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share EHRs for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns through a variety of hypothetical examples. The first of these concerns related to a party's competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which data guardians should address when evaluating proposals for the secondary use of data.
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Affiliation(s)
- Jessica Stockdale
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Department of Philosophy, School of History, Art History and Philosophy, University of Sussex, Brighton, UK
| | - Jackie Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
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18
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Botkin JR. Transparency and choice in learning healthcare systems. Learn Health Syst 2018; 2:e10049. [PMID: 31245576 PMCID: PMC6508837 DOI: 10.1002/lrh2.10049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/18/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022] Open
Abstract
Learning healthcare systems rely on potentially sensitive data and biospecimens from patients who typically have no knowledge of secondary uses of these resources for research. While this failure to inform patients of these practices is consistent with human subject regulations for research, these practices risk controversy and a loss of trust in the integrity of healthcare institutions. This article reviews recent controversies in this domain and argues for new institutional practices that entail patient education about secondary uses of data and biospecimens and the opportunity for patient choice in the form of an opt-out system. This approach would enhance transparency and reduce the risk of a loss of public trust in the research enterprise.
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Public and physician's expectations and ethical concerns about electronic health record: Benefits outweigh risks except for information security. Int J Med Inform 2017; 110:98-107. [PMID: 29331259 DOI: 10.1016/j.ijmedinf.2017.12.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Electronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. OBJECTIVES To record public and physicians' awareness, expectations for, and ethical concerns about the use of EHRs. METHODS A convenience sample was surveyed for both the public and physicians. The Public's Questionnaire was distributed to the public in a printed and an online version. The Physicians' Questionnaire was distributed to physicians in an online version. The questionnaires requested demographic characteristics followed by close-ended questions enquiring about awareness, perceived impact, perceived risks, and ethical issues raised by EHR use. RESULTS In total, 46% of the public and 91% of physicians were aware of EHRs. Physicians' and public opinions were comparable concerning the positive impact of EHRs on better, more effective, and faster decisions on the patients' health, on better coordination between hospitals/clinics and on quality and reduced cost of health care. However, physicians were concerned that an EHR system would be a burden for their finances, for their time concerning training on the system, for their everyday workload and workflow. The majority of the public generally agreed that they would worry about the possibility that a non-authorized, third party might gain access to their personal health information (48.8%), and that they would worry about future discriminations due to possible disclosure of their health information (48.8%). Most physicians disagreed that EHRs will disrupt the doctor-patient relationship (58.1%) but they would worry about the safety of their patients' information (53.1%). Overall, both the public and physicians were in favor of the implementation of an EHR system, evaluating that possible benefits are more important than possible risks. The majority of the public believed that physicians should have full access to an EHR (90.9%), whereas nursing staff, pharmacists, laboratory staff, and other healthcare professional should have partial access. CONCLUSIONS The factors identified in the present study present actionable insights that may increase awareness about EHRs. The survey illustrates that both the public and physicians acknowledge the benefits and support EHRs on the condition that sufficient guarantees are provided about privacy and security.
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Rothwell E, Goldenberg A, Johnson E, Riches N, Tarini B, Botkin JR. An Assessment of a Shortened Consent Form for the Storage and Research Use of Residual Newborn Screening Blood Spots. J Empir Res Hum Res Ethics 2017; 12:335-342. [PMID: 29073807 DOI: 10.1177/1556264617736199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
As state newborn screening programs develop approaches to parental permission for the storage and use of residual dried newborn screening samples, it is important to understand how the public comprehends the consent elements. Focus groups in Utah, California, and Michigan ( n = 7 groups, 69 participants) were conducted to evaluate the language on a shortened consent form. Outcomes from the analysis included barriers to conceptualizing biospecimen research, the overly cautious tone and awkwardness of the consent form, and perceptions of community versus individual benefit. This research offers insight on public response to, and comprehension of, commonly used consent language for the storage and use of dried blood spot research in a shortened consent form.
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Affiliation(s)
| | | | | | | | - Beth Tarini
- 3 The University of Iowa, Iowa City, IA, USA
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21
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22
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Page SA, Manhas KP, Muruve DA. A survey of patient perspectives on the research use of health information and biospecimens. BMC Med Ethics 2016; 17:48. [PMID: 27527514 PMCID: PMC4986353 DOI: 10.1186/s12910-016-0130-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Personal health information and biospecimens are valuable research resources essential for the advancement of medicine and protected by national standards and provincial statutes. Research ethics and privacy standards attempt to balance individual interests with societal interests. However these standards may not reflect public opinion or preferences. The purpose of this study was to assess the opinions and preferences of patients with kidney disease about the use of their health information and biospecimens for medical research. METHODS A 45-item survey was distributed to a convenience sample of patients at an outpatient clinic in a large urban centre. The survey briefly addressed sociodemographic and illness characteristics. Opinions were sought on the research use of health information and biospecimens including consent preferences. RESULTS Two hundred eleven of 400 distributed surveys were completed (response rate 52.8 %). Respondents were generally supportive of medical research and trusting of researchers. Many respondents supported the use of their information and biospecimens for health research and also preferred consent be sought for use of health information and biospecimens. Some supported the use of their information and biospecimens for research without consent. There were significant differences in the opinions people offered regarding the research use of biospecimens compared to health information. Some respondent perspectives about consent were at odds with current regulatory and legal standards. CONCLUSIONS Clinical health data and biospecimens are valuable research resources, critical to the advancement of medicine. Use of these data for research requires balancing respect for individual autonomy, privacy and the societal interest in the greater good. Incongruence between some respondent perspectives and the regulatory standards suggest both a need for public education and review of legislation to increase understanding and ensure the public's trust is maintained.
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Affiliation(s)
- Stacey A Page
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. .,Conjoint Health Research Ethics Board, Research Services, University of Calgary, MacKimmie Library Tower, 3rd Floor, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Kiran Pohar Manhas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Alberta Centre for Child, Family & Community Research, Child Development Centre, 2888 Shaganappi Trail NW, Calgary, AB, T3B-6A8, Canada
| | - Daniel A Muruve
- Department of Medicine, Division of Nephrology and Hypertension, Snyder Institute for Chronic Diseases, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada
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Botkin JR, Rothwell E, Anderson RA, Rose NC, Dolan SM, Kuppermann M, Stark LA, Goldenberg A, Wong B. Prenatal Education of Parents About Newborn Screening and Residual Dried Blood Spots: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:543-9. [PMID: 27043416 PMCID: PMC7755042 DOI: 10.1001/jamapediatrics.2015.4850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research clearly indicates that current approaches to newborn blood spot screening (NBS) education are ineffective. Incorporating NBS education into prenatal care is broadly supported by lay and professional opinion. OBJECTIVE To determine the efficacy and effect of prenatal education about newborn screening and use of residual dried blood spots (DBS) in research on parental knowledge, attitudes, and behaviors. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial of prenatal educational interventions, with outcomes measured by survey at 2 to 4 weeks postpartum. Participants were recruited from obstetric clinics in Salt Lake City, Utah; San Francisco, California; and the Bronx, New York. Eligible women were English- or Spanish-speaking adults and did not have a high-risk pregnancy. A total of 901 women were enrolled. Participants who completed the follow-up survey included 212 women in the usual care group (70% retention), 231 in the NBS group (77% retention), and 221 women in the NBS + DBS group (75% retention). Those who completed the survey were similar across the 3 groups with respect to age, ethnicity, race, education, marital status, income, obstetric history, and language. INTERVENTIONS Participants were randomized into 1 of 3 groups: usual care (n = 305), those viewing an NBS movie and brochure (n = 300), and those viewing both the NBS and DBS movies and brochures (n = 296). MAIN OUTCOMES AND MEASURES Two to four weeks postpartum, women completed a 91-item survey by telephone, addressing knowledge, attitudes, and behavior with respect to opting out of NBS or DBS for their child. RESULTS A total of 901 women (mean age, 31 years) were randomized and 664 completed the follow-up survey. The total correct responses on the knowledge instrument in regard to NBS were 69% in the usual care group, 79% in the NBS group, and 75% in the NBS + DBS group, a significant between-group difference (P < .05). Although all groups showed strong support for NBS, the percentage of women who were "very supportive" was highest in the NBS group (94%), followed by the NBS + DBS group (86%) and was lowest in the usual care group (73%) (P < .001). The interventions were not associated with decisions to decline newborn screening or withdraw residual DBS. Nine women stated that they had declined NBS (all the usual care group; P < .001). With respect to DBS, 5 participants indicated that they contacted the health department to have their child's sample withdrawn after testing: 3 in the NBS + DBS group and 2 in the usual care group (P = .25). CONCLUSIONS AND RELEVANCE Educational interventions can be implemented in the prenatal clinic, using multimedia tools and electronic platforms. Prenatal education is effective in increasing postnatal knowledge and support for these programs. These results are relevant to other contexts in which residual clinical specimens and data are used for research purposes. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02676245.
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Affiliation(s)
| | | | | | - Nancy C. Rose
- University of Utah, Salt Lake City2Intermountain Healthcare, Salt Lake City, Utah
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | | | | | | | - Bob Wong
- University of Utah, Salt Lake City
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Abstract
This article discusses a new approach for the conduct of focus groups in health research. Identifying ways to educate and inform participants about the topic of interest prior to the focus group discussion can promote more quality data from informed opinions. Data on this deliberative discussion approach are provided from research within three federally funded studies. As healthcare continues to improve from scientific and technological advancements, educating the research participants prior to data collection about these complexities is essential to gather quality data.
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Nurmsoo S, Hayes M. Awareness of risks of biobank research may affect public attitudes toward consent. J Community Genet 2015; 6:181-2. [PMID: 25644873 DOI: 10.1007/s12687-015-0215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/21/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sean Nurmsoo
- Department of Pediatrics, Dalhousie University, 1256 Barrington St., 4th Floor, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada,
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Public trust in health information sharing: implications for biobanking and electronic health record systems. J Pers Med 2015; 5:3-21. [PMID: 25654300 PMCID: PMC4384055 DOI: 10.3390/jpm5010003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 12/28/2022] Open
Abstract
Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon’s MTurk system (n = 447). We found that seeing one’s primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust) were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public’s trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making.
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Grady C, Eckstein L, Berkman B, Brock D, Cook-Deegan R, Fullerton SM, Greely H, Hansson MG, Hull S, Kim S, Lo B, Pentz R, Rodriguez L, Weil C, Wilfond BS, Wendler D. Broad Consent for Research With Biological Samples: Workshop Conclusions. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:34-42. [PMID: 26305750 PMCID: PMC4791589 DOI: 10.1080/15265161.2015.1062162] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health (NIH) Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and timely topic.
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Affiliation(s)
| | | | - Ben Berkman
- NHGRI Bioethics Core and NIH CC Department of Bioethics
| | - Dan Brock
- Division of Medical Ethics, Harvard Medical School
| | | | | | | | | | - Sara Hull
- NHGRI Bioethics Core and NIH CC Department of Bioethics
| | - Scott Kim
- Department of Bioethics, NIH Clinical Center
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Botkin JR. Crushing Consent Under the Weight of Expectations. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:47-49. [PMID: 26305753 DOI: 10.1080/15265161.2015.1062181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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