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Majeed S, Johnston C, Saeedi S, Mighton C, Rokoszak V, Abbasi I, Grewal S, Aguda V, Kissoondoyal A, Malkin D, Bombard Y. International policies guiding the selection, analysis, and clinical management of secondary findings from genomic sequencing: A systematic review. Am J Hum Genet 2024; 111:2079-2093. [PMID: 39299240 DOI: 10.1016/j.ajhg.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/22/2024] Open
Abstract
Secondary findings (SFs) from genomic sequencing can have significant impacts on patient health, yet existing practices guiding their clinical investigation are inconsistent. We systematically reviewed existing SFs policies to identify variations and gaps in guidance. We cataloged and appraised international policies from academic databases (n = 5, inception-02/2022) and international human genetic societies (n = 64; inception-05/2022), across the continuum of SFs selection, analysis, and clinical management. We assessed quality using AGREE-II and interpreted results using qualitative description. Of the 63 SFs policies identified, most pertained to clinical management of SFs (98%; n = 62; primarily consent and disclosure), some guided SFs analysis (60%; n = 38), while fewer mentioned SFs selection (48%; n = 30). Overall, policies recommend (1) identifying clinically actionable, pathogenic variants with high positive predictive values for disease (selection), (2) bioinformatically filtering variants using evidence-informed gene lists (analysis), and (3) discussing with affected individuals the SFs identified, their penetrance, expressivity, medical implications, and management (clinical management). Best practices for SFs variant analysis, clinical validation, and follow-up (i.e., surveillance, treatment, etc.) were minimally described. Upon quality assessment, policies were highly rated for scope and clarity (median score, 69) but were limited by their rigor and applicability (median scores, 27 and 25). Our review represents a comprehensive international synthesis of policy guiding SFs across the continuum of selection, analysis, and clinical management. Our synthesis will help providers navigate critical decision points in SFs investigation, although significant work is needed to address gaps in SFs analysis, clinical validation, and follow-up processes and to support evidence-based practice.
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Affiliation(s)
- Safa Majeed
- Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christine Johnston
- Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saumeh Saeedi
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Chloe Mighton
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vanessa Rokoszak
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Ilham Abbasi
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sonya Grewal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vernie Aguda
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Ashby Kissoondoyal
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Malkin
- Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Genetics Adviser, Toronto, ON, Canada.
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Lieb W, Strathmann EA, Röder C, Jacobs G, Gaede KI, Richter G, Illig T, Krawczak M. Population-Based Biobanking. Genes (Basel) 2024; 15:66. [PMID: 38254956 PMCID: PMC10815030 DOI: 10.3390/genes15010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Population-based biobanking is an essential element of medical research that has grown substantially over the last two decades, and many countries are currently pursuing large national biobanking initiatives. The rise of individual biobanks is paralleled by various networking activities in the field at both the national and international level, such as BBMRI-ERIC in the EU. A significant contribution to population-based biobanking comes from large cohort studies and national repositories, including the United Kingdom Biobank (UKBB), the CONSTANCES project in France, the German National Cohort (NAKO), LifeLines in the Netherlands, FinnGen in Finland, and the All of Us project in the U.S. At the same time, hospital-based biobanking has also gained importance in medical research. We describe some of the scientific questions that can be addressed particularly well by the use of population-based biobanks, including the discovery and calibration of biomarkers and the identification of molecular correlates of health parameters and disease states. Despite the tremendous progress made so far, some major challenges to population-based biobanking still remain, including the need to develop strategies for the long-term sustainability of biobanks, the handling of incidental findings, and the linkage of sample-related and sample-derived data to other relevant resources.
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Affiliation(s)
- Wolfgang Lieb
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Eike A. Strathmann
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
| | - Christian Röder
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- Institute for Experimental Cancer Research (IET), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Gunnar Jacobs
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Karoline I. Gaede
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- BioMaterialBank (BMB) North, Research Center Borstel, Leibniz Lung Center, 23845 Borstel, Germany
| | - Gesine Richter
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- Institute of Experimental Medicine (IEM), Division of Biomedical Ethics, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Thomas Illig
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- Hannover Unified Biobank (HUB), Hannover Medical School, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), 30625 Hannover, Germany
| | - Michael Krawczak
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- Institute of Medical Informatics and Statistics (IMIS), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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Wolf SM, Green RC. Return of Results in Genomic Research Using Large-Scale or Whole Genome Sequencing: Toward a New Normal. Annu Rev Genomics Hum Genet 2023; 24:393-414. [PMID: 36913714 PMCID: PMC10497726 DOI: 10.1146/annurev-genom-101122-103209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
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Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
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Rebbeck TR, Bridges JFP, Mack JW, Gray SW, Trent JM, George S, Crossnohere NL, Paskett ED, Painter CA, Wagle N, Kano M, Nez Henderson P, Henderson JA, Mishra SI, Willman CL, Sussman AL. A Framework for Promoting Diversity, Equity, and Inclusion in Genetics and Genomics Research. JAMA HEALTH FORUM 2022; 3:e220603. [PMID: 35755401 PMCID: PMC9223088 DOI: 10.1001/jamahealthforum.2022.0603] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
IMPORTANCE Research into the genetic and genomic ("genomics") foundations of disease is central to our understanding of disease prevention, early detection, diagnostic accuracy, and therapeutic intervention. Inequitable participation in genomics research by historically excluded populations limits the ability to translate genomic knowledge to achieve health equity and ensure that findings are generalizable to diverse populations. OBSERVATIONS We propose a novel framework for promoting diversity, equity, and inclusion in genomics research. Building on principles of community-based participatory research and collective impact frameworks, the framework can guide our understanding of the social, cultural, health system, policy, community, and individual contexts in which engagement and genomics research are being done. Our framework highlights the involvement of a multistakeholder team, including the participants and communities to be engaged, to ensure robust methods for recruitment, retention, return of genomic results, quality of engagement, follow-up, and monitoring of participants. CONCLUSIONS AND RELEVANCE The proposed engagement framework will guide investigators in optimizing equitable representation in research and enhancing the rigor of genomics investigation.
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Affiliation(s)
- Timothy R Rebbeck
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - John F P Bridges
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Jennifer W Mack
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Stacy W Gray
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Jeffrey M Trent
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Suzanne George
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Norah L Crossnohere
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Electra D Paskett
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Corrie A Painter
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Nikhil Wagle
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Miria Kano
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Patricia Nez Henderson
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Jeffrey A Henderson
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Shiraz I Mishra
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Cheryl L Willman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Andrew L Sussman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
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Anie KA, Olayemi E, Paintsil V, Owusu-Dabo E, Adeyemo TA, Sani MU, Galadanci NA, Nnodu O, Tluway F, Adjei DN, Mensah P, Sarfo-Antwi J, Nwokobia H, Gambo A, Benjamin A, Salim A, Osae-Larbi JA, Ofori-Acquah SF. Sickle Cell Disease Genomics of Africa (SickleGenAfrica) Network: ethical framework and initial qualitative findings from community engagement in Ghana, Nigeria and Tanzania. BMJ Open 2021; 11:e048208. [PMID: 34301659 PMCID: PMC8311318 DOI: 10.1136/bmjopen-2020-048208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To provide lay information about genetics and sickle cell disease (SCD) and to identify and address ethical issues concerning the Sickle Cell Disease Genomics of Africa Network covering autonomy and research decision-making, risk of SCD complications and organ damage, returning of genomic findings, biorepository, data sharing, and healthcare provision for patients with SCD. DESIGN Focus groups using qualitative methods. SETTING Six cities in Ghana, Nigeria and Tanzania within communities and secondary care. PARTICIPANTS Patients, parents/caregivers, healthcare professionals, community leaders and government healthcare representatives. RESULTS Results from 112 participants revealed similar sensitivities and aspirations around genomic research, an inclination towards autonomous decision-making for research, concerns about biobanking, anonymity in data sharing, and a preference for receiving individual genomic results. Furthermore, inadequate healthcare for patients with SCD was emphasised. CONCLUSIONS Our findings revealed the eagerness of patients and parents/caregivers to participate in genomics research in Africa, with advice from community leaders and reassurance from health professionals and policy-makers, despite their apprehensions regarding healthcare systems.
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Affiliation(s)
- Kofi A Anie
- Faculty of Medicine, Imperial College London, London, UK
- Haematology and Sickle Cell Centre, London North West University Healthcare NHS Trust, London, UK
| | - Edeghonghon Olayemi
- Department of Haematology, University of Ghana Medical School, University of Ghana, Accra, Ghana
- Ghana Institute of Clinical Genetics, Accra, Ghana
| | - Vivian Paintsil
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Titilope Adenike Adeyemo
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Najibah Aliyu Galadanci
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Obiageli Nnodu
- Department of Haematology and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Furahini Tluway
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - David Nana Adjei
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | | | | | | | | | - Arafa Salim
- Community Liaison, Dar es Salaam, Tanzania, United Republic of
| | - Judith A Osae-Larbi
- West African Genetic Medicine Centre (WAGMC), College of Health Sciences, University of Ghana, Legon, Ghana
| | - Solomon Fiifi Ofori-Acquah
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Legon, Ghana
- West African Genetic Medicine Centre (WAGMC), College of Health Sciences, University of Ghana, Legon, Ghana
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6
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Taylor CO, Manov NF, Crew KD, Weng C, Connolly JJ, Chute CG, Ford DE, Lehmann H, Rahm AK, Kullo IJ, Caraballo PJ, Holm IA, Mathews D. Preferences for Updates on General Research Results: A Survey of Participants in Genomic Research from Two Institutions. J Pers Med 2021; 11:399. [PMID: 34065005 PMCID: PMC8151672 DOI: 10.3390/jpm11050399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 01/11/2023] Open
Abstract
There is a need for multimodal strategies to keep research participants informed about study results. Our aim was to characterize preferences of genomic research participants from two institutions along four dimensions of general research result updates: content, timing, mechanism, and frequency. METHODS We conducted a web-based cross-sectional survey that was administered from 25 June 2018 to 5 December 2018. RESULTS 397 participants completed the survey, most of whom (96%) expressed a desire to receive research updates. Preferences with high endorsement included: update content (brief descriptions of major findings, descriptions of purpose and goals, and educational material); update timing (when the research is completed, when findings are reviewed, when findings are published, and when the study status changes); update mechanism (email with updates, and email newsletter); and update frequency (every three months). Hierarchical cluster analyses based on the four update preferences identified four profiles of participants with similar preference patterns. Very few participants in the largest profile were comfortable with budgeting less money for research activities so that researchers have money to set up services to send research result updates to study participants. CONCLUSION Future studies may benefit from exploring preferences for research result updates, as we have in our study. In addition, this work provides evidence of a need for funders to incentivize researchers to communicate results to participants.
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Affiliation(s)
- Casey Overby Taylor
- Department of Medicine, Department of Biomedical Engineering, and The Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Natalie Flaks Manov
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (N.F.M.); (D.E.F.)
| | - Katherine D. Crew
- Department of Medicine and Epidemiology, Columbia University, New York, NY 10032, USA;
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA;
| | - John J. Connolly
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Christopher G. Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Daniel E. Ford
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (N.F.M.); (D.E.F.)
| | - Harold Lehmann
- Department of Medicine, Division of Health Sciences Informatics, Johns Hopkins University, Baltimore, MD 21205, USA;
| | | | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | | | - Ingrid A. Holm
- Division of Genetics and Genomics, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA;
| | - Debra Mathews
- Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD 21205, USA;
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7
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African genetic diversity and adaptation inform a precision medicine agenda. Nat Rev Genet 2021; 22:284-306. [PMID: 33432191 DOI: 10.1038/s41576-020-00306-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/29/2023]
Abstract
The deep evolutionary history of African populations, since the emergence of modern humans more than 300,000 years ago, has resulted in high genetic diversity and considerable population structure. Selected genetic variants have increased in frequency due to environmental adaptation, but recent exposures to novel pathogens and changes in lifestyle render some of them with properties leading to present health liabilities. The unique discoverability potential from African genomic studies promises invaluable contributions to understanding the genomic and molecular basis of health and disease. Globally, African populations are understudied, and precision medicine approaches are largely based on data from European and Asian-ancestry populations, which limits the transferability of findings to the continent of Africa. Africa needs innovative precision medicine solutions based on African data that use knowledge and implementation strategies aligned to its climatic, cultural, economic and genomic diversity.
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8
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Kelly MA, Leader JB, Wain KE, Bodian D, Oetjens MT, Ledbetter DH, Martin CL, Strande NT. Leveraging population-based exome screening to impact clinical care: The evolution of variant assessment in the Geisinger MyCode research project. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:83-94. [PMID: 33576083 DOI: 10.1002/ajmg.c.31887] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023]
Abstract
Exome and genome sequencing are increasingly utilized in research studies and clinical care and can provide clinically relevant information beyond the initial intent for sequencing, including medically actionable secondary findings. Despite ongoing debate about sharing this information with patients and participants, a growing number of clinical laboratories and research programs routinely report secondary findings that increase the risk for selected diseases. Recently, there has been a push to maximize the potential benefit of this practice by implementing proactive genomic screening at the population level irrespective of medical history, but the feasibility of deploying population-scale proactive genomic screening requires scaling key elements of the genomic data evaluation process. Herein, we describe the motivation, development, and implementation of a population-scale variant-first screening pipeline combining bioinformatics-based filtering with a manual review process to screen for clinically relevant findings in research exomes generated through the DiscovEHR collaboration within Geisinger's MyCode® research project. Consistent with other studies, this pipeline yields a screen-positive detection rate between 2.1 and 2.6% (depending on inclusion of those with prior indication-based testing) in 130,048 adult MyCode patient-participants screened for clinically relevant findings in 60 genes. Our variant-first pipeline affords cost and time savings by filtering out negative cases, thereby avoiding analysis of each exome one-by-one, as typically employed in the diagnostic setting. While research is still needed to fully appreciate the benefits of population genomic screening, MyCode provides the first demonstration of a program at scale to help shape how population genomic screening is integrated into routine clinical care.
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Affiliation(s)
| | | | - Karen E Wain
- Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Dale Bodian
- Geisinger Medical Center, Danville, Pennsylvania, USA
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9
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Fadda M, Fiordelli M, Amati R, Falvo I, Ibnidris A, Hurst S, Albanese E. Returning individual-specific results of a dementia prevalence study: insights from prospective participants living in Switzerland. Int J Geriatr Psychiatry 2021; 36:207-214. [PMID: 32869397 PMCID: PMC7756381 DOI: 10.1002/gps.5416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore prospective participants' preferences regarding the return of their individual-specific results from a dementia prevalence study (a probabilistic diagnosis of dementia). METHODS/DESIGN We conducted a qualitative study with 22 individuals aged 45 to 86 and resident in the Canton of Ticino (Switzerland). Participants had previously joined the validation phase of an epidemiological study into dementia and its impact. RESULTS We found that individuals welcome the return of their individual-specific results, provided these meet a number of validity, clinical, and personal utility criteria. They justify researchers' duty to return study findings with the principles of beneficence (eg, providing information that can help participants' medical decision-making) and justice (eg, acknowledging participants' efforts to help research by sharing their personal information). Furthermore, individuals anticipate societal benefits of the return of individual specific study findings, including improved interpersonal relationships among individuals and decreased dementia-related stigma. CONCLUSIONS Our findings suggest that researchers should address the return of individual-specific study results early on during study design and involve prospective participants in identifying both the conditions under which results should be offered and the perceived individual and societal benefits returning can have.
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Affiliation(s)
- Marta Fadda
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Maddalena Fiordelli
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland,Institute of Communication and Health, Faculty of Communication SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Ilaria Falvo
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Aliaa Ibnidris
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Samia Hurst
- Institute for Ethics, History and the HumanitiesUniversity of GenevaGenevaSwitzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
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10
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Blasimme A, Brall C, Vayena E. Reporting Genetic Findings to Individual Research Participants: Guidelines From the Swiss Personalized Health Network. Front Genet 2020; 11:585820. [PMID: 33362850 PMCID: PMC7759560 DOI: 10.3389/fgene.2020.585820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022] Open
Abstract
In 2017 the Swiss federal government established the Swiss Personalized Health Network (SPHN), a nationally coordinated data infrastructure for genetic research. The SPHN advisory group on Ethical, Legal, and Social Implications (ELSI) was tasked with the creation of a recommendation to ensure ethically responsible reporting of genetic research findings to research participants in SPHN-funded studies. Following consultations with expert stakeholders, including geneticists, pediatricians, sociologists, university hospitals directors, patient representatives, consumer protection associations, and insurers, the ELSI advisory group issued its recommendation on "Reporting actionable genetic findings to research participants" in May 2020. In this paper we outline the development of this recommendation and the provisions it contains. In particular, we discuss some of its key features, namely: (1) that participation in SPHN-funded studies as a research subject is conditional to accepting that medically relevant genetic research findings will be reported; (2) that a Multidisciplinary Expert Panel (MEP) should be created to support researchers' decision-making processes about reporting individual genetic research findings; (3) that such Multidisciplinary Expert Panel will make case-by-case decisions about whether to allow reporting of genetic findings, instead of relying on a pre-defined list of medically relevant variants; (4) that research participants shall be informed of the need to disclose genetic mutations when applying for private insurance, which may influence individual decisions about participation in research. By providing an account of the procedural background and considerations leading to the SPHN recommendation on "Reporting actionable genetic findings to research participants," we seek to promote a better understanding of the proposed guidance, as well as to contribute to the global dialog on the reporting of genetic research findings.
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Affiliation(s)
- Alessandro Blasimme
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Caroline Brall
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
- Ethical, Legal, and Social Implications (ELSI) Advisory Group, Swiss Personalized Health Network (SPHN), Bern, Switzerland
| | - Effy Vayena
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
- Ethical, Legal, and Social Implications (ELSI) Advisory Group, Swiss Personalized Health Network (SPHN), Bern, Switzerland
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11
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Nobile H, Borry P, Moldenhauer J, Bergmann MM. Return of Results in Population Studies: How Do Participants Perceive Them? Public Health Ethics 2020. [DOI: 10.1093/phe/phaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
As a cornerstone of public health, epidemiology has lately undergone substantial changes enabled by, among other factors, the use of biobank infrastructures. In biobank-related research, the return of results to participants constitutes an important and complex ethical question. In this study, we qualitatively investigated how individuals perceive the results returned following their participation in cohort studies with biobanks. In our semi-structured interviews with 31 participants of two such German studies, we observed that some participants overestimate the nature of the personal information they will receive from the study. Although this misestimation does not seem to jeopardize the validity of the consent provided at recruitment, it may still represent a threat for participants’ trust in research and thus their long-term commitment, crucial for such studies. We argue that such misestimation may have ethical consequences on the principles guiding the reflection on the return of results in biobank research, i.e. autonomy, beneficence, non-maleficence and reciprocity. We suggest that shifting from the idea of directly benefiting participants through the return of research results could help focusing on benefiting society as a whole, thereby increasing research trustworthiness of population-based studies using biobanks.
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Affiliation(s)
- Hélène Nobile
- Department of Epidemiology, German Institute for Human Nutrition, and Centre of Biomedical Ethics and Law, Department of Public Health, KU Leuven
| | - Pascal Borry
- Centre of Biomedical Ethics and Law, Department of Public Health, KU Leuven
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12
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Ethical challenges of precision cancer medicine. Semin Cancer Biol 2020; 84:263-270. [PMID: 33045356 DOI: 10.1016/j.semcancer.2020.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/25/2020] [Accepted: 09/20/2020] [Indexed: 11/21/2022]
Abstract
Amongst common diseases, cancer is often both a leader in self-regulatory policy, or the field for contentious ethical issues such as the patenting of the BRCA1/2 genes. With the advent of genomic sequencing technologies, achieving precision cancer medicine requires prospective norms due to the large and varied sources of data involved. Here, we discuss the ethical and legal aspects of the policy debate around the relevant topics in precision cancer medicine: the return of incidental findings and sequencing raw data to patients, the communication of genetic results to patients' relatives, privacy and communication risks with concomitant oversight strategies, patient participation and consent models. We present the arguments and empirical data supporting specific policy solutions delineating still contested areas. What type of consent and oversight are required to acquire genomic data or to access it where desired, either by the participant/patient or third-party researchers? Most of the raw sequencing data is still uninterpretable and the variants revealed subject to reinterpretation over time. No doubt the ethical challenges of precision cancer medicine are a prototype of what's to come for other diseases. They are also paradigmatic for regulatory and ethical questions of the translational endeavors since the two worlds - basic science and patient care - are governed by different ethical and legal principles that need to be reconciled in precision cancer medicine.
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13
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Alahmad G, Alzahrany H, Almutairi AF. Returning Results of Stored Biological Samples and Biobanks: Perspectives of Saudi Arabian Biomedical Researchers. Biopreserv Biobank 2020; 18:395-402. [PMID: 32706976 DOI: 10.1089/bio.2020.0002] [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] [Indexed: 12/20/2022] Open
Abstract
Scientific medical research involving human samples often leads to improved diagnosis, the discovery of treatment modalities, or the identification of possible risk factors for many diseases. Some findings, including incidental findings, may be important to donors, and some may require intervention. This study aimed to explore the perspectives of health care professionals in their use of stored biological samples for biomedical research regarding the concept of the research results and the challenges of informing donors regarding the results. This qualitative study involved 19 medical researchers doing research with stored biological samples and biobanks. The data were gathered during face-to-face interviews in English using a semistructured interview technique. The participants provided rich and illuminating experiences, framed in the following themes: the professional duty of researchers to return the research results and the right of donors to know; factors affecting informing donors of results (e.g., severity of disease; impact of the provided information; reliability of the research results; and donor approval); challenges to physically returning the results; and the nature of the informed consent, as well as the elements required in the informed consent documentation. Although the majority of researchers agree on the importance of returning research results, some have contradictory views such as that returning research results is not the researcher's responsibility. The study results also support the view that a number of elements should be included in the informed consent, such as the intention of informing the donors of the results as well as the benefits and risks.
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Affiliation(s)
- Ghiath Alahmad
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Haneen Alzahrany
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Adel F Almutairi
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
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14
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Perspectives regarding family disclosure of genetic research results in three racial and ethnic minority populations. J Community Genet 2020; 11:433-443. [PMID: 32562160 DOI: 10.1007/s12687-020-00472-6] [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: 10/02/2019] [Accepted: 06/11/2020] [Indexed: 12/27/2022] Open
Abstract
The lack of data on perspectives of racial and ethnic minority populations regarding family disclosure of individual research results (IRR) hinders the development of return of IRR policies and practices that are meaningful and culturally appropriate in diverse populations. This research aims to uncover preferences regarding family disclosure of IRR and identify factors that may shape the preferences in three minority populations. Nine focus groups with 68 adult African American, Hispanic/Latinx, and American Indian/Alaska Native individuals were conducted. Data were analyzed using thematic analysis. Participants were willing to share IRR with relatives who elected to know and preferred a participant-driven (vs. researcher-driven) decision-making process. Privacy of personal information was deemed important, as were anticipated familial benefits from genetic information, except when improper use of the information was suspected. Factors influencing family disclosure decisions included the family's biological and emotional closeness, and participants' perceived mental preparedness of the relative. Family disclosure of IRR among racial and ethnic minority individuals is a complex decision-making process wherein issues of individual privacy are entangled with family dynamic and familial benefit considerations. These data suggest that policies surrounding family disclosure of IRR should carefully consider participant preferences and adopt a participant-driven approach.
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15
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Tindana P, Depuur C, de Vries J, Seeley J, Parker M. Informed consent in genomic research and biobanking: taking feedback of findings seriously. Glob Bioeth 2020; 31:200-215. [PMID: 33343193 PMCID: PMC7734033 DOI: 10.1080/11287462.2020.1717896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Genomic research and biobanking present several ethical, social and cultural challenges, particularly when conducted in settings with limited scientific research capacity. One of these challenges is determining the model of consent that should support the sharing of human biological samples and data in the context of international collaborative research. In this paper, we report on the views of key research stakeholders in Ghana on what should count as good ethical practice when seeking consent for genomic research and biobanking in Africa. This study was part of a multi-country qualitative case study conducted in three African countries: Ghana, Uganda and Zambia under the auspices of the Human Heredity and Health in Africa initiative (H3Africa). Our study suggests that while participants are willing to give consent for their samples and associated data to be used for future research purposes, they expect to receive feedback about the progress of the research and about the kinds of research being undertaken on their samples and data. These expectations need to be anticipated and discussed during the consent process which should be seen as part of an ongoing communication process throughout the research process.
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Affiliation(s)
- Paulina Tindana
- Department of Health Policy, Planning and Management, University of Ghana School of Public Health, Accra, Ghana
| | | | | | - Janet Seeley
- MRC/UVRI Uganda Research Unit on Aids, Kampala, Uganda
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16
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Brelsford KM, Spratt SE, Beskow LM. Research use of electronic health records: patients' perspectives on contact by researchers. J Am Med Inform Assoc 2019; 25:1122-1129. [PMID: 29986107 PMCID: PMC6118867 DOI: 10.1093/jamia/ocy087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/07/2018] [Indexed: 01/13/2023] Open
Abstract
Objective The use of electronic health records (EHRs) for research has the potential to improve the diagnosis and treatment of disease, yet contact with patients based on results of EHR phenotyping has received little attention. Researchers will almost certainly discover discrepancies in EHRs that call for resolution and, in some cases, raise the ethical dilemma of whether to contact patients about a potentially undiagnosed or untreated health concern. The objective of this study was to explore patients' attitudes and opinions about potential contact by researchers who have had access to their EHRs. Materials and methods We conducted 15 focus groups in four diverse counties in the southeastern United States. We designed vignettes to describe different situations in which researchers conducting a hypothetical study might have reason to consider contact with patients. Results Many patients believed it was important for researchers to take action if they discovered information suggesting a current serious health concern. Relaying the information through patients' physicians was considered the most appropriate course of action. Across vignettes, there were significant differences between urban and rural sites. Discussion and conclusions Researchers may increasingly encounter situations involving contact with patients following EHR phenotyping. They should carefully consider the possibility of such contact when planning their studies, including the time and expertise needed to adjudicate potentially serious discrepancies. Our focus group results are one source of input for the development of ethical approaches to the research use of EHRs.
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Affiliation(s)
- Kathleen M Brelsford
- Center for Biomedical Ethics and Society, and Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan E Spratt
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, and Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Papaz T, Liston E, Zahavich L, Stavropoulos DJ, Jobling RK, Kim RH, Reuter M, Miron A, Oechslin E, Mondal T, Bergin L, Smythe JF, Altamirano-Diaz L, Lougheed J, Yao R, Akinrinade O, Breckpot J, Mital S. Return of genetic and genomic research findings: experience of a pediatric biorepository. BMC Med Genomics 2019; 12:173. [PMID: 31775751 PMCID: PMC6882371 DOI: 10.1186/s12920-019-0618-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Assess process, uptake, validity and resource needs for return of actionable research findings to biobank participants. Methods Participants were prospectively enrolled in a multicenter biorepository of childhood onset heart disease. Clinically actionable research findings were reviewed by a Return of Research Results Committee (RRR) and returned to the physician or disclosed directly to the participant through a research genetic counselor. Action taken following receipt of this information was reviewed. Results Genetic data was generated in 1963 of 7408 participants. Fifty-nine new findings were presented to the RRR committee; 20 (34%) were deemed reportable. Twelve were returned to the physician, of which 7 were disclosed to participants (median time to disclosure, 192 days). Seven findings were returned to the research genetic counselor; all have been disclosed (median time to disclosure, 19 days). Twelve families (86%) opted for referral to clinical genetics after disclosure of findings; 7 results have been validated, 5 results are pending. Average cost of return and disclosure per reportable finding incurred by the research program was $750 when utilizing a research genetic counselor; clinical costs associated with return were not included. Conclusions Return of actionable research findings was faster if disclosed directly to the participant by a research genetic counselor. There was a high acceptability amongst participants for receiving the findings, for referral to clinical genetics, and for clinical validation of research findings, with all referred cases being clinically confirmed.
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Affiliation(s)
- Tanya Papaz
- Division of Cardiology, Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Eriskay Liston
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, Hospital for Sick Children, Toronto, ON, Canada
| | - Laura Zahavich
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dimitri J Stavropoulos
- Genome Diagnostics, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rebekah K Jobling
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, Hospital for Sick Children, Toronto, ON, Canada.,Genome Diagnostics, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Raymond H Kim
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, Hospital for Sick Children, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Miriam Reuter
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, Hospital for Sick Children, Toronto, ON, Canada
| | - Anastasia Miron
- Division of Cardiology, Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Erwin Oechslin
- Division of Cardiology, Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Division of Cardiology, Toronto Congenital Cardiac Centre for Adults at Peter Munk Cardiac Centre, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Tapas Mondal
- Division of Cardiology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Lynn Bergin
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, London, ON, Canada
| | - John F Smythe
- Division of Cardiology, Department of Pediatrics, Kingston General Hospital, Kingston, ON, Canada
| | - Luis Altamirano-Diaz
- Division of Cardiology, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | - Jane Lougheed
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Roderick Yao
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Oyediran Akinrinade
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jeroen Breckpot
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada.,Center for Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Seema Mital
- Division of Cardiology, Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. .,Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada.
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18
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Seiffert DJ, McCarthy Veach P, LeRoy B, Guan W, Zierhut H. Beyond medical actionability: Public perceptions of important actions in response to hypothetical genetic testing results. J Genet Couns 2019; 28:355-366. [PMID: 30710467 DOI: 10.1002/jgc4.1048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 01/09/2023]
Abstract
Rationales for returning results from whole genome sequencing (WGS) and genetic testing have historically focused on medical utility. Understanding the wide array of actions individuals might take following genetic testing results could have important implications for clinical care. We aimed to survey the public regarding their perceptions of the importance of a wide variety of different actions one might take upon receiving hypothetical results from a WGS test where the results indicate a high risk of developing a genetic condition. We assessed whether demographic characteristics, type of condition, and perceived severity of the condition differentially affected importance ratings of actions they would take. In a survey administered at the 2015 Minnesota State Fair, 909 participants imagined that they had a blood test that looked at their genes and indicated that they were at high risk of developing one of three randomized conditions (Alzheimer's disease, macular degeneration, or colon cancer). Participants rated the importance of 35 actions. Principal component analysis, used to categorize actions, yielded eight categories: (1) medical management and communication; (2) partner support; (3) support and life fulfillment; (4) diet and exercise; (5) distal planning; (6) religion/spiritual support; (7) reproductive actions; and (8) proximal planning. Participants rated a wide range of actions as important, with medical management and communication, and partner support receiving the highest mean ratings. Linear regression yielded significant associations between importance ratings and demographics variables (age and gender), genetic condition, and perceived severity of the condition for different action categories. Genetic counselors and other healthcare professionals should consider a variety of possible patient actions beyond medical actionability when discussing genetic testing results.
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Affiliation(s)
| | - Patricia McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
| | - Bonnie LeRoy
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
| | - Weihua Guan
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota
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19
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Gordon DR, Radecki Breitkopf C, Robinson M, Petersen WO, Egginton JS, Chaffee KG, Petersen GM, Wolf SM, Koenig BA. Should Researchers Offer Results to Family Members of Cancer Biobank Participants? A Mixed-Methods Study of Proband and Family Preferences. AJOB Empir Bioeth 2018; 10:1-22. [PMID: 30596322 DOI: 10.1080/23294515.2018.1546241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Genomic analysis may reveal both primary and secondary findings with direct relevance to the health of probands' biological relatives. Researchers question their obligations to return findings not only to participants but also to family members. Given the social value of privacy protection, should researchers offer a proband's results to family members, including after the proband's death? METHODS Preferences were elicited using interviews and a survey. Respondents included probands from two pancreatic cancer research resources, plus biological and nonbiological family members. Hypothetical scenarios based on actual research findings from the two cancer research resources were presented; participants were asked return of results preferences and justifications. Interview transcripts were coded and analyzed; survey data were analyzed descriptively. RESULTS Fifty-one individuals (17 probands, 21 biological relatives, 13 spouses/partners) were interviewed. Subsequently, a mailed survey was returned by 464 probands, 1,040 biological family members, and 399 spouses/partners. This analysis highlights the interviews, augmented by survey findings. Probands and family members attribute great predictive power and lifesaving potential to genomic information. A majority hold that a proband's genomic results relevant to family members' health ought to be offered. While informants endorse each individual's choice whether to learn results, most express a strong moral responsibility to know and to share, particularly with the younger generation. Most have few concerns about sharing genetic information within the family; rather, their concerns focus on the health consequences of not sharing. CONCLUSIONS Although additional studies in diverse populations are needed, policies governing return of genomic results should consider how families understand genomic data, how they value confidentiality within the family, and whether they endorse an ethics of sharing. A focus on respect for individual privacy-without attention to how the broad social and cultural context shapes preferences within families-cannot be the sole foundation of policy.
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Affiliation(s)
- Deborah R Gordon
- a Department of Anthropology, History and Social Medicine , University of California, San Francisco
| | | | | | | | | | | | | | | | - Barbara A Koenig
- g Program in Bioethics , University of California, San Francisco
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20
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Beskow LM, Hammack CM, Brelsford KM. Thought leader perspectives on benefits and harms in precision medicine research. PLoS One 2018; 13:e0207842. [PMID: 30475858 PMCID: PMC6258115 DOI: 10.1371/journal.pone.0207842] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 11/01/2018] [Indexed: 01/06/2023] Open
Abstract
Precision medicine research is underway to identify targeted approaches to improving health and preventing disease. However, such endeavors raise significant privacy and confidentiality concerns. The objective of this study was to elucidate the potential benefits and harms associated with precision medicine research through in-depth interviews with a diverse group of thought leaders, including primarily U.S.-based experts and scholars in the areas of ethics, genome research, health law, historically-disadvantaged populations, informatics, and participant-centric perspectives, as well as government officials and human subjects protections leaders. The results suggest the prospect of an array of individual and societal benefits, as well as physical, dignitary, group, economic, psychological, and legal harms. Relative to the way risks and harms are commonly described in consent forms for precision medicine research, the thought leaders we interviewed arguably emphasized a somewhat different set of issues. The return of individual research results, harm to socially-identifiable groups, the value-dependent nature of many benefits and harms, and the risks to the research enterprise itself emerged as important cross-cutting themes. Our findings highlight specific challenges that warrant concentrated care during the design, conduct, dissemination, and translation of precision medicine research and in the development of consent materials and processes.
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Affiliation(s)
- Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Catherine M. Hammack
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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21
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Boardman F, Hale R. Responsibility, identity, and genomic sequencing: A comparison of published recommendations and patient perspectives on accepting or declining incidental findings. Mol Genet Genomic Med 2018; 6:1079-1096. [PMID: 30370638 PMCID: PMC6305652 DOI: 10.1002/mgg3.485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of genomic sequencing techniques is increasingly being incorporated into mainstream health care. However, there is a lack of agreement on how "incidental findings" (IFs) should be managed and a dearth of research on patient perspectives. METHODS In-depth qualitative interviews were carried out with 31 patients undergoing genomic sequencing at a regional genetics service in England. Interviews explored decisions around IFs and were comparatively analyzed with published recommendations from the literature. RESULTS Thirteen participants opted to receive all IFs from their sequence, 12 accepted some and rejected others, while six participants refused all IFs. The key areas from the literature, (a) genotype/phenotype correlation, (b) seriousness of the condition, and (c) implications for biological relatives, were all significant; however, patients drew on a broader range of social and cultural information to make their decisions. CONCLUSION This study highlights the range of costs and benefits for patients of receiving IFs from a genomic sequence. While largely positive views toward the dissemination of genomic data were reported, ambivalence surrounding genetic responsibility and its associated behaviors (e.g., duty to inform relatives) was reported by both IF decliners and accepters, suggesting a need to further explore patient perspectives on this highly complex topic area.
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22
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Nobile H, Borry P, Pischon T, Steinbrecher A, Boeing H, Vigl M, Bergmann MM. Participants' decision to enroll in cohort studies with biobanks: quantitative insights from two German studies. Per Med 2018; 14:477-485. [PMID: 29749857 DOI: 10.2217/pme-2017-0049] [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] [Indexed: 01/09/2023]
Abstract
AIM To understand participants' actual motivations to enroll in cohort studies with biobanks. METHODS Participants of two such studies currently ongoing in Germany were invited to fill in a questionnaire about their decision to enroll. RESULTS From the 623 questionnaires completed, contributing to scientific knowledge appeared as a main motive for enrollment, followed by learning about personal health status and receiving personal medical advice. CONCLUSION Motivating participation as a way to contribute to the common good rather than as a way to obtain personal benefits appears to be particularly appropriate to ensure participants' long-term commitment and should therefore be further investigated in this setting.
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Affiliation(s)
- Hélène Nobile
- Department of Epidemiology, German Institute for Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.,Center for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Center for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Astrid Steinbrecher
- Molecular Epidemiology Research Group, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute for Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Matthäus Vigl
- Department of Epidemiology, German Institute for Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Manuela M Bergmann
- Department of Epidemiology, German Institute for Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
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23
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Radecki Breitkopf C, Wolf SM, Chaffee KG, Robinson ME, Lindor NM, Gordon DR, Koenig BA, Petersen GM. Attitudes Toward Return of Genetic Research Results to Relatives, Including After Death: Comparison of Cancer Probands, Blood Relatives, and Spouse/Partners. J Empir Res Hum Res Ethics 2018; 13:295-304. [PMID: 29701109 DOI: 10.1177/1556264618769165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Genetic research generates results with implications for relatives. Recommendations addressing relatives' access to a participant's genetic research findings include eliciting participant preferences about access and choosing a representative to make decisions about access upon participant incapacity/death. Representatives are likely to be blood relatives or spouse/partners (who may share genetically related children). This raises the question of whether relatives hold similar attitudes about access or divergent attitudes that may yield conflict. We surveyed pancreatic cancer biobank participants (probands) and relatives in a family registry (blood relatives and spouse/partners of probands); 1,903 (>55%) surveys were returned. Results revealed few attitudinal differences between the groups. A slightly higher proportion of blood relatives agreed with statements reflecting proband privacy. In conclusion, probands' decisions on access are likely to be accepted by relatives; in choosing a representative, probands may not face major differences in attitudes about privacy/sharing between a blood relative and a spouse/partner.
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24
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Vermeulen E, Rebers S, Aaronson NK, Brandenburg AP, van Leeuwen FE, Schmidt MK. Patients' Attitudes Towards the Return of Incidental Findings After Research with Residual Tissue: A Mixed Methods Study. Genet Test Mol Biomarkers 2018; 22:178-186. [PMID: 29461872 DOI: 10.1089/gtmb.2017.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS To investigate the attitudes of patients toward the return of individual research results from scientific research with residual tissue. METHODS AND FINDINGS We recruited 1319 patients from 6 Dutch hospitals. In total, 673 patients (51% response rate) completed the questionnaire and 146 were interviewed. Based on the questionnaire data, the majority of respondents (92%) wanted to be informed of incidental findings about both a curable (92%) and an incurable (76%) disease. Respondents' wishes to be informed about incidental findings did not vary significantly as a function of patient demographics or type of disease. The interview data show that respondents wished to be informed about incidental findings because they considered it to be normal practice; they expected the information to be of benefit for their health. Information should be provided by their physician. Yet, most respondents (84%) would consent to research even if they would not be informed about incidental findings, primarily because they recognized that there might be practical problems in providing such information, and because they valued scientific research highly. CONCLUSIONS We conclude that, while the majority of patients want to be informed about incidental findings, they also recognize that this may be difficult.
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Affiliation(s)
- Eric Vermeulen
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,2 VSOP, Dutch Alliance for Rare and Genetic Diseases, Soest, the Netherlands
| | - Susanne Rebers
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,3 Division of Molecular Pathology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
| | - Neil K Aaronson
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
| | - Alexander P Brandenburg
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,4 KWF-Dutch Cancer Society , Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
| | - Marjanka K Schmidt
- 1 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute , Amsterdam, the Netherlands .,3 Division of Molecular Pathology, The Netherlands Cancer Institute , Amsterdam, the Netherlands
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25
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Haga SB, Friedman B, Richard G. Considering the Benefits and Risks of Research Participants' Access to Sequence Data. Genet Test Mol Biomarkers 2017; 21:717-721. [PMID: 29045186 DOI: 10.1089/gtmb.2017.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of sequencing technologies has greatly expanded in both research and clinical settings. The generation of voluminous datasets has raised several issues regarding data sharing and access. Current regulations require clinical laboratories and some research laboratories to provide access to test data, including sequencing data, directly to patients upon request. There is some controversy over whether this access right may be somewhat broader, encompassing research data as well-a question beyond the scope of this article. It is clear that in the research setting, deposition of sequencing data into public or private databases often occurs, although little information exists about the return of data files to research participants (in contrast to the extensive deliberations regarding return of results). Thus, further consideration of the issue of access to data files is warranted as well as more effort to understand both patients' and research participants' use of the data.
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Affiliation(s)
- Susanne B Haga
- 1 Center for Applied Genomics and Precision Medicine, Duke University School of Medicine , Durham, North Carolina
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26
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Nestor JG, Groopman EE, Gharavi AG. Towards precision nephrology: the opportunities and challenges of genomic medicine. J Nephrol 2017; 31:47-60. [PMID: 29043570 DOI: 10.1007/s40620-017-0448-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/10/2017] [Indexed: 12/28/2022]
Abstract
The expansion of genomic medicine is furthering our understanding of many human diseases. This is well illustrated in the field of nephrology, through the characterization, discovery, and growing insight into various renal diseases through use of Next Generation Sequencing (NGS) technologies. This review will provide an overview of the diagnostic opportunities of using genetic testing in the clinical setting by describing notable discoveries regarding inherited forms of renal disease that have advanced the field and by highlighting some of the potential benefits of establishing a molecular diagnosis in a clinical practice. In addition, it will discuss some of the challenges associated with the expansion of genetic testing into the clinical setting, including clinical variant interpretation and return of genetic results.
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Affiliation(s)
- Jordan G Nestor
- Division of Nephrology, Department of Medicine, College of Physicians and Surgeons, Columbia University, 1150 St. Nicholas Ave, Room 413, New York, NY, 10032, USA
| | - Emily E Groopman
- Division of Nephrology, Department of Medicine, College of Physicians and Surgeons, Columbia University, 1150 St. Nicholas Ave, Room 413, New York, NY, 10032, USA
| | - Ali G Gharavi
- Division of Nephrology, Department of Medicine, College of Physicians and Surgeons, Columbia University, 1150 St. Nicholas Ave, Room 413, New York, NY, 10032, USA.
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27
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Yamamoto K, Hachiya T, Fukushima A, Nakaya N, Okayama A, Tanno K, Aizawa F, Tokutomi T, Hozawa A, Shimizu A. Population-based biobank participants' preferences for receiving genetic test results. J Hum Genet 2017; 62:1037-1048. [PMID: 28794501 PMCID: PMC5709720 DOI: 10.1038/jhg.2017.81] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/22/2017] [Accepted: 06/28/2017] [Indexed: 01/18/2023]
Abstract
There are ongoing debates on issues relating to returning individual research results (IRRs) and incidental findings (IFs) generated by genetic research in population-based biobanks. To understand how to appropriately return genetic results from biobank studies, we surveyed preferences for returning IRRs and IFs among participants of the Tohoku Medical Megabank Project (TMM). We mailed a questionnaire to individuals enrolled in the TMM cohort study (Group 1; n=1031) and a group of Tohoku region residents (Group 2; n=2314). The respondents were required to be over 20 years of age. Nearly 90% of Group 1 participants and over 80% of Group 2 participants expressed a preference for receiving their genetic test results. Furthermore, over 60% of both groups preferred to receive their genetic results ‘from a genetic specialist.’ A logistic regression analysis revealed that engaging in ‘health-conscious behaviors’ (such as regular physical activity, having a healthy diet, intentionally reducing alcohol intake and/or smoking and so on) was significant, positively associated with preferring to receive their genetic test results (odds ratio=2.397 (Group 1) and 1.897 (Group 2)). Our findings provided useful information and predictors regarding the return of IRRs and IFs in a population-based biobank.
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Affiliation(s)
- Kayono Yamamoto
- Division of Innovation and Education, Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University, Iwate, Japan.,Department of Clinical Genetics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Tsuyoshi Hachiya
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University, Iwate, Japan
| | - Akimune Fukushima
- Division of Innovation and Education, Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University, Iwate, Japan.,Department of Clinical Genetics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Naoki Nakaya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, Iwate, Japan.,Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University, Iwate, Japan
| | - Fumie Aizawa
- Center for Liberal Arts and Sciences, Iwate Medical University, Iwate, Japan
| | - Tomoharu Tokutomi
- Division of Innovation and Education, Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University, Iwate, Japan.,Department of Clinical Genetics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Atsushi Shimizu
- Division of Biomedical Information Analysis, Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University, Iwate, Japan
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28
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Plöthner M, Frank M, von der Schulenburg JMG. Cost analysis of whole genome sequencing in German clinical practice. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:623-633. [PMID: 27380512 DOI: 10.1007/s10198-016-0815-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 06/23/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Whole genome sequencing (WGS) is an emerging tool in clinical diagnostics. However, little has been said about its procedure costs, owing to a dearth of related cost studies. This study helps fill this research gap by analyzing the execution costs of WGS within the setting of German clinical practice. METHODOLOGY First, to estimate costs, a sequencing process related to clinical practice was undertaken. Once relevant resources were identified, a quantification and monetary evaluation was conducted using data and information from expert interviews with clinical geneticists, and personnel at private enterprises and hospitals. This study focuses on identifying the costs associated with the standard sequencing process, and the procedure costs for a single WGS were analyzed on the basis of two sequencing platforms-namely, HiSeq 2500 and HiSeq Xten, both by Illumina, Inc. In addition, sensitivity analyses were performed to assess the influence of various uses of sequencing platforms and various coverage values on a fixed-cost degression. RESULTS In the base case scenario-which features 80 % utilization and 30-times coverage-the cost of a single WGS analysis with the HiSeq 2500 was estimated at €3858.06. The cost of sequencing materials was estimated at €2848.08; related personnel costs of €396.94 and acquisition/maintenance costs (€607.39) were also found. In comparison, the cost of sequencing that uses the latest technology (i.e., HiSeq Xten) was approximately 63 % cheaper, at €1411.20. CONCLUSIONS The estimated costs of WGS currently exceed the prediction of a 'US$1000 per genome', by more than a factor of 3.8. In particular, the material costs in themselves exceed this predicted cost.
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Affiliation(s)
- Marika Plöthner
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159, Hannover, Germany.
| | - Martin Frank
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Otto-Brenner-Straße 1, 30159, Hannover, Germany
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29
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Abstract
The past 15 years has seen considerable changes in the research environment. These changes include the development of new sophisticated genetic and genomic technologies, a proliferation of databases containing large amount of genotypic and phenotypic data, and wide-spread data sharing among many institutions, nationally and internationally. These changes have raised new questions regarding how best to protect the participants of biobanking research. In response to these questions, best practices for addressing the legal, ethical, and social issues of biobanking have been developed. In addition, new ethical guidelines related to biobanking have been established, as well as new regulations regarding privacy and human subject protections. Finally, changes in the science and the research environment have raised complex ethical issues related to biobanking, such as questions about the most appropriate consent models to use for biobanking research, commercial use and ownership issues, and whether and how to return individual research results to biobank participants. This article reviews some of the developments over the past 15 years related to the ELSI of biobanking with a look toward the future.
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30
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Tremblay M, Rouleau G. Deep genealogical analysis of a large cohort of participants in the CARTaGENE project (Quebec, Canada). Ann Hum Biol 2017; 44:357-365. [PMID: 28325067 DOI: 10.1080/03014460.2017.1300326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Genealogical analysis helps to better understand the genetic structure of populations. The population of Quebec (Canada) often serves as a model for this type of analysis, having one of the world's most complete genealogical databases. AIM The main objective of this study was to reconstruct, analyse and compare the ascending genealogies of participants to CARTaGENE, a project that aims at building a database on various aspects of public health. SUBJECTS AND METHODS In total, 5110 genealogies from four Quebec regions were reconstructed. Distribution of ancestors, completeness and depth of the genealogies, characteristics of immigrant ancestors and kinship and inbreeding coefficients were analysed. RESULTS Most genealogies go back to the 17th century, with a mean genealogical depth of 10 generations. Origins of immigrant ancestors are more diverse in the Montreal region, resulting in lower inbreeding and kinship among the participants from this region. Inbreeding and kinship values are mainly explained by remote genealogical links (from 6 to 11 generations). CONCLUSION Deep genealogies allowed for a precise measurement of the geographic origins of the participants' immigrant ancestors, as well as inbreeding and kinship ties in the population, which may be crucial for studies aiming to identify genetic variations associated with Mendelian or complex diseases.
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Affiliation(s)
- Marc Tremblay
- a Département des Sciences Humaines et Sociales , Université du Québec à Chicoutimi , Chicoutimi , Québec , Canada
| | - Gabrielle Rouleau
- a Département des Sciences Humaines et Sociales , Université du Québec à Chicoutimi , Chicoutimi , Québec , Canada
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Lohmann E, Gasser T, Grundmann K. Needs and Requirements of Modern Biobanks on the Example of Dystonia Syndromes. Front Neurol 2017; 8:9. [PMID: 28194131 PMCID: PMC5276852 DOI: 10.3389/fneur.2017.00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 01/09/2017] [Indexed: 01/16/2023] Open
Abstract
Dystonia belongs to a group of rare diseases (RDs) characterized by etiologic heterogeneity, affection often in childhood, severe and variable clinical manifestation. The burden of this disease is aggravated by the lack of effective and specific treatment. In the field of dystonia as in other RDs the number of available biospecimens is, in general, limited. Here, we report a new approach to collect clinical and genetic data in biospecimens maintained collaboratively by researchers and their associated institutions in a decentralized system. Allowing researchers to have access to significant numbers of samples and corresponding clinical data, biobanking in dystonia might not only provide a powerful tool in the identification of disease genes but also the classification of variants detected in known genes with respect to their clinical relevance. Growing data in genetics due to the technical progress demand for well-annotated and well-managed biobanks, which in near future hold even the potential for biomarker research and generating medical treatment based on clinical and genetic data currently summarized as “personalized medicine.”
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Affiliation(s)
- Ebba Lohmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany; Istanbul Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul University, Istanbul, Turkey
| | - Thomas Gasser
- DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany; Istanbul Faculty of Medicine, Department of Neurology, Behavioral Neurology and Movement Disorders Unit, Istanbul University, Istanbul, Turkey
| | - Kathrin Grundmann
- Department of Medical Genetics and Applied Genomics, University of Tübingen , Tübingen , Germany
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32
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Pulford DJ, Harter P, Floquet A, Barrett C, Suh DH, Friedlander M, Arranz JA, Hasegawa K, Tada H, Vuylsteke P, Mirza MR, Donadello N, Scambia G, Johnson T, Cox C, Chan JK, Imhof M, Herzog TJ, Calvert P, Wimberger P, Berton-Rigaud D, Lim MC, Elser G, Xu CF, du Bois A. Communicating BRCA research results to patients enrolled in international clinical trials: lessons learnt from the AGO-OVAR 16 study. BMC Med Ethics 2016; 17:63. [PMID: 27769273 PMCID: PMC5073453 DOI: 10.1186/s12910-016-0144-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 10/07/2016] [Indexed: 01/15/2023] Open
Abstract
Background The focus on translational research in clinical trials has the potential to generate clinically relevant genetic data that could have importance to patients. This raises challenging questions about communicating relevant genetic research results to individual patients. Methods An exploratory pharmacogenetic analysis was conducted in the international ovarian cancer phase III trial, AGO-OVAR 16, which found that patients with clinically important germ-line BRCA1/2 mutations had improved progression-free survival prognosis. Mechanisms to communicate BRCA results were evaluated, because these findings may be beneficial to patients and their families. Results Communicating individual BRCA results was not anticipated during clinical trial design. Consequently, options were not available for patients to indicate their preference for receiving their individual results when they signed pharmacogenetic informed consent. Differences in local requirements, clinical practice, and opinion regarding the ethical aspects of how to convey genetic results to patients are all potential barriers to returning individual BRCA results to patients. Communicating the aggregate BRCA result from this study provided clinical investigators with a mechanism to disseminate the overall study finding to patients while taking individual circumstances, local guidelines and clinical practice into account. Conclusion This study illustrates the importance of increasing the clarity and scope of informed consent and the need for patient engagement to ensure clinical trial participants can indicate their preference regarding receipt of potentially important individual pharmacogenetic results. Trial registration This study was registered in the NCT Clinical Trial Registry under NCT00866697 on March 19, 2009, following approval from participating ethics committees (Additional file 1). Electronic supplementary material The online version of this article (doi:10.1186/s12910-016-0144-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David J Pulford
- GlaxoSmithKline Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK.
| | - Philipp Harter
- AGO Study group and Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte (KEM), Essen, Germany
| | - Anne Floquet
- GINECO and Medical Oncology, Institut Bergonié, Bordeaux, France
| | | | - Dong Hoon Suh
- Department of Obstetrics & Gynecology, KGOG and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Michael Friedlander
- ANZGOG and The Prince of Wales Clinical School University of New South Wales, Randwick, NSW, Australia
| | - José Angel Arranz
- GEICO and Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Kosei Hasegawa
- JGOG and Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hiroomi Tada
- GlaxoSmithKline Research and Development, Philadelphia, USA.,Immuno-Oncology Development, Incyte Corporation, Wilmington, DE, USA
| | - Peter Vuylsteke
- BGOG and Medical Oncology, Université Catholique de Louvain, CHU UCL Namur, Belgium
| | | | | | - Giovanni Scambia
- Department of Woman Health, MITO and Catholic University of the Sacred Heart, Rome, Italy
| | - Toby Johnson
- GlaxoSmithKline Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - Charles Cox
- GlaxoSmithKline Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - John K Chan
- Palo Alto Medical Foundation, San Francisco, CA, USA
| | - Martin Imhof
- Karl Landsteiner Research Institute and Department of Obstetrics and Gynecology, General Public Teaching Hospital, Korneuburg, Vienna, Austria
| | - Thomas J Herzog
- NYGOG and University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - Paula Calvert
- Cancer Trials Ireland, 60 Fitzwilliam Square N, Dublin 2, Ireland
| | - Pauline Wimberger
- AGO Germany and Department of Gynecology and Obstetrics, TU Dresden, Carl-Gustav-Carus University, Dresden, Germany
| | | | - Myong Cheol Lim
- KGOG, Gynecologic Cancer Branch and Center for Uterine Cancer, National Cancer Center, Goyang, Korea
| | | | - Chun-Fang Xu
- GlaxoSmithKline Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - Andreas du Bois
- AGO Study group and Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte (KEM), Essen, Germany
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Knoppers BM, Nguyen MT, Sénécal K, Tassé AM, Zawati MH. Next-Generation Sequencing and the Return of Results. Cold Spring Harb Perspect Med 2016; 6:a026724. [PMID: 27599532 PMCID: PMC5046689 DOI: 10.1101/cshperspect.a026724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The impact of next-generation sequencing (NGS) on the issue of return of results is defying clear policy guidance and creating international confusion. Limiting ourselves to the return of results revealed by NGS (including incidental findings) in adults, children, family members of deceased individuals, and population studies, we describe and contrast emerging policy positions in Europe, Canada, and the United States. Until there are clear, scientific, and professional standards and practical policy, both researchers and clinicians cannot be faulted for being either hesitant or pressured to return NGS results.
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Affiliation(s)
| | - Minh Thu Nguyen
- Centre of Genomics and Policy, McGill University, Montreal, Quebec H3A 0G1, Canada
| | - Karine Sénécal
- Centre of Genomics and Policy, McGill University, Montreal, Quebec H3A 0G1, Canada
| | - Anne Marie Tassé
- Public Population Project in Genomics and Society (PG), Montreal, Quebec H3A 0G1, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Quebec H3A 0G1, Canada
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Leitsalu L, Alavere H, Jacquemont S, Kolk A, Maillard AM, Reigo A, Nõukas M, Reymond A, Männik K, Ng PC, Metspalu A. Reporting incidental findings of genomic disorder-associated copy number variants to unselected biobank participants. Per Med 2016; 13:303-314. [PMID: 29749813 DOI: 10.2217/pme-2016-0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Procedural guidelines for disclosure of incidental genomic information are lacking. METHODS We introduce a method and evaluated the impact of returning results to population biobank participants with 16p11.2 copy number variants, which are commonly associated with neurodevelopmental disorders and BMI imbalance. Of the 7877 participants, 11 carriers were detected. Eight participants were informed of their carrier status and surveyed 11-17 months later. RESULTS All participants demonstrated preference for disclosure. Although two participants experienced worry, all five survey respondents rated receiving this information favorably. One participant reported modifications in treatment and three felt that their treatment/condition had since improved. CONCLUSION This approach can be adapted and applied for the return of incidental findings to biobank participants.
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Affiliation(s)
- Liis Leitsalu
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia.,Institute of Molecular & Cell Biology, University of Tartu, Tartu, 51010, Estonia
| | - Helene Alavere
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia
| | - Sébastien Jacquemont
- Service of Medical Genetics, Lausanne University Hospital, Lausanne, 1011, Switzerland
| | - Anneli Kolk
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia.,Department of Neurology, Children's Clinic of Tartu University Hospital, Tartu, 50406, Estonia
| | - Anne M Maillard
- Service of Medical Genetics, Lausanne University Hospital, Lausanne, 1011, Switzerland
| | - Anu Reigo
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia
| | - Margit Nõukas
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia.,Institute of Molecular & Cell Biology, University of Tartu, Tartu, 51010, Estonia
| | - Alexandre Reymond
- Center for Integrative Genomics, University of Lausanne, Lausanne, 1015, Switzerland
| | - Katrin Männik
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia.,Center for Integrative Genomics, University of Lausanne, Lausanne, 1015, Switzerland
| | - Pauline C Ng
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia.,Genome Institute of Singapore, Singapore, 138672, Singapore
| | - Andres Metspalu
- Estonian Genome Center, University of Tartu (EGCUT), Tartu, 51010, Estonia.,Institute of Molecular & Cell Biology, University of Tartu, Tartu, 51010, Estonia
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35
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Stroud K, O'Doherty KC. Ethically sustainable governance in the biobanking of eggs and embryos for research. Monash Bioeth Rev 2016; 33:277-94. [PMID: 26712609 DOI: 10.1007/s40592-015-0047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Biobanking of human tissues is associated with a range of ethical, legal, and social (ELS) challenges. These include difficulties in operationalising informed consent protocols, protecting donors' privacy, managing the return of incidental findings, conceptualising ownership of tissues, and benefit sharing. Though largely unresolved, these challenges are well documented and debated in academic literature. One common response to the ELS challenges of biobanks is a call for strong and independent governance of biobanks. Theorists who argue along these lines suggest that since fully informed consent to a single research project is often not feasible, research participants should be given the additional protection of being allowed to consent to the governance framework of the biobank. Such governance therefore needs to be transparent and ethically sustainable. In this paper we review the governance challenges of establishing and maintaining human tissue biobanks. We then discuss how the creation of a biobank for eggs and embryos, in particular, may introduce additional or unique challenges beyond those presented by the biobanking of other human tissues. Following previous work on biobank governance, we argue that ethically sustainable governance needs to be participatory, adaptive, and trustworthy.
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Affiliation(s)
- Karla Stroud
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Kieran C O'Doherty
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
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36
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Budin-Ljøsne I, Mascalzoni D, Soini S, Machado H, Kaye J, Bentzen HB, Rial-Sebbag E, D'Abramo F, Witt M, Schamps G, Katić V, Krajnovic D, Harris JR. Feedback of Individual Genetic Results to Research Participants: Is It Feasible in Europe? Biopreserv Biobank 2016; 14:241-8. [PMID: 27082461 PMCID: PMC4913503 DOI: 10.1089/bio.2015.0115] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There is growing consensus that individual genetic research results that are scientifically robust, analytically valid, and clinically actionable should be offered to research participants. However, the general practice in European research projects is that results are usually not provided to research participants for many reasons. This article reports on the views of European experts and scholars who are members of the European COST Action CHIP ME IS1303 (Citizen's Health through public-private Initiatives: Public health, Market and Ethical perspectives) regarding challenges to the feedback of individual genetic results to research participants in Europe and potential strategies to address these challenges. MATERIALS AND METHODS A consultation of the COST Action members was conducted through an email survey and a workshop. The results from the consultation were analyzed following a conventional content analysis approach. RESULTS Legal frameworks, professional guidelines, and financial, organizational, and human resources to support the feedback of results are largely missing in Europe. Necessary steps to facilitate the feedback process include clarifying legal requirements to the feedback of results, developing harmonized European best practices, promoting interdisciplinary and cross-institutional collaboration, designing educational programs and cost-efficient IT-based platforms, involving research ethics committees, and documenting the health benefits and risks of the feedback process. CONCLUSIONS Coordinated efforts at pan-European level are needed to enable equitable, scientifically sound, and socially robust feedback of results to research participants.
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Affiliation(s)
- Isabelle Budin-Ljøsne
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Norwegian Cancer Genomics Consortium, Kreftgenomikk.no, Oslo, Norway
| | - Deborah Mascalzoni
- Center for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
- Center for Biomedicine, EURAC, Bolzano, Italy
| | - Sirpa Soini
- Helsinki Biobank, Helsinki University Hospital, Helsinki, Finland
| | - Helena Machado
- Centre for Social Studies, University of Coimbra, Coimbra, Portugal
| | - Jane Kaye
- Nuffield Department of Population Health, Centre for Health, Law and Emerging Technologies (HeLEX), University of Oxford, Oxford, United Kingdom
| | - Heidi Beate Bentzen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Norwegian Cancer Genomics Consortium, Kreftgenomikk.no, Oslo, Norway
- Norwegian Research Center for Computers and Law, Faculty of Law, University of Oslo, Oslo, Norway
| | | | | | - Michał Witt
- Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland
| | - Geneviève Schamps
- Centre for Medical and Biomedical Law, Université Catholique de Louvain, Leuven, Belgium
| | - Višnja Katić
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Jennifer R. Harris
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
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Darnell AJ, Austin H, Bluemke DA, Cannon RO, Fischbeck K, Gahl W, Goldman D, Grady C, Greene MH, Holland SM, Hull SC, Porter FD, Resnik D, Rubinstein WS, Biesecker LG. A Clinical Service to Support the Return of Secondary Genomic Findings in Human Research. Am J Hum Genet 2016; 98:435-441. [PMID: 26942283 PMCID: PMC4800041 DOI: 10.1016/j.ajhg.2016.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Indexed: 11/28/2022] Open
Abstract
Human genome and exome sequencing are powerful research tools that can generate secondary findings beyond the scope of the research. Most secondary genomic findings are of low importance, but some (for a current estimate of 1%-3% of individuals) confer high risk of a serious disease that could be mitigated by timely medical intervention. The impact and scope of secondary findings in genome and exome sequencing will only increase in the future. There is considerable agreement that high-impact findings should be returned to participants, but many researchers performing genomic research studies do not have the background, skills, or resources to identify, verify, interpret, and return such variants. Here, we introduce a proposal for the formation of a secondary-genomic-findings service (SGFS) that would support researchers by enabling the return of clinically actionable sequencing results to research participants in a standardized manner. We describe a proposed structure for such a centralized service and evaluate the advantages and challenges of the approach. We suggest that such a service would be of greater benefit to all parties involved than present practice, which is highly variable. We encourage research centers to consider the adoption of a centralized SGFS.
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Affiliation(s)
- Andrew J Darnell
- Program in Science and Society, Duke University, Durham, NC 27710, USA
| | - Howard Austin
- Kidney Disease Section, National Institute of Diabetes, Digestive, and Kidney Diseases, NIH, Bethesda, MD 20892, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, MD 20892, USA
| | - Richard O Cannon
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood institute, NIH, Bethesda, MD 20892, USA
| | - Kenneth Fischbeck
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - William Gahl
- Office of the Clinical Director, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - David Goldman
- Laboratory of Neurogenetics and Office of the Clinical Director, National Institute of Alcohol Abuse and Alcoholism, NIH, Bethesda, MD 20892, USA
| | - Christine Grady
- Department of Bioethics, Clinical Research Center, NIH, Bethesda, MD 20892, USA
| | - Mark H Greene
- Clinical Genetics Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, NIH, Bethesda, MD 20892, USA
| | - Sara Chandros Hull
- Department of Bioethics, Clinical Research Center, NIH, Bethesda, MD 20892, USA; Bioethics Core, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Forbes D Porter
- Section on Molecular Dysmorphology, National Institute of Child Health and Human Development, NIH, Bethesda, MD 20892, USA
| | - David Resnik
- Office of the Director, National Institute of Environmental Health Sciences, NIH, Bethesda, MD 20892, USA
| | - Wendy S Rubinstein
- Information Engineering Branch, National Center for Biotechnology Information, National Library of Medicine, NIH, Bethesda, MD 20892, USA
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA.
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Jamuar SS, Kuan JL, Brett M, Tiang Z, Tan WLW, Lim JY, Liew WKM, Javed A, Liew WK, Law HY, Tan ES, Lai A, Ng I, Teo YY, Venkatesh B, Reversade B, Tan EC, Foo R. Incidentalome from Genomic Sequencing: A Barrier to Personalized Medicine? EBioMedicine 2016; 5:211-6. [PMID: 27077130 PMCID: PMC4816806 DOI: 10.1016/j.ebiom.2016.01.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/16/2016] [Accepted: 01/25/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In Western cohorts, the prevalence of incidental findings (IFs) or incidentalome, referring to variants in genes that are unrelated to the patient's primary condition, is between 0.86% and 8.8%. However, data on prevalence and type of IFs in Asian population is lacking. METHODS In 2 cohorts of individuals with genomic sequencing performed in Singapore (total n = 377), we extracted and annotated variants in the 56 ACMG-recommended genes and filtered these variants based on the level of pathogenicity. We then analyzed the precise distribution of IFs, class of genes, related medical conditions, and potential clinical impact. RESULTS We found a total of 41,607 variants in the 56 genes in our cohort of 377 individuals. After filtering for rare and coding variants, we identified 14 potential variants. After reviewing primary literature, only 4 out of the 14 variants were classified to be pathogenic, while an additional two variants were classified as likely pathogenic. Overall, the cumulative prevalence of IFs (pathogenic and likely pathogenic variants) in our cohort was 1.6%. CONCLUSION The cumulative prevalence of IFs through genomic sequencing is low and the incidentalome may not be a significant barrier to implementation of genomics for personalized medicine.
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Affiliation(s)
- Saumya Shekhar Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Paediatric Academic Clinical Programme, Singhealth Duke-NUS Graduate Medical School, Singapore
| | - Jyn Ling Kuan
- Genome Institute of Singapore, ASTAR, Singapore; Cardiovascular Research Institute, National University of Singapore, National University Health System, Singapore
| | - Maggie Brett
- KK Research Center, KK Women's and Children's Hospital, Singapore
| | - Zenia Tiang
- Genome Institute of Singapore, ASTAR, Singapore; Cardiovascular Research Institute, National University of Singapore, National University Health System, Singapore
| | - Wilson Lek Wen Tan
- Genome Institute of Singapore, ASTAR, Singapore; Cardiovascular Research Institute, National University of Singapore, National University Health System, Singapore
| | - Jiin Ying Lim
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Wendy Kein Meng Liew
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Paediatric Academic Clinical Programme, Singhealth Duke-NUS Graduate Medical School, Singapore
| | - Asif Javed
- Genome Institute of Singapore, ASTAR, Singapore
| | - Woei Kang Liew
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Hai Yang Law
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Paediatric Academic Clinical Programme, Singhealth Duke-NUS Graduate Medical School, Singapore
| | - Ee Shien Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Paediatric Academic Clinical Programme, Singhealth Duke-NUS Graduate Medical School, Singapore
| | - Angeline Lai
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Paediatric Academic Clinical Programme, Singhealth Duke-NUS Graduate Medical School, Singapore
| | - Ivy Ng
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Paediatric Academic Clinical Programme, Singhealth Duke-NUS Graduate Medical School, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Ene Choo Tan
- KK Research Center, KK Women's and Children's Hospital, Singapore
| | - Roger Foo
- Genome Institute of Singapore, ASTAR, Singapore; Cardiovascular Research Institute, National University of Singapore, National University Health System, Singapore
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39
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Impact of whole-body MRI in a general population study. Eur J Epidemiol 2015; 31:31-9. [DOI: 10.1007/s10654-015-0101-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 11/04/2015] [Indexed: 01/01/2023]
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40
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Fernandez CV, OʼConnell C, Ferguson M, Orr AC, Robitaille JM, Knoppers BM, McMaster CR. Stability of Attitudes to the Ethical Issues Raised by the Return of Incidental Genomic Research Findings in Children: A Follow-Up Study. Public Health Genomics 2015; 18:299-308. [PMID: 26352440 DOI: 10.1159/000439244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We explore the stability of parental attitudes to the ethical issues raised by the return of genomic research results. METHODS A 19-item questionnaire was mailed to participants in a large genome research consortium 18 months following a baseline survey. We describe the stability of parental attitudes to (a) sharing of genomic research results, (b) endorsement of children in genomic research, (c) responsibilities of researchers, and (d) responsibilities to extended family. We also explore their experience in receiving results. RESULTS Of 170 original participants, 154 (91%) responded. Most participants expressed positive rights to receive incidental genomic research findings (85%), including when ameliorative therapy was unknown (85%). Only 3% found it acceptable to delegate the decision to return results to an independent committee. Researchers, either with a parent (42%) or physician (17%), were felt to be responsible to convey research results to children when they reach adulthood. Most participants (74%) indicated that results should be shared with potentially affected extended family. These results are very similar to those of the baseline survey. All participants who received genomic results would do so again and reported actions similar to their expressed attitudes. CONCLUSIONS The opinions of parents regarding genomic research remain stable over time. Guidelines on the return of results should incorporate these findings.
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Affiliation(s)
- Conrad V Fernandez
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, N.S., Canada
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41
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Abstract
Genetic testing based on whole-genome sequencing (WGS) often returns results that are not directly clinically actionable as well as raising the possibility of incidental (secondary) findings. In this article, we first survey the laws and policies guiding both researchers and clinicians in the return of results for WGS-based genetic testing. We then provide an overview of the landscape of international legislation and policies for return of these results, including considerations for return of incidental findings. Finally, we consider a range of approaches for the return of results.
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42
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McBride KA, Hallowell N, Tattersall MHN, Kirk J, Ballinger ML, Thomas DM, Mitchell G, Young MA. Timing and context: important considerations in the return of genetic results to research participants. J Community Genet 2015; 7:11-20. [PMID: 26004130 DOI: 10.1007/s12687-015-0231-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022] Open
Abstract
General consensus exists that clinically significant germline genetic research results should be fed back to research participants. A body of literature is emerging about Australian research participants' experiences of feedback of genetic research results and factors that influence a participant's actions after receiving such information. This exploratory qualitative study conducted interviews with 11 participants from the International Sarcoma Kindred Study, four probands and seven of their relatives. They had been informed by letter of the availability of clinically significant germline TP53 mutations identified through research. We examined the participants' views about the feedback of these genetic test results. Thematic (inductive) analysis was used to analyse the data. A number of factors influenced participants' responses following notification. This included participants' understanding of the notification letter and their perception of the relevance of the information for them and/or their family. Most notably, timing of the letter in the context of an individual's current life experiences was important. Timing and context are novel factors identified that may impact on research participants' understanding or their ability to access clinically significant research results. We outline strategies for disseminating results to research participants and their next of kin that may reduce their uncertainty around the receipt of research results.
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Affiliation(s)
- Kate A McBride
- School of Public Health, Sydney Medical School, Camperdown, NSW, 2006, Australia. .,The Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead, NSW, 2145, Australia.
| | - Nina Hallowell
- Centre for Health and Society, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Martin H N Tattersall
- Department of Cancer Medicine, Sydney Medical School, Royal Prince Alfred Hospital, Camperdown, NSW, 2006, Australia
| | - Judy Kirk
- The Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead, NSW, 2145, Australia
| | - Mandy L Ballinger
- Research Division, Peter MacCallum Cancer Centre, East Melbourne, VIC, 3002, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - David M Thomas
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, 2010, Australia
| | - Gillian Mitchell
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, 3052, Australia.,Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC, 3002, Australia
| | - Mary-Anne Young
- Familial Cancer Centre, Peter MacCallum Cancer Centre, East Melbourne, VIC, 3002, Australia
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Frequency and spectrum of actionable pathogenic secondary findings in 196 Korean exomes. Genet Med 2015; 17:1007-11. [PMID: 25856671 DOI: 10.1038/gim.2015.26] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/23/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE One of the biggest challenges of exome and genome sequencing in the era of genomic medicine is the identification and reporting of secondary findings. In this study we investigated the frequency and spectrum of actionable pathogenic secondary findings in Korean exomes. METHODS Data from 196 Korean exomes were screened for variants from a list of 56 genes recommended by the American College of Medical Genetics and Genomics (ACMG) for return of secondary findings. Identified variants were classified according to the evidence-based guidelines reached by a joint consensus of the ACMG and the Association for Molecular Pathology. RESULTS Among the 196 exomes, which were from 100 healthy controls and 96 patients with suspected genetic disorders, 11 variants in 13 individuals were found to be pathogenic or likely pathogenic. We estimated that the frequency of actionable pathogenic secondary findings was 7% for the control subjects (7/100) and 6% for the patients with disease (6/96). For one autosomal-recessive disease, four individuals exhibited either one pathogenic or one likely pathogenic variant of the MUTYH gene, leading to a carrier frequency of 2% (4/196). CONCLUSION Secondary findings are not uncommon in Korean exomes.
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Family decision maker perspectives on the return of genetic results in biobanking research. Genet Med 2015; 18:82-8. [PMID: 25856669 PMCID: PMC4600004 DOI: 10.1038/gim.2015.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/17/2015] [Indexed: 02/06/2023] Open
Abstract
PURPOSE There are many ethical considerations regarding the return of genetic results to biobanking participants, especially when biobanks collect samples from deceased organ and tissue donors that require the authorization of a family decision maker (FDM). This article explores FDM knowledge and opinions regarding return of genetic results in the context of the Genotype-Tissue Expression (GTEx) Project, which does not return results to participants. METHODS Data collection included a survey completed by Organ Procurement Organization requesters (n = 22) and semistructured telephone interviews with FDM (n = 55). RESULTS Nearly every FDM wanted some form of genetic results returned. Information regarding treatable diseases (94.3%) and diseases that could affect their children (84.9%) were more desirable than that regarding untreatable diseases (71.7%). Sixty percent of FDMs understood that GTEx would not return genetic results. FDMs were four times more likely to have correct knowledge of the GTEx policy when their GTEx requester reported discussing the topic with them. CONCLUSION FDMs from the GTEx project were interested in receiving genetic test results. Marked changes in the infrastructure of the GTEx would be required to alter the policy. Regardless, care must be taken to ensure that the return policy is clearly communicated with FDMs to dispel misconceptions.Genet Med 18 1, 82-88.
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Bacon PL, Harris ED, Ziniel SI, Savage SK, Weitzman ER, Green RC, Huntington NL, Holm IA. The development of a preference-setting model for the return of individual genomic research results. J Empir Res Hum Res Ethics 2015; 10:107-20. [PMID: 25742675 DOI: 10.1177/1556264615572092] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Understanding participants' preferences for the return of individual research results (IRR) in genomic research may allow for the implementation of more beneficial result disclosure methods. We tested four preference-setting models through cognitive interviews of parents to explore how parents conceptualize the process of setting preferences and which disease characteristics they believe to be most important when deciding what results to receive on their child. Severity and preventability of a condition were highly influential in decision making and certain groups of research results were anticipated by participants to have negative psychological effects. These findings informed the development of an educational tool and preference-setting model that can be scaled for use in the return of IRR from large biobank studies.
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Affiliation(s)
- Phoebe L Bacon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sonja I Ziniel
- Harvard Medical School, Boston, MA, USA Boston Children's Hospital, MA, USA
| | | | - Elissa R Weitzman
- Harvard Medical School, Boston, MA, USA Boston Children's Hospital, MA, USA
| | - Robert C Green
- Harvard Medical School, Boston, MA, USA Partners Personalized Medicine, Boston, MA, USA
| | | | - Ingrid A Holm
- Harvard Medical School, Boston, MA, USA Boston Children's Hospital, MA, USA
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Beskow LM, O'Rourke PP. Return of Genetic Research Results to Participants and Families: IRB Perspectives and Roles. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:502-13. [PMID: 26479559 PMCID: PMC4617597 DOI: 10.1111/jlme.12292] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We surveyed IRB chairs' perspectives on offering individual genetic research results to participants and families, including family members of deceased participants, and the IRB's role in addressing these issues. Given a particular hypothetical scenario, respondents favored offering results to participants but not family members, giving choices at the time of initial consent, and honoring elicited choices. They felt IRBs should have authority regarding the process issues, but a more limited role in medical and scientific issues.
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Affiliation(s)
- Laura M Beskow
- Associate Professor at the Duke University School of Medicine and Duke Clinical Research Institute, where her work focuses on ethics and policy issues in biomedical research - particularly human subjects issues in large-scale genomic and translational research. She holds a B.S. in nutrition from Iowa State University, an M.P.H. with a concentration in health law from Boston University, and a Ph.D. in health policy and administration from the University of North Carolina at Chapel Hill
| | - P Pearl O'Rourke
- Director of Human Research Affairs at Partners HealthCare in Boston. She is an Associate Professor of Pediatrics at Harvard Medical School. She received her B.A. from Yale University, and completed medical school at Dartmouth Medical School and the University of Minnesota Medical School
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Fernandez CV, O'Rourke PP, Beskow LM. Canadian Research Ethics Board Leadership Attitudes to the Return of Genetic Research Results to Individuals and Their Families. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:514-22. [PMID: 26479560 PMCID: PMC4617195 DOI: 10.1111/jlme.12293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Genomic research may uncover results that have direct actionable benefit to the individual. An emerging debate is the degree to which researchers may have responsibility to offer results to the biological relatives of the research participant. In a companion study to one carried out in the United States, we describe the attitudes of Canadian Research Ethics Board (REB) chairs to this issue and their opinions as to the role of the REB in developing related policy.
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Affiliation(s)
- Conrad V Fernandez
- Professor and Head of the Division of Pediatric Hematology/Oncology in the Department of Pediatrics, IWK Health Centre, Dalhousie University and is cross-appointed in Bioethics, Medicine and Postgraduate Studies. He obtained his Hon. B.Sc. at the University of Western Ontario, his medical degree at McMaster University, specialist certification in Pediatrics as a Fellow of the Royal College of Physicians and Surgeons of Canada at Dalhousie University, and completed specialty training in Pediatric Hematology/Oncology at the University of British Columbia
| | - P Pearl O'Rourke
- Director of Human Research Affairs at Partners HealthCare in Boston. She is an Associate Professor of Pediatrics at Harvard Medical School. She received her B.A. from Yale University, and completed medical school at Dartmouth Medical School and the University of Minnesota Medical School
| | - Laura M Beskow
- Associate Professor at the Duke University School of Medicine and Duke Clinical Research Institute, where her work focuses on ethics and policy issues in biomedical research-particularly human subjects issues in large-scale genomic and translational research. She holds a B.S. in nutrition from Iowa State University, an M.P.H. with a concentration in health law from Boston University, and a Ph.D. in health policy and administration from the University of North Carolina at Chapel Hill
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Thorogood A, Joly Y, Knoppers BM, Nilsson T, Metrakos P, Lazaris A, Salman A. An implementation framework for the feedback of individual research results and incidental findings in research. BMC Med Ethics 2014; 15:88. [PMID: 25539799 PMCID: PMC4391472 DOI: 10.1186/1472-6939-15-88] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 12/05/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This article outlines procedures for the feedback of individual research data to participants. This feedback framework was developed in the context of a personalized medicine research project in Canada. Researchers in this domain have an ethical obligation to return individual research results and/or material incidental findings that are clinically significant, valid and actionable to participants. Communication of individual research data must proceed in an ethical and efficient manner. Feedback involves three procedural steps: assessing the health relevance of a finding, re-identifying the affected participant, and communicating the finding. Re-identification requires researchers to break the code in place to protect participant identities. Coding systems replace personal identifiers with a numerical code. Double coding systems provide added privacy protection by separating research data from personal identifying data with a third "linkage" database. A trusted and independent intermediary, the "keyholder", controls access to this linkage database. DISCUSSION Procedural guidelines for the return of individual research results and incidental findings are lacking. This article outlines a procedural framework for the three steps of feedback: assessment, re-identification, and communication. This framework clarifies the roles of the researcher, Research Ethics Board, and keyholder in the process. The framework also addresses challenges posed by coding systems. Breaking the code involves privacy risks and should only be carried out in clearly defined circumstances. Where a double coding system is used, the keyholder plays an important role in balancing the benefits of individual feedback with the privacy risks of re-identification. Feedback policies should explicitly outline procedures for the assessment of findings, and the re-identification and contact of participants. The responsibilities of researchers, the Research Ethics Board, and the keyholder must be clearly defined. We provide general guidelines for keyholders involved in feedback. We also recommend that Research Ethics Boards should not be directly involved in the assessment of individual findings. Hospitals should instead establish formal, interdisciplinary clinical advisory committees to help researchers determine whether or not an uncertain finding should be returned.
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Affiliation(s)
- Adrian Thorogood
- Centre of Genomics and Policy, McGill University, 740, avenue Dr. Penfield, suite 5200, Montreal, QC, H3A 0G1, Canada.
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, 740, avenue Dr. Penfield, suite 5200, Montreal, QC, H3A 0G1, Canada.
- Faculty of Medicine, McGill University, Montreal, Canada.
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, McGill University, 740, avenue Dr. Penfield, suite 5200, Montreal, QC, H3A 0G1, Canada.
- Faculty of Medicine, McGill University, Montreal, Canada.
| | - Tommy Nilsson
- Research Institute of the McGill University Health Centre, Montreal, Canada.
| | - Peter Metrakos
- General Surgery, McGill University Health Centre, Montreal, Canada.
| | - Anthoula Lazaris
- General Surgery, McGill University Health Centre, Montreal, Canada.
| | - Ayat Salman
- General Surgery, McGill University Health Centre, Montreal, Canada.
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Budin-Ljøsne I, Burton P, Isaeva J, Gaye A, Turner A, Murtagh MJ, Wallace S, Ferretti V, Harris JR. DataSHIELD: an ethically robust solution to multiple-site individual-level data analysis. Public Health Genomics 2014; 18:87-96. [PMID: 25532061 DOI: 10.1159/000368959] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND DataSHIELD (Data Aggregation Through Anonymous Summary-statistics from Harmonised Individual levEL Databases) has been proposed to facilitate the co-analysis of individual-level data from multiple studies without physically sharing the data. In a previous paper, we investigated whether DataSHIELD could protect participant confidentiality in accordance with UK law. In this follow-up paper, we investigate whether DataSHIELD addresses a broader range of ethics-related data-sharing concerns. METHODS Ethics-related data-sharing concerns of Institutional Review Boards, ethics experts, international research consortia and research participants were identified through a literature search and systematically examined at a multidisciplinary workshop to determine whether DataSHIELD proposes mechanisms which can address these concerns. RESULTS DataSHIELD addresses several ethics-related data-sharing concerns related to privacy, confidentiality, and the protection of the research participant's rights while sharing data and after the data have been shared. The data remain entirely under the direct management of the study that collected them. Data processing commands are strictly supervised, and the data are queried in a protected environment. Issues related to the return of individual research results when data are shared are eliminated; the responsibility for return remains at the study of origin. CONCLUSION DataSHIELD can provide an innovative and robust solution for addressing commonly encountered ethics-related data-sharing concerns.
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Affiliation(s)
- Isabelle Budin-Ljøsne
- Division of Epidemiology, Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
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Ethical considerations in biobanks: how a public health ethics perspective sheds new light on old controversies. J Genet Couns 2014; 24:428-32. [PMID: 25348083 DOI: 10.1007/s10897-014-9781-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
Biobanks, collections of biospecimens with or without linked medical data, have increased dramatically in number in the last two decades. Their potential power to identify the underlying mechanisms of both rare and common disease has catalyzed their proliferation in the academic, medical, and private sectors. Despite demonstrated public support of biobanks, some within the academic, governmental, and public realms have also expressed cautions associated with the ethical, legal, and social (ELSI) implications of biobanks. These issues include concerns related to the privacy and confidentiality of data; return of results and incidental findings to participants; data sharing and secondary use of samples; informed consent mechanisms; ownership of specimens; and benefit sharing (i.e., the distribution of financial or other assets that result from the research). Such apprehensions become amplified as more researchers seek to pursue national and cross-border collaborations between biobanks. This paper provides an overview of two of the most contentious topics in biobank literature - informed consent and return of individual research results or incidental findings - and explores how a public health ethics lens may help to shed new light on how these issues may be best approached and managed. Doing so also demonstrates the important role that genetic counselors can play in the ongoing discussion of ethically appropriate biobank recruitment and management strategies, as well as identifies important areas of ongoing empirical research on these unresolved topics.
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