1
|
Maseme M, Gardner J, Mahomed S. Broad consent for biobank research in South Africa - Towards an enabling ethico-legal framework. Glob Bioeth 2023; 35:2288331. [PMID: 38179086 PMCID: PMC10763822 DOI: 10.1080/11287462.2023.2288331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
Broad consent is permitted by the South African National Department of Health Ethics Guidelines but appears to be prohibited by section 13(1) of the Protection of Personal Information Act 4 of 2013. Additionally, the Act mandates that all personal data (including biobank sample data) be collected for lawful, explicit, and clearly defined purposes. There is possibility for ambiguity in interpretation because of this discrepancy between the two instruments. Given the association between the transfer of samples and data, the long-term nature of biobanking, which makes it impractical to provide too much or enough information because it is simply not available at the time of sample collection, and the various ways that the Protection of Personal Information Act 4 of 2013 have been interpreted, we aim to demonstrate that South Africa's current regulatory framework should appropriately permit broad consent use for biobank research where the transfer of samples and their associated data are contemplated. In summary, the proposed amendments include removing regulatory ambiguity regarding broad consent use, ensuring adequate safeguards for research participants by specifying rules for data access and personal information processing, and incorporating consent form information requirements into the national Consent Template.
Collapse
Affiliation(s)
- Mantombi Maseme
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Biobank, National Health Laboratory Service, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jillian Gardner
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Safia Mahomed
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Law, University of South Africa, Pretoria, South Africa
| |
Collapse
|
2
|
Geiger J, Fuchs J, Starke M, Neumann M, Baber R, Nussbeck SY, Kiehntopf M, Specht C, Illig T, Hummel M, Jahns R. GBA/GBN-position on the feedback of incidental findings in biobank-based research: consensus-based workflow for hospital-based biobanks. Eur J Hum Genet 2023; 31:1066-1072. [PMID: 36732662 PMCID: PMC10474025 DOI: 10.1038/s41431-023-01299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Incidental research findings pose a considerable challenge to hospital-based research biobanks since they are acting as intermediaries between healthcare and research. In a joint action the centralized biobank ibdw (Interdisciplinary Bank of Biomaterials and Data Wuerzburg) together with local authorities drafted a coherent concept to manage incidental research findings in full compliance with relevant ethical and data privacy regulations. The concept was developed and elaborated in close collaboration with the German Biobank Alliance (GBA). Comprehensive documentation of all steps guarantees the traceability of the process. By a mandatory assessment of the findings prior to re-identification of the individual concerned, unnecessary measures can be avoided. The individual's "right not to know" is respected according to the stipulations of the informed consent. As a general principle any communication with the individual occurs exclusively through the hospital and by competent physicians with appropriate knowledge and communication skills. We propose this scheme as a blueprint for reporting workflows for incidental research findings at hospital-based biobanks.
Collapse
Affiliation(s)
- Joerg Geiger
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Joerg Fuchs
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Madeline Starke
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Neumann
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ronny Baber
- Leipzig Medical Biobank, University Leipzig, Leipzig, Germany
| | - Sara Y Nussbeck
- University Medical Center Goettingen, Central Biobank, UMG, Goettingen, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Cornelia Specht
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Hummel
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
3
|
Richter JG, Filla T, Acar H, Bleck E, Kernder A, Düsing C, Vordenbäumen S, Schröder M, Hansen R, Distler JHW, Schneider M. Sustained agreement rates in the longitudinal assessment of lupus patients to a Broad Consent for personal data and specimen usage in the RHINEVIT biobank. Front Med (Lausanne) 2023; 10:1208006. [PMID: 37415767 PMCID: PMC10321663 DOI: 10.3389/fmed.2023.1208006] [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: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Background Biobanks are essential structures for scientific research. The RHINEVIT biobank is used to recruit biomaterials from rheumatology patients in outpatient care and to conduct clinical research studies (e.g., cohort studies) and basic research. RHINEVIT established Broad Consents (BC) to allow extensive and relevant usage of data and biospecimens without the need for specific project restrictions. For quality assurance, we compared the consent rate of individual items of the BC versions in patients with systemic lupus erythematosus (SLE) in the longitudinal study. Methods BCs were used for biomaterial donation. Informed consent data from RHINEVIT were analyzed. Due to the content restructuring of the BC items due to changes from the templates of the working group of the Medical Ethics Commissions in the Federal Republic of Germany and GDPR requirements, content mapping of the items was performed for the analysis. Results From September 2015 to March 2022, 291 SLE outpatients donated biomaterials. In 119 patients, the BC was renewed at least once in a subsequent biomaterial donation. Three biomaterial donations were obtained from 21 patients and four from six patients using the respective BC. However, one consent was later revoked. Consent to the BC topics showed consistently high rates of agreement (range 97.5%-100%), with only some patients disagreeing with individual topics. This remained stable over time (median 526 days [Q1 400, Q3 844]). None of the patients disagreed with a certain topic in two consecutive visits. Conclusion Modifications to the BC did not result in any relevant changes in the approval rates for SLE patients. RHINEVIT's BC is successfully used for the quality-assured handling of excellently annotated biomaterial. The long-term use of these highly valuable biospecimens for unrestricted research, also in an international context, remains assured.
Collapse
Affiliation(s)
- Jutta G. Richter
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Tim Filla
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Hasan Acar
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Ellen Bleck
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Kernder
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Christina Düsing
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Meerbusch, Germany
| | | | | | - Jörg H. W. Distler
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Matthias Schneider
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| |
Collapse
|
4
|
Bettio V, Mazzucco E, Aleni C, Cracas S, Rinaldi C, Antona A, Varalda M, Venetucci J, Ferrante D, Rimedio A, Capello D. UPO Biobank: The Challenge of Integrating Biobanking into the Academic Environment to Support Translational Research. J Pers Med 2023; 13:911. [PMID: 37373900 DOI: 10.3390/jpm13060911] [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] [Received: 04/05/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Biobanks are driving motors of precision and personalized medicine by providing high-quality biological material/data through the standardization and harmonization of their collection, preservation, and distribution. UPO Biobank was established in 2020 as an institutional, disease, and population biobank within the University of Piemonte Orientale (UPO) for the promotion and support of high-quality, multidisciplinary studies. UPO Biobank collaborates with UPO researchers, sustaining academic translational research, and supports the Novara Cohort Study, a longitudinal cohort study involving the population in the Novara area that will collect data and biological specimens that will be available for epidemiological, public health, and biological studies on aging. UPO Biobank has been developed by implementing the quality standards for the field and the ethical and legal issues and normative about privacy protection, data collection, and sharing. As a member of the "Biobanking and Biomolecular Resources Research Infrastructure" (BBMRI) network, UPO Biobank aims to expand its activity worldwide and launch cooperation with new national and international partners and researchers. The objective of this manuscript is to report an institutional and operational experience through the description of the technical and procedural solutions and ethical and scientific implications associated with the establishment of this university research biobank.
Collapse
Affiliation(s)
- Valentina Bettio
- UPO Biobank, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Eleonora Mazzucco
- UPO Biobank, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Chiara Aleni
- Department of Sustainable Development and Ecological Transition, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Silvia Cracas
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Carmela Rinaldi
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
- Learning and Research Area, A.O.U. Maggiore della Carità, 28100 Novara, Italy
| | - Annamaria Antona
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Marco Varalda
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Jacopo Venetucci
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Antonio Rimedio
- Ethics Committee of the University "Hospital Major of Charity" in Novara, Local Health Authorities Biella, 28100 Novara, Italy
| | - Daniela Capello
- UPO Biobank, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| |
Collapse
|
5
|
Australian Donation and Transplantation Biobank: A Research Biobank Integrated Within a Deceased Organ and Tissue Donation Program. Transplant Direct 2022; 9:e1422. [PMID: 36591329 PMCID: PMC9750700 DOI: 10.1097/txd.0000000000001422] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/04/2022] [Indexed: 12/27/2022] Open
Abstract
We aimed to facilitate the donation of tissue samples for research by establishing a centralized system integrated in the organ donation program for collection, storage, and distribution of samples (the Australian Donation and Transplantation Biobank [ADTB]). Methods Feasibility of a research biobank integrated within the deceased organ and tissue donation program was assessed. DonateLife Victoria sought consent for ADTB donation after consent was received for organ donation for transplantation from the donor's senior available next of kin. ADTB samples were collected during donation surgery and distributed fresh to researchers or stored for future research. The main outcome measures were ADTB donation rates, ADTB sample collection, ADTB sample use, and to identify ethical considerations. Results Over 2 y, samples were collected for the ADTB from 69 donors (28% of 249 donors). Samples were obtained from the spleen (n = 59, 86%), colon (n = 57, 83%), ileum (n = 56, 82%), duodenum (n = 55, 80%), blood (n = 55, 80%), bone marrow (n = 55, 80%), skin (n = 54, 78%), mesenteric lymph nodes (n = 56, 81%), liver (n = 21, 30%), lung (n = 29, 42%), and lung-draining lymph node (n = 29, 42%). Heart (n = 20), breast (n = 1), and lower urinary tract (n = 1) samples were obtained in the second year. Five hundred fifty-six samples were used in 19 ethics-approved research projects spanning the fields of immunology, microbiology, oncology, anatomy, physiology, and surgery. Conclusions The integration of routine deceased donation and transplantation activities with a coordinated system for retrieval and allocation of donor samples for use in a range of research projects is feasible and valuable.
Collapse
|
6
|
Schüttler C, Jahns R, Prokosch U, Wach S, Wullich B. [Biobanks, translational research and medical informatics]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:722-727. [PMID: 35925243 DOI: 10.1007/s00120-022-01850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
When we think of medical research, one intuitively associates it with the analysis of study data collected for a specific research question or with the secondary use of patient data from routine care. However, these are not the only sources for answering scientific questions. Especially for translational research, tissue and liquid samples such as blood, DNA or other body fluids provide essential insights into disease pathogenesis, development of new therapies and treatment decisions. Access to these biomedical materials is provided by so-called biobanks. By collecting, characterizing, documenting and, if necessary, processing human biospecimens in accordance with high quality standards, they can support research of the causes of diseases, early diagnosis and the targeted treatment of diseases, or make a significant contribution to the investigation of common diseases.
Collapse
Affiliation(s)
- C Schüttler
- Central Biobank Erlangen (CeBE), Universitätsklinikum Erlangen und Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Jahns
- Interdisziplinäre Biomaterial- und Datenbank der Medizinischen Fakultät Würzburg, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - U Prokosch
- Lehrstuhl für Medizinische Informatik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - S Wach
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Wullich
- Central Biobank Erlangen (CeBE), Universitätsklinikum Erlangen und Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
| |
Collapse
|
7
|
Zenker S, Strech D, Ihrig K, Jahns R, Müller G, Schickhardt C, Schmidt G, Speer R, Winkler E, von Kielmansegg SG, Drepper J. Data protection-compliant broad consent for secondary use of health care data and human biosamples for (bio)medical research: Towards a new German national standard. J Biomed Inform 2022; 131:104096. [PMID: 35643273 DOI: 10.1016/j.jbi.2022.104096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The secondary use of deidentified but not anonymized patient data is a promising approach for enabling precision medicine and learning health care systems. In most national jurisdictions (e.g., in Europe), this type of secondary use requires patient consent. While various ethical, legal, and technical analyses have stressed the opportunities and challenges for different types of consent over the past decade, no country has yet established a national consent standard accepted by the relevant authorities. METHODS A working group of the national Medical Informatics Initiative in Germany conducted a requirements analysis and developed a GDPR-compliant broad consent standard. The development included consensus procedures within the Medical Informatics Initiative, a documented consultation process with all relevant stakeholder groups and authorities, and the ultimate submission for approval via the national data protection authorities. RESULTS This paper presents the broad consent text together with a guidance document on mandatory safeguards for broad consent implementation. The mandatory safeguards comprise i) independent review of individual research projects, ii) organizational measures to protect patients from involuntary disclosure of protected information, and iii) comprehensive information for patients and public transparency. This paper further describes the key issues discussed with the relevant authorities, especially the position on additional or alternative consent approaches such as dynamic consent. DISCUSSION Both the resulting broad consent text and the national consensus process are relevant for similar activities internationally. A key challenge of aligning consent documents with the various stakeholders was explaining and justifying the decision to use broad consent and the decision against using alternative models such as dynamic consent. Public transparency for all secondary use projects and their results emerged as a key factor in this justification. While currently largely limited to academic medicine in Germany, the first steps for extending this broad consent approach to wider areas of application, including smaller institutions and medical practices, are currently under consideration.
Collapse
Affiliation(s)
- Sven Zenker
- Staff Unit for Scientific & Medical Technology Development & Coordination (MWTek), Commercial Directorate, Institute for Medical Biometry, Informatics & Epidemiology, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusbergcampus 1, 53127 Bonn, Germany.
| | - Daniel Strech
- QUEST Center, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kristina Ihrig
- Department of Medicine, Hematology/Oncology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), University and University Hospital of Würzburg, Building A8/A9, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Gabriele Müller
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christoph Schickhardt
- Section of Translational Medical Ethics, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Georg Schmidt
- Department of Internal Medicine 1, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, German Centre for Cardiovascular Research partner site Munich Heart Alliance, Munich, Germany
| | - Ronald Speer
- LIFE - Leipzig Research Center for Civilization Diseases, Medical Faculty, Leipzig University, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Eva Winkler
- Section for Translational Medical Ethics, Dept Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, INF 460, 69121 Heidelberg
| | | | - Johannes Drepper
- TMF - Technology, Methods, and Infrastructure for Networked Medical Research, Charlottenstrasse 42, 10117 Berlin, Germany
| |
Collapse
|
8
|
Wagner H, Kenk M, Fraser M, Berlin A, Fleshner N. Biorepositories and Databanks for the Development of Novel Biomarkers for Genitourinary Cancer Prevention and Management. Eur Urol Focus 2021; 7:513-521. [PMID: 34167926 DOI: 10.1016/j.euf.2021.06.002] [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: 04/09/2021] [Revised: 05/15/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022]
Abstract
CONTEXT Translational research in uro-oncology depends on the availability of high-quality biospecimens and associated data to advance precision medicine and improve clinical outcomes. Procurement, storage, and annotation of these specimens represent critical steps towards this end. OBJECTIVE To review best-practice experiences gained via the McCain GU BioBank, a repository of more than 750 000 biospecimens obtained from more than 16 000 patients attending clinics at the University Health Network in Toronto, Canada. EVIDENCE ACQUISITION The review summarizes our experiences at a large single-institution genitourinary oncology biorepository. EVIDENCE SYNTHESIS Key findings are placed in the context of emerging trends in genitourinary oncology, with a focus on integration of molecular profiling and clinical data with traditional biorepository management. Proposed approaches provide high-quality biospecimens with comprehensive and reliable clinical data that can fuel innovation and discovery in research. CONCLUSIONS Biorepositories are vital for improving clinical outcomes and advancing personalized medicine. High-quality biospecimens and their associated clinical data are crucial for validation of biomarkers in oncology. Efforts to procure, store, and annotate clinical specimens represent critical steps in translational research. Elements such as biobank size, biospecimen types, disease cohorts, predetermined collection protocols, broad informed consent, sample handling and storage protocols, and available infrastructure directly influence the effectiveness and capacity of a biobank. PATIENT SUMMARY Biorepositories, or biobanks, are facilities that store biospecimens such as blood, urine, or tissue (usually collected from humans) for use in research. Biobanks have become an important resource in medical research, as they provide high-quality specimens to support different types of contemporary research such as genomics, biomarker discovery, and personalized medicine. Clinical management and treatment of genitourinary cancers, such as prostate, kidney, and bladder cancers, are particularly suited for biomarker research. The provision of biospecimens and their associated clinical data have become crucial for validation of biomarkers in these cancers.
Collapse
Affiliation(s)
- Heidi Wagner
- McCain GU BioBank, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Miran Kenk
- McCain GU BioBank, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Michael Fraser
- McCain GU BioBank, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Prostate Cancer Genome Network, Toronto, Canada
| | - Alejandro Berlin
- Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Prostate Cancer Genome Network, Toronto, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Neil Fleshner
- McCain GU BioBank, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
9
|
Knowledge, perceptions and attitude of Egyptian physicians towards biobanking issues. PLoS One 2021; 16:e0248401. [PMID: 33770108 PMCID: PMC7996976 DOI: 10.1371/journal.pone.0248401] [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: 10/29/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives Collection and storage of biospecimens and data for biobanking raise many ethical concerns. Stakeholders’ opinions about these ethical issues are important since they can help in the development of ethical guidelines to govern biobanking activities. Physicians are among the important stakeholders since they contact potential participants and could be biobank users. The goal of this study is to evaluate the perceptions and attitude of Egyptian physicians towards ethical issues in biobanking. Methods A cross-sectional online survey was designed and distributed with the target group between November 2019 and January 2020. Results The questionnaire was completed by 223 physicians. While 65.5% reported hearing the term "Biobanking" before, 45.7% knew that there are biobanks in Egypt. Participants had a general positive attitude towards the value of biobanks in research. About 73% agreed that biobanks can share biospecimens with international research organizations, but only 42.6% supported collaboration with pharmaceutical companies, and 44% agreed to the use of user fees by biobanks. About 48% supported the use of broad consent in biobanks, and 73.1% believed that donors of biospecimens should be informed about results of research performed on their biospecimens. Conclusion Although many Egyptian physicians heard about biobanking, they had limited knowledge about the existence of biobanks in Egypt. They had concerns about commercialization, use of broad consent and user fees. A knowledge gap exists among these stakeholders, which should be covered by different educational activities. Community discussions should start to reach consensus about the issues of commercialization and return of research results.
Collapse
|
10
|
Vlahou A, Hallinan D, Apweiler R, Argiles A, Beige J, Benigni A, Bischoff R, Black PC, Boehm F, Céraline J, Chrousos GP, Delles C, Evenepoel P, Fridolin I, Glorieux G, van Gool AJ, Heidegger I, Ioannidis JPA, Jankowski J, Jankowski V, Jeronimo C, Kamat AM, Masereeuw R, Mayer G, Mischak H, Ortiz A, Remuzzi G, Rossing P, Schanstra JP, Schmitz-Dräger BJ, Spasovski G, Staessen JA, Stamatialis D, Stenvinkel P, Wanner C, Williams SB, Zannad F, Zoccali C, Vanholder R. Data Sharing Under the General Data Protection Regulation: Time to Harmonize Law and Research Ethics? Hypertension 2021; 77:1029-1035. [PMID: 33583200 PMCID: PMC7968961 DOI: 10.1161/hypertensionaha.120.16340] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. The General Data Protection Regulation (GDPR) became binding law in the European Union Member States in 2018, as a step toward harmonizing personal data protection legislation in the European Union. The Regulation governs almost all types of personal data processing, hence, also, those pertaining to biomedical research. The purpose of this article is to highlight the main practical issues related to data and biological sample sharing that biomedical researchers face regularly, and to specify how these are addressed in the context of GDPR, after consulting with ethics/legal experts. We identify areas in which clarifications of the GDPR are needed, particularly those related to consent requirements by study participants. Amendments should target the following: (1) restricting exceptions based on national laws and increasing harmonization, (2) confirming the concept of broad consent, and (3) defining a roadmap for secondary use of data. These changes will be achieved by acknowledged learned societies in the field taking the lead in preparing a document giving guidance for the optimal interpretation of the GDPR, which will be finalized following a period of commenting by a broad multistakeholder audience. In parallel, promoting engagement and education of the public in the relevant issues (such as different consent types or residual risk for re-identification), on both local/national and international levels, is considered critical for advancement. We hope that this article will open this broad discussion involving all major stakeholders, toward optimizing the GDPR and allowing a harmonized transnational research approach.
Collapse
Affiliation(s)
- Antonia Vlahou
- From the Systems Biology Center, Biomedical Research Foundation, Academy of Athens, Greece (A.V.)
| | - Dara Hallinan
- FIZ Karlsruhe - Leibniz-Institut für Informationsinfrastruktur, Eggenstein-Leopoldshafen, Germany (D.H., F.B.)
| | - Rolf Apweiler
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom (R.A.)
| | - Angel Argiles
- SAS RD-Néphrologie and Bio-Communication Cardio-Métabolique (BC2M) EA7288 and University Hospital Lapeyronie, University of Montpellier, France (A.A.)
| | - Joachim Beige
- KfH-Nierenzentrum und Klinikum St. Georg, Nephrologie, Leipzig, Germany (J.B.)
| | - Ariela Benigni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy (A.B., G.R.)
| | - Rainer Bischoff
- Department of Analytical Biochemistry, University of Groningen, The Netherlands (R.B.)
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Canada (P.C.B.)
| | - Franziska Boehm
- FIZ Karlsruhe - Leibniz-Institut für Informationsinfrastruktur, Eggenstein-Leopoldshafen, Germany (D.H., F.B.)
| | - Jocelyn Céraline
- Institute of Genetics and Molecular and Cellular Biology, Institut de cancérologie Strasbourg Europe, Université de Strasbourg, France (J.C.)
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, Greece; (G.P.C.)
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (C.D.)
| | - Pieter Evenepoel
- Laboratory of Nephrology, Department of Immunology and Microbiology, Leuven, Belgium (P.E.)
| | - Ivo Fridolin
- Department of Health Technologies, Tallinn University of Technology, Estonia (I.F.)
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Belgium (G.G., R.V.)
| | - Alain J van Gool
- Translational Metabolic Laboratory, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands (A.J.v.G.)
| | - Isabel Heidegger
- Department of Urology, Medizinische Universität Innsbruck, Austria (I.H.)
| | - John P A Ioannidis
- Departments of Medicine and of Epidemiology and Population Health and Meta-Research Innovation Center at Stanford (METRICS), Stanford University (J.P.A.I.)
| | - Joachim Jankowski
- Institute of Cardiovascular Research, RWTH Aachen University, Germany (J.J., V.J.)
| | - Vera Jankowski
- Institute of Cardiovascular Research, RWTH Aachen University, Germany (J.J., V.J.)
| | - Carmen Jeronimo
- Cancer Biology and Epigenetics Group, Portuguese Oncology Institute of Porto and Abel Salazar Institute of Biomedical Sciences, University of Porto, Portugal (C.J.)
| | - Ashish M Kamat
- Division of Surgery, Department of Urology, The University of Texas MD Anderson Cancer Centre, Houston (A.K.)
| | - Rosalinde Masereeuw
- Div. Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, NL (R.M.)
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medizinische Universität Innsbruck, Austria (G.M.)
| | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics AG, Hannover, Germany (H.M.)
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS - Fundación Jiménez Díaz-UAM, Madrid, Spain (A.O.)
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy (A.B., G.R.)
| | - Peter Rossing
- Steno Diabetes Center, University of Copenhagen, Denmark (P.R.)
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse and Université Toulouse III Paul-Sabatier, France (J.P.S.)
| | - Bernd J Schmitz-Dräger
- Urologie 24, Nuremberg, and Department of Urology, Friedrich-Alexander University of Erlangen, Germany (B.J.S-D)
| | - Goce Spasovski
- Department of Nephrology, University Clinical Center Skopje, North Macedonia (G.S.)
| | - Jan A Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium, Biomedical Science Group, University of Leuven (J.A.S.)
| | - Dimitrios Stamatialis
- Bioartificial organs, Department of Biomaterials Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands (D.S.)
| | - Peter Stenvinkel
- Department of Renal Medicine M99, Karolinska University Hospital, Stockholm, Sweden (P.S.)
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany (C.W.)
| | - Stephen B Williams
- Department of Surgery, Division of Urology, The University of Texas Medical Branch, Galveston (S.B.W.)
| | - Faiez Zannad
- Centre d'Investigation Clinique Inserm and Université de Lorraine, CHU Nancy, France (F.Z.)
| | - Carmine Zoccali
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Italy (C.Z.)
| | | |
Collapse
|
11
|
Schmanski A, Roberts E, Coors M, Wicks SJ, Arbet J, Weber R, Crooks K, Barnes KC, Taylor MRG. Research participant understanding and engagement in an institutional, self-consent biobank model. J Genet Couns 2020; 30:257-267. [PMID: 32951257 DOI: 10.1002/jgc4.1316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/25/2020] [Accepted: 07/04/2020] [Indexed: 11/09/2022]
Abstract
The number of institutional and governmental biobanks and the target enrollment sizes of modern biobanks are increasing, affording more opportunities for the public to participate in biobanking efforts. In parallel with these expansions are pressures to increase the efficiency of obtaining informed consent using shorter consent forms that cover a broader scope of research and increasingly include provisions for return of research or clinical genetic test results to participants. Given these changes, how well these participants understand genetics, their level of understanding of what they are consenting to, and their wishes to engage longitudinally and receive biobank results are not well understood. We surveyed participants in a large, medical system-based biobank who had enrolled through a two-page, self-consent process about their baseline knowledge of genetics, understanding and recall of the consent process, wishes for future contact and engagement, and level of interest in receiving clinical genetic testing results. A total of 856 consented persons participated in the survey (67% women; 67% white). Participants' general reported genetics knowledge was relatively high (mean 11.60 of 15 questions answered correctly) as was recall of key elements from the two-page consent form. Overall participant enthusiasm for future contact by the biobank and for receiving clinical genetic testing results was high. The use of a two-page, self-consent process in a large, institutional biobank resulted in high levels of consent recall and enthusiasm for future ongoing engagement and receipt of genetic testing results by participants.
Collapse
Affiliation(s)
- Andrew Schmanski
- Department of Genetic Medicine, Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Emily Roberts
- Department of Medicine, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marilyn Coors
- Department of Medicine, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephen J Wicks
- Department of Medicine, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jaron Arbet
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Weber
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristy Crooks
- Department of Medicine, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathleen C Barnes
- Department of Medicine, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R G Taylor
- Department of Medicine, Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
12
|
Patients' decision to contribute to a biobank in the light of the patient-recruiter relationship-a qualitative study of broad consent in a hospital setting. J Community Genet 2020; 12:15-25. [PMID: 32779150 PMCID: PMC7846645 DOI: 10.1007/s12687-020-00479-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
Findings from recent studies show that the relationship developed with the particular researcher asking for broad consent plays an important role in the participant’s willingness to give consent. Interviews and focus groups were conducted in order to present a description and analysis of meetings in which broad consent took place and to examine the role of recruiters in the patients’ decision-making and in building trust in the Lausanne University Hospital Institutional Biobank (BIL). Our findings suggest that patient broad consent to biobanking is strongly related to its setting. BIL recruiters’ were aware of their role as ambassadors of the BIL and their responsibility towards patients. Patient interviewees were sensitive to the quality of the information delivered, the timing of the consent request and the recruiters’ attitudes and behaviours, including the presence of the white coat. Participating in the BIL also seemed to reinforce the patient’s self-esteem and perceived efficacy, particularly since they are themselves ill and inactive when requested to participate. Recruiters and participants report that participation may be motivated by fundamental (existential) goals. Organisational factors also affected recruiters’ activity and the broad consent procedure raising several ethical issues. This qualitative study suggests that biobanking based on information-based models of decision-making might need to be re-evaluated in order to improve broad consent. Our findings have implications for the practice of broad consent and patient autonomy, as well as for the recruiters’ role and training.
Collapse
|
13
|
Luckhaus C, Roosterman D, Juckel G. [Biobanking in Psychiatry]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:722-729. [PMID: 32542622 DOI: 10.1055/a-0832-8766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Medical biobanking is concerned with establishing and maintaining large-scale repositories of biological specimens combined with comprehensive archives of clinical and biographical information on donors. This aims for controlled high and consistent quality of specimens for future biomedical research. One major objective is to assemble multiple blood components for various types of biochemical analysis and experimentation including different isolated cell types. With proper cryo-conservation, blood-derived cells can be conserved and revitalized after thawing and employed as in-vitro cell models carrying specific biological traits of donors. Optimizing pre-analytical methods can reduce pre-analytical variance thereby reducing imprecision of analytical data. This is particularly valuable for multivariate analyses of biological systems ("omics") and biomarker research. Introducing biobanking to psychiatry carries the challenge of making diagnostic allocation more compatible with biological entities than is achieved with current diagnostic categories of ICD-10 or DSM-V. Diagnostic or transdiagnostic subgroups can be stratified using biologically anchored clinical criteria. An important ethical issue of biobanking is the need for broad consent by the donors for specimen use in not yet defined future research projects. The organizational, logistic and financial costs of establishing and maintaining a biobank are considerable, but seem well warranted in view of the gainable advances in biomedical research quality, translations and clinical applications.
Collapse
|
14
|
Soares SE, Anderson NR, Solis LJ, López JE. Modeling Clinical Processes to Consent Research Donors of Remnant Biospecimens in an Outpatient Cardiology Clinic. Biopreserv Biobank 2020; 18:53-63. [PMID: 31880471 PMCID: PMC7185316 DOI: 10.1089/bio.2019.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Informed consent for research biospecimen donations is traditionally obtained through a face-to-face interaction with research staff and by signing an Institutional Review Board (IRB)-approved printed form. Electronic signatures (eSign) are routinely used in the electronic medical record (EMR) for the consenting of clinical services after patients review printed documentation. Our goal was to develop an electronic self-consenting workflow that mimicked clinical services. Specifically, we tested a research consent process for the biobanking of remnant clinical samples that relies solely on clinical resources in a busy outpatient practice. Materials and Methods: The Biorepositories Core Resource (BCR) unit initiated a new enterprise-wide biobanking infrastructure for consenting patients, termed Biospecimen Use for Research-Related Investigations and Translational Objectives (BURRITO). BURRITO is modeled after an established clinical process called Terms and Conditions of Service (TACOS). The TACOS requires patients to annually review printed documentation and self-consent electronically for clinical services. BURRITO also requires patients to review printed documentation and self-consent with eSign to opt-in for remnant biospecimen banking, but patients must complete this process only once. We captured eSign for consents directly into the EMR without research staff. Results: Patients reviewed the IRB-approved documents and self-consented during their cardiology clinic visit. At checkout, their participation preferences were electronically documented by clinic staff. During a 6-month period, 123 patients agreed to donate. After a review of process, a second 3-month period identified 202 patients agreeing to donate. BURRITO did not require face-to-face interactions with research staff, used a "no-paper" eSign for consent, and created discrete fields in the clinical EMR of the patient's preference. Conclusions: BURRITO electronically documents informed consent using an EMR functionality and the least amount of clinical and research resources. Our results show promise for developing institutionally adopted processes, which could leverage existing clinical workflows for universal research consenting and scalability.
Collapse
Affiliation(s)
- Stephanie E. Soares
- Clinical and Translational Science Center, University of California Davis Medical Center, Sacramento, California
| | - Nicholas R. Anderson
- Clinical and Translational Science Center, University of California Davis Medical Center, Sacramento, California
- Division of Health Informatics, Department of Public Health Sciences, University of California, Davis, Sacramento, California
| | - Leslie J. Solis
- Clinical and Translational Science Center, University of California Davis Medical Center, Sacramento, California
| | - Javier E. López
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, California
- Cardiovascular Research Institute, University of California, Davis, Sacramento, California
| |
Collapse
|
15
|
Cumyn A, Barton A, Dault R, Cloutier A, Jalbert R, Ethier J. Informed consent within a learning health system: A scoping review. Learn Health Syst 2020; 4:e10206. [PMID: 32313834 PMCID: PMC7156861 DOI: 10.1002/lrh2.10206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/18/2019] [Accepted: 10/08/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION A major consideration for the implementation of a learning health system (LHS) is consent from participants to the use of their data for research purposes. The main objective of this paper was to identify in the literature which types of consent have been proposed for participation in research observational activities in a LHS. We were particularly interested in understanding which approaches were seen as most feasible and acceptable and in which context, in order to inform the development of a Quebec-based LHS. METHODS Using a scoping review methodology, we searched scientific and legal databases as well as the gray literature using specific terms. Full-text articles were reviewed independently by two authors on the basis of the following concepts: (a) LHS and (b) approach to consent. The selected papers were imported in NVivo software for analysis in the light of a conceptual framework that distinguishes various, largely independent dimensions of consent. RESULTS A total of 93 publications were analysed for this review. Several studies reach opposing conclusions concerning the best approach to consent within a LHS. However, in the light of the conceptual framework we developed, we found that many of these results are distorted by the conflation between various characteristics of consent. Thus, when these characteristics are distinguished, the results mainly suggest the prime importance of the communication process, by contrast to the scope of consent or the kind of action required by participants (opt-in/opt-out). We identified two models of consent that were especially relevant for our purpose: metaconsent and dynamic consent. CONCLUSIONS Our review shows the importance of distinguishing carefully the various features of the consent process. It also suggests that the metaconsent model is a valuable model within a LHS, as it addresses many of the issues raised with regards to feasibility and acceptability. We propose to complement this model by adding the modalities of the information process to the dimensions relevant in the metaconsent process.
Collapse
Affiliation(s)
- Annabelle Cumyn
- Département de médecine, Faculté de médecine et des sciences de la santéUniversité de SherbrookeQuebecCanada
- Groupe de recherche interdisciplinaire en informatique de la santé (GRIIS), Faculté de médecine et des sciences de la santé/Faculté des sciencesUniversité de SherbrookeQuebecCanada
| | - Adrien Barton
- Groupe de recherche interdisciplinaire en informatique de la santé (GRIIS), Faculté de médecine et des sciences de la santé/Faculté des sciencesUniversité de SherbrookeQuebecCanada
- Centre national de la recherche scientifique ‐ Institut de recherche en informatique de Toulouse (CNRS‐IRIT)ToulouseFrance
| | - Roxanne Dault
- Groupe de recherche interdisciplinaire en informatique de la santé (GRIIS), Faculté de médecine et des sciences de la santé/Faculté des sciencesUniversité de SherbrookeQuebecCanada
| | - Anne‐Marie Cloutier
- Groupe de recherche interdisciplinaire en informatique de la santé (GRIIS), Faculté de médecine et des sciences de la santé/Faculté des sciencesUniversité de SherbrookeQuebecCanada
| | - Rosalie Jalbert
- Groupe de recherche interdisciplinaire en informatique de la santé (GRIIS), Faculté de médecine et des sciences de la santé/Faculté des sciencesUniversité de SherbrookeQuebecCanada
| | - Jean‐François Ethier
- Département de médecine, Faculté de médecine et des sciences de la santéUniversité de SherbrookeQuebecCanada
- Groupe de recherche interdisciplinaire en informatique de la santé (GRIIS), Faculté de médecine et des sciences de la santé/Faculté des sciencesUniversité de SherbrookeQuebecCanada
| |
Collapse
|
16
|
Broad consent in practice: lessons learned from a hospital-based biobank for prospective research on genomic and medical data. Eur J Hum Genet 2020; 28:915-924. [PMID: 32086443 DOI: 10.1038/s41431-020-0585-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/15/2019] [Accepted: 01/28/2020] [Indexed: 11/08/2022] Open
Abstract
Broad consent is increasingly recommended as an acceptable consent model for biobanking human samples and health data with a view to their future use in research. Empirical evidence on the practice of broad consent and its implementation in the hospital setting, however, is still very limited. We analyse and discuss results from a qualitative study of perceptions of a sample of patients and biobank recruiters regarding broad consent to participate in a hospital-based biobank for prospective research on genomic and health data. Our findings suggest that contextual and relational factors play an important role in the practice of broad consent, and illustrate that broad consent relies as much on intuition as on reasoning. Moreover, we show that seeking broad consent in the hospital affects patient-recruiter interaction and that "conditional" trust plays a significant role in broad-consent decision-making. In conclusion, we provide recommendations to improve patient autonomy in the context of hospital-based broad consent.
Collapse
|
17
|
Hallinan D. Broad consent under the GDPR: an optimistic perspective on a bright future. LIFE SCIENCES, SOCIETY AND POLICY 2020; 16:1. [PMID: 31903508 PMCID: PMC6943899 DOI: 10.1186/s40504-019-0096-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
Broad consent - the act of gaining one consent for multiple potential future research projects - sits at the core of much current genomic research practice. Since the 25th May 2018, the General Data Protection Regulation (GDPR) has applied as valid law concerning genomic research in the EU and now occupies a dominant position in the legal landscape. Yet, the position of the GDPR concerning broad consent has recently been cause for concern in the genomic research community. Whilst the text of the GDPR apparently supports the practice, recent jurisprudence contains language which is decidedly less positive. This article takes an in-depth look at the situation concerning broad consent under the GDPR and - despite the understandable concern flowing from recent jurisprudence - offers a positive outlook. This positive outlook is argued from three perspectives, each of which is significant in defining the current, and ongoing, legitimacy and utility of broad consent under the GDPR: the principled, the legal technical, and the practical.
Collapse
Affiliation(s)
- Dara Hallinan
- FIZ Karlsruhe - Leibniz-Institut für Informationsinfrastruktur, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany.
| |
Collapse
|
18
|
Peppercorn J, Campbell E, Isakoff S, Horick NK, Rabin J, Quain K, Sequist LV, Bardia A, Collyar D, Hlubocky F, Mathews D. Patient Preferences for Use of Archived Biospecimens from Oncology Trials When Adequacy of Informed Consent Is Unclear. Oncologist 2020; 25:78-86. [PMID: 31492767 PMCID: PMC6964122 DOI: 10.1634/theoncologist.2019-0365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Oncology research increasingly involves biospecimen collection and data sharing. Ethical challenges emerge when researchers seek to use archived biospecimens for purposes that were not well defined in the original informed consent document (ICD). We sought to inform ongoing policy debates by assessing patient views on these issues. MATERIALS AND METHODS We administered a cross-sectional self-administered survey to patients with cancer at an academic medical center. Survey questions addressed attitudes toward cancer research, willingness to donate biospecimens, expectations regarding use of biospecimens, and preferences regarding specific ethical dilemmas. RESULTS Among 240 participants (response rate 69%), virtually all (94%) indicated willingness to donate tissue for research. Most participants (86%) expected that donated tissue would be used for any research deemed scientifically important, and virtually all (94%) expected that the privacy of their health information would be protected. Broad use of stored biospecimens and data sharing with other researchers increased willingness to donate tissue. For three scenarios in which specific consent for proposed biobank research was unclear within the ICD, a majority of patient's favored allowing the research to proceed: 76% to study a different cancer, 88% to study both inherited (germline) and tumor specific (somatic) mutations, and 70% to permit data sharing. A substantial minority believed that research using stored biospecimens should only proceed with specific consent. CONCLUSION When debates arise over appropriate use of archived biospecimens, the interests of the research participants in seeing productive use of their blood or tissue should be considered, in addition to addressing concerns about potential risks and lack of specific consent. IMPLICATIONS FOR PRACTICE This survey evaluated views of patients with cancer regarding the permissible use of stored biospecimens from cancer trials when modern scientific methods are not well described in the original informed consent document. The vast majority of patients support translational research and expect that any biospecimens they donate will be used to advance knowledge. When researchers, policy makers, and those charged with research oversight debate use of stored biospecimens, it is important to recognize that research participants have an interest in productive use of their blood, tissue, or data, in addition to considerations of risks and the adequacy of documented consent.
Collapse
Affiliation(s)
- Jeffrey Peppercorn
- Division of Hematology/Oncology, Massachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Eric Campbell
- Mongan Institute Health Policy Center, Massachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Steve Isakoff
- Division of Hematology/Oncology, Massachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Nora K. Horick
- MGH Biostatistics Center, Massachusetts General HospitalBostonMassachusettsUSA
| | - Julia Rabin
- Mongan Institute Health Policy Center, Massachusetts General HospitalBostonMassachusettsUSA
| | - Katharine Quain
- Division of Hematology/Oncology, Massachusetts General HospitalBostonMassachusettsUSA
| | - Lecia V. Sequist
- Division of Hematology/Oncology, Massachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Aditya Bardia
- Division of Hematology/Oncology, Massachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Fay Hlubocky
- Section of Hematology/Oncology, Department of Medicine, MacLean Center for Clinical Medical Ethics, The Cancer Research Center, The University of ChicagoChicagoIllinoisUSA
| | - Debra Mathews
- Department of Pediatrics, Berman Institute of Bioethics, Johns Hopkins UniversityBaltimoreMarylandUSA
| |
Collapse
|
19
|
Jahns R, Geiger J, Schlünder I, Strech D, Brumhard M, von Kielmansegg SG. Broad donor consent for human biobanks in Germany and Europe: a strategy to facilitate cross-border sharing and exchange of human biological materials and related data. J LAB MED 2019. [DOI: 10.1515/labmed-2017-0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Human biobanks are generally recognized as essential resources for effective biomedical research. All over the world biosamples and data from human subjects are collected in large biobanks. The biological material is stored long term for current and future (undetermined) research issues, which often require cross-border exchange of biosamples and related data.
Content
Commonly, the informed consent for research on human biospecimen is intended to cover only defined, specific research objectives. In June 2016, the biobank Task-Force of the Working Party of the German Medical Ethics Committees (WP-GMEC) updated its template for the broad use of human biological samples and related data. It complies with the current Organisation for Economic Co-operation and Development (OECD) and World Medical Association (WMA) recommendations and furnishes a framework that permits long-term storage and multi-purpose research use of human biological material and related data, including cross-border research.
However, both (i) human biobanks storing and (ii) research projects requesting “broad consent” biological samples generally require an ethical approval; in addition, “broad consent” conditions should be reciprocated by making biobank processes transparent and by fostering both donor and public involvement.
Outlook
The broad consent template of the WP-GMEC clearly states that biological samples and data donated for medical research serve to address current and future research questions. It appears perfectly suited as a template for a Europe-wide harmonized broad consent facilitating biobank-based cross-border research.
Collapse
|
20
|
Broad-scale informed consent: A survey of the CTSA landscape. J Clin Transl Sci 2019; 3:253-260. [PMID: 31660250 PMCID: PMC6813518 DOI: 10.1017/cts.2019.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction: Research opportunities associated with the proliferation of the electronic health record (EHR), big data initiatives, and innovative approaches to trial design can present challenges for obtaining and documenting informed consent. Broad-scale informed consent (a term used herein to describe institutional models, rather than the Common Rule’s strict regulatory definition for “broad consent”) may facilitate the use of existing data and samples and speed the pace of research by minimizing barriers to consent. We explored the use of broad-scale informed consent within the Clinical Translational Science Award (CTSA) Program Network. Methods: We surveyed CTSA Hubs concerning policies, practices, experiences, and needs within three domains of broad-scale informed consent: (1) participant recontact; (2) biospecimens; and (3) clinical data sharing. Results: Of 61 CTSA Hubs surveyed, 37 (61%) indicated ongoing work related to at least 1 domain of broad-scale informed consent; 18 Hubs (30%) reported work in all 3 domains. The EHR predominated as the implementation system across all three domains. Research and IT leadership and the Institutional Review Board were most commonly endorsed as institutional drivers, while systems/technical issues and impact on clinical workflow were the most commonly reported barriers. Conclusions: While survey results indicate considerable variability in the implementation of broad-scale informed consent across the CTSA consortium, it is clear that all CTSA Hubs are actively considering policy and process related to these concepts. Next steps cluster within three areas: training and workforce development, streamlined policies and templates, and implementation strategies that facilitate integration into clinical workflow.
Collapse
|
21
|
Fachiroh J, Dwianingsih EK, Wahdi AE, Pramatasari FLT, Hariyanto S, Pastiwi N, Yunus J, Mendy M, Scheerder B, Lazuardi L. Development of a Biobank from a Legacy Collection in Universitas Gadjah Mada, Indonesia: Proposed Approach for Centralized Biobank Development in Low-Resource Institutions. Biopreserv Biobank 2019; 17:387-394. [PMID: 31009252 DOI: 10.1089/bio.2018.0125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: The establishment of a biobank requires specific expertise along with relatively expensive infrastructure and appropriate technology. This causes certain challenges in biobank implementation for research in low-middle-income countries. Biobank development with established specimens and data collection (legacy collection) was an approach used in the Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada. This approach aimed to identify the resources available at present, while providing nontechnical information for further development of a centralized biobank. Materials and Methods: Retrospective modeling was done in 2015 by recruiting existing specimen collections and their associated data. The steps were as follows: (1) informing research stakeholders through discussion with experts and stakeholders; (2) identifying specimen collections to be used; (3) determining the system, infrastructure, and consumables needed; (4) determining inclusion criteria; (5) building an in-house database system; (6) organizing data and physical specimen collections; and (7) validating data and physical sample arrangement. All technical procedures were built into standard operating procedures. Results: The model included specimens from one -80°C freezer. The associated data included demographic, clinical diagnosis, and physical sample information. Samples came from six studies, collected between 2001 and 2014. A web-based database was built based on the MySQL programming system. Information on biospecimens from a total of 4196 subjects collected in 11,358 vials was entered into the database, following physical rearrangement of vials in the -80°C freezer with one-dimensional barcodes taped to vials, boxes, and racks. A validation test was done for data concordance between the database and physical arrangement in the -80°C freezer, showing no discrepancies. Conclusion: This report demonstrated current technical and nontechnical insights to further develop a centralized biobank for health research at an academic institution in Indonesia.
Collapse
Affiliation(s)
- Jajah Fachiroh
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
- Biobank Development Team, Molecular Biology Laboratory, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| | - Ery Kus Dwianingsih
- Biobank Development Team, Molecular Biology Laboratory, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| | - Amirah Ellyza Wahdi
- Biobank Development Team, Molecular Biology Laboratory, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
- Center for Reproductive Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| | - F Linda Tri Pramatasari
- Biobank Development Team, Molecular Biology Laboratory, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| | - Sunandar Hariyanto
- Biobank Development Team, Molecular Biology Laboratory, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
- Information Technology Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| | - Nenes Pastiwi
- Biobank Development Team, Molecular Biology Laboratory, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| | - Junaedy Yunus
- Department of Anatomy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| | - Maimuna Mendy
- Education and Training Program, The International Agency for Research in Cancer (IARC), Lyon, France
| | - Bart Scheerder
- Biobank University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Lutfan Lazuardi
- Biobank Development Team, Molecular Biology Laboratory, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
- Department of Health Management and Policy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (FK-KMK UGM), Yogyakarta, Indonesia
| |
Collapse
|
22
|
Tai CG, Harris-Wai J, Schaefer C, Liljestrand P, Somkin CP. Multiple Stakeholder Views on Data Sharing in a Biobank in an Integrated Healthcare Delivery System: Implications for Biobank Governance. Public Health Genomics 2019; 21:207-216. [PMID: 31167204 DOI: 10.1159/000500442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Beginning in 2005, researchers at Kaiser Permanente Northern California (KPNC) Division of Research developed the Research Program on Genes, Environment, and Health (RPGEH), a research resource of linked biospecimens, health surveys, and electronic health records on more than 200,000 adult KPNC members. This study examined multiple stakeholders' values and preferences regarding protection of participants' privacy and wide sharing of participant data by RPGEH. METHODS We conducted 45 semi-structured interviews in person or via phone and two focus groups with seven stakeholder groups, including RPGEH participants and decliners who are KPNC members, KPNC research scientists, external scientists, leadership, Human Subjects Research Protection Program staff, and RPGEH Community Advisory Panel members. RESULTS Three major themes emerged related to: (1) perceived individual and social harms associated with data sharing; (2) concerns to address when governing access to RPGEH data; and (3) impact of a blurred boundary between research and clinical care in the context of biobanking. CONCLUSIONS The study results were considered in the development of RPGEH data governance and motivated the inclusion of KPNC Community Advisory Panel members and ELSI experts on committees that evaluate data access proposals. Our findings can help inform other biobanks going through similar processes developing data sharing and access policies.
Collapse
Affiliation(s)
- Caroline G Tai
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
| | - Julie Harris-Wai
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Catherine Schaefer
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Petra Liljestrand
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Carol P Somkin
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA, .,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA,
| |
Collapse
|
23
|
Caliebe A, Scherag A, Strech D, Mansmann U. [Scientific and ethical evaluation of projects in data-driven medicine]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:765-772. [PMID: 31073661 DOI: 10.1007/s00103-019-02958-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The generation and usage of extensive data from medical care aims at answering crucial medical research questions. Buzzwords in this area are learning health system, data-driven medicine and big data. In addition to classical biostatistical methods, machine learning approaches are frequently applied for analysis.In the evaluation of projects from data-driven medicine by research ethics committees, the question arises of how to assess the benefit-risk ratio and the scientific and social value. Which knowledge is required for that purpose? How can research ethics committees prepare for these challenges? Scientific approaches from the area of observational studies and the consideration of agreed-upon ethical aspects (consent, validity, justice, benefit-risk ratio and transparency) can help to answer the above-mentioned questions. One has to bear in mind that data-driven medicine is no paradigm shift that in principle challenges the established scientific and ethical evaluation procedures. Nevertheless, the evaluation of projects from data-driven medicine requires enhanced specialisation and comprehensive methodical expertise from the areas of machine learning and observational studies.Empirical research of the progression and governance of data-driven medicine will support the development and continual adaptation of effective strategies for evaluation by research ethics committees. Training and networking of experts will enable us to meet the challenges of data-driven medicine.
Collapse
Affiliation(s)
- Amke Caliebe
- Institut für Medizinische Informatik und Statistik, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - André Scherag
- Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Universitätsklinikum Jena, Jena, Deutschland
| | - Daniel Strech
- AG "Translationale Bioethik", QUEST - Center, Berliner Institut für Gesundheitsforschung (BIG/BIH), Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ulrich Mansmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Lehrstuhl Medizinische Biometrie und Bioinformatik, LMU München, Marchioninistraße 15, 81377, München, Deutschland.
| |
Collapse
|
24
|
Patient views on research use of clinical data without consent: Legal, but also acceptable? Eur J Hum Genet 2019; 27:841-847. [PMID: 30683927 DOI: 10.1038/s41431-019-0340-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/27/2018] [Accepted: 12/25/2018] [Indexed: 01/11/2023] Open
Abstract
The research exemption implemented in the new EU General Data Protection Regulation (EU-GDPR) gives member states leeway in determining whether patient consent is required for secondary data use in medical research. However, even though broad consent has become common in data-rich medical research in many EU countries, giving up consent altogether is likely to be controversial. The aim of this study was to examine whether abolishing consent for secondary data use would be acceptable to patients. A questionnaire study was conducted among 700 outpatients of a northern German university hospital to assess their attitude towards use of clinical data for scientific research without consent. There was both strong willingness to give broad consent for secondary data use (468 of 503 responders, 93.0%) and strong approval of abolishing patient consent (n = 381, 75.7%) among study participants. The willingness to give consent was moderately associated with approval of the respective stipulations by the EU-GDPR. In research settings where broad consent is widely accepted (e.g. university hospitals), abolishing consent for secondary research use of clinical data will likely be acceptable to a large majority of patients.
Collapse
|
25
|
Ursin L, Stuifbergen M. Ethics of dead participants: policy recommendations for biobank research. JOURNAL OF MEDICAL ETHICS 2018; 44:695-699. [PMID: 29921618 DOI: 10.1136/medethics-2017-104241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 02/05/2018] [Accepted: 05/17/2018] [Indexed: 05/04/2023]
Abstract
Respecting people's consent choices for use of their material and data is a cornerstone of biobank ethics. Participation in biobanks is characteristically based on broad consent that presupposes an ongoing possibility of informing and interacting with participants over time. The death of a participant means the end of any interaction, but usually not the end of participation. Research on causes of death makes biobank material from deceased participants extremely valuable. But as new research questions and methods develop over time, the question arises whether stored biobank material from deceased persons still can be used on the basis of their broad consent. In this paper, we discuss policies for postmortem use of biobank material, including consent options, proxy consent and criteria for limitation of types of use and duration of storage. We conclude that the interests of participants in biobank research are best served by asking at enrolment if and how the biobank material may be used after death. We state that the use of biobank material from deceased participants should be delimited both by their consent and by the prevailing broad consent choices of living participants.Biobanks also need to inform participants at enrolment about the duration of storage of biobank material or at minimum have procedures for deciding how long material will be stored for and for which purpose. For older collections, in the absence of such information or consent options, relevant authorities should decide.
Collapse
Affiliation(s)
- Lars Ursin
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway
| | - Maria Stuifbergen
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway
| |
Collapse
|
26
|
Jahns R, Schirmacher P. [The current ethical and legal framework for human biobanks]. DER PATHOLOGE 2018; 39:445-448. [PMID: 30076434 DOI: 10.1007/s00292-018-0472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- R Jahns
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw), Universitätsklinikum Würzburg, Straubmühlweg 2a, 97078, Würzburg, Deutschland.
| | - P Schirmacher
- Pathologisches Institut, Universität Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.
| |
Collapse
|
27
|
Abstract
With the ethical, legal, and societal issues (ELSI) Knowledge Base, we introduce a key element of the Biobanking and Biomolecular Resources Research Infrastructure-European Research Infrastructure Consortium (BBMRI-ERIC) Common Service ELSI, which provides ethical, legal, and societal support for researchers and biobankers involved in transnational research. In contrast to the customized support provided by the ELSI Helpdesk, the ELSI Knowledge Base will be available to the user on a self-serve basis. The information that is made available through a knowledge base comes from multiple sources, usually from several expert contributors who are well versed in the subject matter. The knowledge base provides users with a first orientation on the subject matter, as well as allowing them to explore more detailed information if desired in a self-service manner. It is crucial that the information and knowledge provided are shared in a manner that is user friendly. Long lists of links, legalistic language, and multiple links have to be avoided wherever possible. The long-term sustainability and accuracy of a knowledge base need to be ensured by placing its expert curation and technical maintenance under the responsibility of an organization rather than a research consortium. In its core, it builds on a scenario-based approach using a nonlegalistic language. In addition, the knowledge base connects to frequently asked questions, promotes contract and informed consent templates, how-to-guides, best-practice models, and scripts. The ELSI Knowledge Base is a key element of the BBMRI-ERIC Common Service ELSI, which currently serves biobanks but will be enlarged to serve the biological and medical sciences community. In contrast to the ELSI Helpdesk, which provides customized support, the ELSI Knowledge Base is available to the user on a self-serve basis. The conceptualization of the ELSI Knowledge Base builds on assessments of several ethical, legal, and societal guidance tools that favor a single sustainable knowledge base for closing the knowledge gap by providing practical hands-on guidance for researchers. Ultimately, the ELSI Knowledge Base aims at promoting practical know-how and skills for conducting responsible research.
Collapse
|
28
|
Tomlinson T, De Vries RG, Kim HM, Gordon L, Ryan KA, Krenz CD, Jewell S, Kim SYH. Effect of deliberation on the public's attitudes toward consent policies for biobank research. Eur J Hum Genet 2018; 26:176-185. [PMID: 29348694 PMCID: PMC5838972 DOI: 10.1038/s41431-017-0063-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 11/02/2017] [Accepted: 11/18/2017] [Indexed: 01/07/2023] Open
Abstract
In this study, we evaluate the effect of education and deliberation on the willingness of members of the public to donate tissue to biobank research and on their attitudes regarding various biobank consent policies. Participants were randomly assigned to a democratic deliberation (DD) group, an education group that received only written materials, and a control group. Participants completed a survey before the deliberation and two surveys post-deliberation: one on (or just after) the deliberation day, and one 4 weeks later. Subjects were asked to rate 5 biobank consent policies as acceptable (or not) and to identify the best and worst policies. Analyses compared acceptability of different policy options and changes in attitudes across the three groups. After deliberation, subjects in the DD group were less likely to find broad consent (defined here as consent for the use of donations in an unspecified range of future research studies, subject to content and process restrictions) and study-by-study consent acceptable. The DD group was also significantly less likely to endorse broad consent as the best policy (OR = 0.34), and more likely to prefer alternative consent options. These results raise ethical challenges to the current widespread reliance on broad consent in biobank research, but do not support study-by-study consent.
Collapse
Affiliation(s)
- Tom Tomlinson
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA.
| | - Raymond G De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - H Myra Kim
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Linda Gordon
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chris D Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Scott Jewell
- Van Andel Research Institute, Grand Rapids, MI, USA
| | - Scott Y H Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
29
|
Mc Cord KA, Al-Shahi Salman R, Treweek S, Gardner H, Strech D, Whiteley W, Ioannidis JPA, Hemkens LG. Routinely collected data for randomized trials: promises, barriers, and implications. Trials 2018; 19:29. [PMID: 29325575 PMCID: PMC5765645 DOI: 10.1186/s13063-017-2394-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Routinely collected health data (RCD) are increasingly used for randomized controlled trials (RCTs). This can provide three major benefits: increasing value through better feasibility (reducing costs, time, and resources), expanding the research agenda (performing trials for research questions otherwise not amenable to trials), and offering novel design and data collection options (e.g., point-of-care trials and other designs directly embedded in routine care). However, numerous hurdles and barriers must be considered pertaining to regulatory, ethical, and data aspects, as well as the costs of setting up the RCD infrastructure. Methodological considerations may be different from those in traditional RCTs: RCD are often collected by individuals not involved in the study and who are therefore blinded to the allocation of trial participants. Another consideration is that RCD trials may lead to greater misclassification biases or dilution effects, although these may be offset by randomization and larger sample sizes. Finally, valuable insights into external validity may be provided when using RCD because it allows pragmatic trials to be performed. METHODS We provide an overview of the promises, challenges, and potential barriers, methodological implications, and research needs regarding RCD for RCTs. RESULTS RCD have substantial potential for improving the conduct and reducing the costs of RCTs, but a multidisciplinary approach is essential to address emerging practical barriers and methodological implications. CONCLUSIONS Future research should be directed toward such issues and specifically focus on data quality validation, alternative research designs and how they affect outcome assessment, and aspects of reporting and transparency.
Collapse
Affiliation(s)
- Kimberly A. Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics (CEB), Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland
| | | | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD UK
| | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB UK
| | - John P. A. Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford School of Medicine, Palo Alto, CA 94304 USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305 USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305 USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA 94305 USA
| | - Lars G. Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics (CEB), Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031 Basel, Switzerland
| |
Collapse
|
30
|
Bossert S, Kahrass H, Heinemeyer U, Prokein J, Strech D. Participatory improvement of a template for informed consent documents in biobank research - study results and methodological reflections. BMC Med Ethics 2017; 18:78. [PMID: 29262814 PMCID: PMC5738718 DOI: 10.1186/s12910-017-0232-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/27/2017] [Indexed: 01/18/2023] Open
Abstract
Background For valid informed consent, it is crucial that patients or research participants fully understand all that their consent entails. Testing and revising informed consent documents with the assistance of their addressees can improve their understandability. In this study we aimed at further developing a method for testing and improving informed consent documents with regard to readability and test-readers’ understanding and reactions. Methods We tested, revised, and retested template informed consent documents for biobank research by means of 11 focus group interviews with members from the documents’ target population. For the analysis of focus group excerpts we used qualitative content analysis. Revisions were made based on focus group feedback in an iterative process. Results Focus group participants gave substantial feedback on the original and on the revised version of the tested documents. Revisions included adding and clarifying explanations, including an info-box summarizing the main points of the text and an illustrative graphic. Conclusion Our results indicate positive effects on the tested and revised informed consent documents in regard to general readability and test-readers’ understanding and reactions. Participatory methods for improving informed consent should be more often applied and further evaluated for both, medical interventions and clinical research. Particular conceptual and methodological challenges need to be addressed in the future. Electronic supplementary material The online version of this article (10.1186/s12910-017-0232-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sabine Bossert
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Hannes Kahrass
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ulrike Heinemeyer
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,MEDIAN Centre for Behavioural Medicine, Bad Pyrmont, Germany
| | - Jana Prokein
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| |
Collapse
|
31
|
Bossert S, Strech D. An integrated conceptual framework for evaluating and improving 'understanding' in informed consent. Trials 2017; 18:482. [PMID: 29041981 PMCID: PMC5645914 DOI: 10.1186/s13063-017-2204-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/22/2017] [Indexed: 01/12/2023] Open
Abstract
Background The development of understandable informed consent (IC) documents has proven to be one of the most important challenges in research with humans as well as in healthcare settings. Therefore, evaluating and improving understanding has been of increasing interest for empirical research on IC. However, several conceptual and practical challenges for the development of understandable IC documents remain unresolved. Methods In this paper, we will outline and systematize some of these challenges. On the basis of our own experiences in empirical user testing of IC documents as well as the relevant literature on understanding in IC, we propose an integrated conceptual model for the development of understandable IC documents. Results The proposed conceptual model integrates different methods for the participatory improvement of written information, including IC, as well as quantitative methods for measuring understanding in IC. Conclusions In most IC processes, understandable written information is an important prerequisite for valid IC. To improve the quality of IC documents, a conceptual model for participatory procedures of testing, revising, and retesting can be applied. However, the model presented in this paper needs further theoretical and empirical elaboration and clarification of several conceptual and practical challenges.
Collapse
Affiliation(s)
- Sabine Bossert
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| |
Collapse
|
32
|
Hake AM, Dacks PA, Arnerić SP. Concise informed consent to increase data and biospecimen access may accelerate innovative Alzheimer's disease treatments. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:536-541. [PMID: 29124112 PMCID: PMC5671623 DOI: 10.1016/j.trci.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction Informed consent forms that restrict the distribution of data and samples have been an impediment to advancing Alzheimer's disease (AD) understandings and treatments. The Coalition Against Major Disease public-private partnership developed concise addenda to responsibly broaden data access of informed consent forms. Methods Coalition Against Major Disease members identified key elements for ensuring data and biospecimen access, and patient privacy protection according to applicable US law. Collaboration with the Alzheimer's Association established the understandability and relevance of the addenda with AD patients and Care Partners. Results Two key findings are (1) patients with dementia and Care Partners were shocked that their data and samples are not broadly shared and (2) with diverse feedback, two concise addenda were created to enable data and sample sharing both within and outside future sponsored studies (see Boxes). Discussion Increasing the access of valuable anonymized patient-level clinical trial data has the potential to inform the foundational and regulatory science required to deliver innovative treatments for AD.
Collapse
Affiliation(s)
- Ann M Hake
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Penny A Dacks
- Alzheimer Drug Discovery Foundation, New York City, NY, USA
| | | | | |
Collapse
|
33
|
Broad consent for health care-embedded biobanking: understanding and reasons to donate in a large patient sample. Genet Med 2017. [PMID: 28640237 DOI: 10.1038/gim.2017.82] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PurposeTo facilitate ethically acceptable and practically successful health care-embedded biobanking, the attitudes and understanding of patients and their motivation to participate need to be explored.MethodsA questionnaire study was conducted among 760 outpatients of a northern German university hospital to assess their awareness of, and motivation for giving broad consent to health care-embedded biobanking, also addressing the issue of feedback on individual-level research findings.ResultsThe overall willingness to give broad consent was high (86.9%) in our study, even though the subjective and objective understanding of patients was found to be only modest. Most participants who consented did so for prosocial reasons (altruism, solidarity, reciprocity, gratitude), whereas self-interest or worries about disadvantages played only a marginal role. Better objective understanding was associated with both a greater demand for feedback on individual research findings and a higher willingness to consent. Intermittent modification of the information material provided by the hospital led to significantly improved objective understanding.ConclusionPatient willingness to give broad consent to health care-embedded biobanking is high, with prosocial reasons driving decision making more than factual knowledge and approval or disapproval of specific consent elements. Future efforts to improve the information material used in health care-embedded biobanking should therefore emphasize prosocial reasons to consent.
Collapse
|
34
|
Barazzetti G, Cavalli S, Benaroyo L, Kaufmann A. “Still Rather Hazy at Present”: Citizens' and Physicians' Views on Returning Results from Biobank Research Using Broad Consent. Genet Test Mol Biomarkers 2017; 21:159-165. [DOI: 10.1089/gtmb.2016.0412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gaia Barazzetti
- Institute of History of Medicine and Public Health, University of Lausanne–CHUV University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne–CHUV University Hospital, Lausanne, Switzerland
| | - Samuele Cavalli
- Institute of History of Medicine and Public Health, University of Lausanne–CHUV University Hospital, Lausanne, Switzerland
| | - Lazare Benaroyo
- Faculty of Biology and Medicine, and Ethos–Interdisciplinary Ethics Platform, University of Lausanne, Lausanne, Switzerland
| | - Alain Kaufmann
- Science-Society Interface, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
35
|
Langhof H, Kahrass H, Sievers S, Strech D. Access policies in biobank research: what criteria do they include and how publicly available are they? A cross-sectional study. Eur J Hum Genet 2017; 25:293-300. [PMID: 28000694 PMCID: PMC5315509 DOI: 10.1038/ejhg.2016.172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/31/2016] [Accepted: 11/01/2016] [Indexed: 12/22/2022] Open
Abstract
Access policies of biobanks specify the governance of sample and data sharing. Basic guidance on relevant access criteria exists, but so far little is known about their public availability and what criteria for access and prioritization they actually include. Access policies were gathered by hand searching the websites of biobanks identified via registries (eg, BBMRI and P3G), and by additional search strategies. Criteria for access and prioritization were synthesized by thematic analysis. Of 523 biobank websites screened, 9% included a publicly available access policy. With all applied search strategies, we finally retrieved 74 access policies. Thematic analysis resulted in 62 different access criteria in three main categories: (a) scientific quality, (b) value and (c) ethical soundness. 'Scientific quality' criteria were mentioned in 70% of all policies, 'value' criteria in 33% and 'ethical soundness' criteria in 73%. Criteria for prioritization were specified in 27% of all policies. Access policies differed broadly in number, specification and operationalization of the included access criteria. In order to make biobank research more effective, efficient and trustworthy, access policies should be more available to the public. Furthermore, access policies should aim for precise and more harmonized wording of access criteria. From a public and governance perspective, the issue of how to prioritize access to scarce samples should form part of access policies.
Collapse
Affiliation(s)
- Holger Langhof
- Institute for History, Ethics and Philosophy of Medicine, CELLS – Centre for Ethics and Law in the Life Sciences, Hannover Medical School (MHH), Hannover, Germany
| | - Hannes Kahrass
- Institute for History, Ethics and Philosophy of Medicine, CELLS – Centre for Ethics and Law in the Life Sciences, Hannover Medical School (MHH), Hannover, Germany
| | - Sören Sievers
- Institute for History, Ethics and Philosophy of Medicine, CELLS – Centre for Ethics and Law in the Life Sciences, Hannover Medical School (MHH), Hannover, Germany
| | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, CELLS – Centre for Ethics and Law in the Life Sciences, Hannover Medical School (MHH), Hannover, Germany
| |
Collapse
|
36
|
Böhm R, Cascorbi I. Pharmacogenetics and Predictive Testing of Drug Hypersensitivity Reactions. Front Pharmacol 2016; 7:396. [PMID: 27818635 PMCID: PMC5073094 DOI: 10.3389/fphar.2016.00396] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/07/2016] [Indexed: 12/15/2022] Open
Abstract
Adverse drug reactions adverse drug reaction (ADR) occur in approximately 17% of patients. Avoiding ADR is thus mandatory from both an ethical and an economic point of view. Whereas, pharmacogenetics changes of the pharmacokinetics may contribute to the explanation of some type A reactions, strong relationships of genetic markers has also been shown for drug hypersensitivity belonging to type B reactions. We present the classifications of ADR, discuss genetic influences and focus on delayed-onset hypersensitivity reactions, i.e., drug-induced liver injury, drug-induced agranulocytosis, and severe cutaneous ADR. A guidance how to read and interpret the contingency table is provided as well as an algorithm whether and how a test for a pharmacogenetic biomarker should be conducted.
Collapse
Affiliation(s)
- Ruwen Böhm
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein Kiel, Germany
| |
Collapse
|
37
|
Chin WWL, Wieschowski S, Prokein J, Illig T, Strech D. Ethics Reporting in Biospecimen and Genetic Research: Current Practice and Suggestions for Changes. PLoS Biol 2016; 14:e1002521. [PMID: 27483445 PMCID: PMC4970810 DOI: 10.1371/journal.pbio.1002521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Modern approaches for research with human biospecimens employ a variety of substantially different types of ethics approval and informed consent. In most cases, standard ethics reporting such as “consent and approval was obtained” is no longer meaningful. A structured analysis of 120 biospecimen studies recently published in top journals revealed that more than 85% reported on consent and approval, but in more than 90% of cases, this reporting was insufficient and thus potentially misleading. Editorial policies, reporting guidelines, and material transfer agreements should include recommendations for meaningful ethics reporting in biospecimen research. Meaningful ethics reporting is possible without higher word counts and could support public trust as well as networked research. This Perspective shows that while ethics reporting on consent and approval for biospecimen research is widespread, for the majority of cases it is not meaningful; the authors make pragmatic suggestions of substantial changes needed to remedy this.
Collapse
Affiliation(s)
- William Wei Lim Chin
- Institute for History, Ethics, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Susanne Wieschowski
- Institute for History, Ethics, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Jana Prokein
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Daniel Strech
- Institute for History, Ethics, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
- * E-mail:
| |
Collapse
|