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Prince S, Then SN, O'Grady KA. Determining the state of guidance on pediatric biobanking for researchers, HRECS, and families: Regulatory mapping of international guidance. Eur J Pediatr 2024; 183:2477-2490. [PMID: 38478133 PMCID: PMC11035456 DOI: 10.1007/s00431-024-05469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 04/23/2024]
Abstract
Biobanking-the storage of human biological samples, including tissue, blood, urine, and genetic data-raises many ethical, legal, and social issues, including confidentiality and privacy. Pediatric biobanking is more complicated, with difficulties arising because children lack capacity to consent and acquire this capacity upon maturity when the research is still ongoing. Yet given the limited availability of pediatric samples, the translational nature of biobanking presents a unique opportunity to share samples and produce clinically necessary information about pediatric development and diseases. Guidance on navigating these legal and ethical difficulties is needed for those involved in pediatric biobanking-including researchers, participants, and families, and those involved in biobank governance. This paper seeks to map the current regulatory framework governing pediatric biobanking to determine what guidance is currently offered. Regulatory mapping of current international and national guidelines on pediatric biobanking addressing the ethical, legal, and social nuances of pediatric biobanking was undertaken. This paper finds that international guidelines around biobanking are mostly for adults, and even when pediatric-specific, documents are non-binding, inconsistent, or only limited guidance is offered on a range of important issues specific to pediatric biobanks. Conclusion: This paper shows a need for consistent, comprehensive, and clear regulation on pediatric biobanking so that research can more quickly, efficiently, and ethically be translated to useful information and treatment in pediatric care. What is Known: • Pediatric biobanking presents new opportunities to conduct valuable translational research to benefit pediatric populations. However, the storage of pediatric biological samples raises many ethical, legal and social issues-in part because child participants may be considered to lack capacity to consent but can acquire this capacity upon maturity when the research is still ongoing. Pediatric biobanks must grapple with issues of consent, confidentiality and privacy, and long-term participation regarding child participants. What is New: • Regulatory guidance on these ethical, legal, and social issues is needed for researchers, participants, and families and those involved in biobank governance. This paper identifies nationally specific and international guidance on biobanking and summarizes the guidance provided in relation to these pediatric specific issues. It finds that most guidance is non-binding and inconsistent between guidance documents and may offer only limited guidance to stakeholders. A need for consistent, comprehensive, and clear regulation on pediatric biobanking is needed at an international level to enable research.
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Affiliation(s)
- Sinead Prince
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Shih-Ning Then
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kerry-Ann O'Grady
- Centre for Healthcare Transformation, Australian Centre for Health Services Innovation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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2
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Kremer S, Shakhnovich V, Riffel AK, Harvey L, Borges CR. Delta-S-Cys-Albumin as a Marker of Pediatric Biospecimen Integrity. Biopreserv Biobank 2024. [PMID: 38651617 DOI: 10.1089/bio.2023.0121] [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: 04/25/2024] Open
Abstract
Blood plasma storage is a crucial element of pediatric biobanking. Improperly stored or handled specimens (e.g., at > -30°C) can result in altered biomolecular compositions that no longer reflects in vivo reality. We report application of a previously developed assay in adults-the ΔS-Cys-Albumin assay, which facilitates estimation of plasma and serum exposure to thawed conditions-to a population of pediatric EDTA plasma samples from patients aged 3-18 years to determine the assay's applicability, estimate its reference range for pediatric samples, and assess the impact of pre-centrifugation delay at 0°C. In addition, the effect of plasma thawed-state exposure to a range of times at 23°C, 4°C, and -20°C on ΔS-Cys-Albumin was evaluated. Using 98 precollected and processed pediatric EDTA plasma specimens, no difference was found in ΔS-Cys-Albumin under conditions of pre-centrifugation delay for up to 10 hours at 0°C. This lack of change allowed us to estimate a pediatric reference range for ΔS-Cys-Albumin of 7.0%-22.5% (mean of 12.8%) with a modest Pearson correlation between ΔS-Cys-Albumin and age (p = 0.0037, R2 = 0.29). ΔS-Cys-Albumin stability in six specimens at 23°C, 4°C, and -20°C was also evaluated. Plateaus in the decay curves were reached by 1 day, 7 days, and 14-28 days at these respective temperatures. The estimated pediatric reference range observed in children was lower than that previously observed in 180 adults of 12.3%-30.6% (mean of 20.0%), and the slope of the age correlation in children was twice as steep as that from adults. ΔS-Cys-Albumin decay curves at 23°C, 4°C, and -20°C were similar to those previously observed in adults. The data reported here support the use of ΔS-Cys-Albumin in evaluating the integrity and overall exposure of pediatric EDTA plasma specimens to thawed conditions. In doing so, they add an important quality control tool to the biobanker's arsenal.
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Affiliation(s)
- Schuyler Kremer
- School of Molecular Sciences, Arizona State University, Tempe, Arizona, USA
- The Biodesign Institute at Arizona State University, Tempe, Arizona, USA
| | - Valentina Shakhnovich
- Children's Mercy Hospital, Kansas City, Missouri, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
- Ironwood Pharmaceuticals, Boston, Massachusetts, USA
| | | | - Lisa Harvey
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Chad R Borges
- School of Molecular Sciences, Arizona State University, Tempe, Arizona, USA
- The Biodesign Institute at Arizona State University, Tempe, Arizona, USA
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Paquette E, Shukla A, Smith T, Pendergrast T, Duyar S, Rychlik K, Davis MM. Barriers to enrollment in a pediatric critical care biorepository. Pediatr Res 2023; 94:803-810. [PMID: 36755188 PMCID: PMC10403376 DOI: 10.1038/s41390-023-02465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Individuals of minority race/ethnicity have lower rates of participation in genomic research. This study evaluated sociodemographic characteristics associated with decisions to enroll in a pediatric critical care biorepository. METHODS Parents of children admitted to the PICU between November 2014 and May 2017 were offered to enroll their child in a biorepository using a single-page opt-in consent. Missed enrollment was assessed by failure to complete the form or declining consent on the form. We conducted a retrospective chart review for sociodemographic and clinical information. Bivariate and multivariable regression analyses were performed. RESULTS In 4055 encounters, representing 2910 patients with complete data, 1480 (50%) completed the consent form and 1223 (83%) enrolled. We found higher odds of incomplete consent for non-English-speaking parents (OR = 2.1, p < 0.0001) and parents of children of all races except non-Hispanic white (OR = 1.27-1.99, p < 0.0001). We found higher odds of declined consent in patients with Medicaid (OR = 1.67, p = 0.003) and parents of children of all races except non-Hispanic white (OR = 1.32-2.9, p < 0.0001). CONCLUSION Inability to enroll patients in a critical care biorepository may be associated with several sociodemographic factors at various points in recruitment/enrollment. IMPACT Individuals of minority race/ethnicity are less likely to enroll in genomic research and in critical care research. This study evaluated sociodemographic characteristics associated with decisions to enroll a child in a pediatric critical care biorepository. Sociodemographic factors including race/ethnicity, primary language, and insurance status and patient clinical characteristics are associated with differential enrollment into a pediatric critical care biorepository. More research is needed to understand how study team-participant interactions may play a role in differential enrollment. Barriers to enrollment occur both at the time of approaching and consenting for enrollment.
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Affiliation(s)
- Erin Paquette
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Avani Shukla
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Tracie Smith
- Mary Ann & J. Milburn Smith Child Health Research, Outcomes and Evaluation Center, Stanley Manne Children's Research Institute, Chicago, IL, USA
| | | | - Susan Duyar
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Rychlik
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Biostatistics Research Core, Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Matthew M Davis
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Mary Ann & J. Milburn Smith Child Health Research, Outcomes and Evaluation Center, Stanley Manne Children's Research Institute, Chicago, IL, USA
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4
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Murdoch B, Jandura A, Caulfield T. Reconsenting paediatric research participants for use of identifying data. JOURNAL OF MEDICAL ETHICS 2023; 49:106-109. [PMID: 35046134 PMCID: PMC9887363 DOI: 10.1136/medethics-2021-107958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
When a minor research participant reaches the age of majority or the level of maturity necessary to be granted legal decision-making capacity, reconsent can be required for ongoing participation in research or use of health information and banked biological materials. Despite potential logistical concerns with implementation and ethical questions about the trade-offs between maximising respect for participant agency and facilitating research that may generate benefits, reconsent is the approach most consistent with both law and research ethics.Canadian common law consent requirements are expansive and likely compel reconsent on obtaining capacity. Common law doctrine recognises that children are entitled to decision-making authority that reflects their evolving intelligence and understanding. Health consent legislation varies by province but generally either compels reconsent on obtaining capacity or delegates the ability to determine reconsent to research ethics boards. These boards largely rely on the Canada's national ethics policy, the Tri-Council Policy Statement, which states that, with few exceptions, reconsent for continued participation is required when minors gain capacity that would allow them to consent to the research in which they participate. A strict interpretation of this policy could require researchers to perform frequent capacity assessments, potentially presenting feasibility concerns. In addition, Canadian policy and law are generally consistent with the core principles of key international ethical standards from the United Nations and elsewhere.In sum, reconsent of paediatric participants upon obtaining capacity should be explicit and informed in Canada, and should not be presumed from continued participation alone.
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Affiliation(s)
- Blake Murdoch
- Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Jandura
- Faculty of Law, University of Alberta, Edmonton, Alberta, Canada
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5
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Casati S, Ellul B, Mayrhofer MT, Lavitrano M, Caboux E, Kozlakidis Z. Paediatric biobanking for health: The ethical, legal, and societal landscape. Front Public Health 2022; 10:917615. [PMID: 36238242 PMCID: PMC9551217 DOI: 10.3389/fpubh.2022.917615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/06/2022] [Indexed: 01/22/2023] Open
Abstract
Biobanks play a central role in pediatric translational research, which deals primarily with genetic data from sample-based research. However, participation of children in biobanking has received only limited attention in the literature, even though research in general and in clinical trials in particular have a long history in involving minors. So, we resolved to explore specific challenging ethical, legal, and societal issues (ELSI) in the current pediatric biobanking landscape to propose a way forward for biobanking with children as partners in research. Methodologically, we first established the accessibility and utilization of pediatric biobanks, mainly in Europe. This was supported by a literature review related to children's participation, taking into account not only academic papers but also relevant guidelines and best-practices. Our findings are discussed under five themes: general vulnerability; ethical issues-balancing risks and benefits, right to an open future, return of results including secondary findings; legal issues-capacity and legal majority; societal issues-public awareness and empowerment; and responsible research with children. Ultimately, we observed an on-going shift from the parents'/guardians' consent being a sine-qua-non condition to the positive minor's agreement: confirming that the minor is the participant, not the parent(s)/guardian(s). This ethical rethinking is paving the way toward age-appropriate, dynamic and participatory models of involving minors in decision-making. However, we identified a requirement for dynamic tools to assess maturity, a lack of co-produced engagement tools and paucity of shared best practices. We highlight the need to provide empowerment and capability settings to support researchers and biobankers, and back this with practical examples. In conclusion, equipping children and adults with appropriate tools, and ensuring children's participation is at the forefront of responsible pediatric biobanking, is an ethical obligation, and a cornerstone for research integrity.
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Affiliation(s)
- Sara Casati
- ELSI Services & Research Unit, BBMRI-ERIC, Graz, Austria
| | - Bridget Ellul
- Centre for Molecular Medicine & Biobanking, University of Malta, Msida, Malta
| | | | | | - Elodie Caboux
- Laboratory Services and Biobank, International Agency for Research on Cancer, IARC, WHO, Lyon, France
| | - Zisis Kozlakidis
- Laboratory Services and Biobank, International Agency for Research on Cancer, IARC, WHO, Lyon, France
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6
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Patrinos D, Knoppers BM, Laplante DP, Rahbari N, Wazana A. Sharing and Safeguarding Pediatric Data. Front Genet 2022; 13:872586. [PMID: 35795212 PMCID: PMC9251179 DOI: 10.3389/fgene.2022.872586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022] Open
Abstract
Data sharing is key to advancing our understanding of human health and well-being. While issues related to pediatric research warrant strong ethical protections, overly protectionist policies may serve to exclude minors from data sharing initiatives. Pediatric data sharing is critical to scientific research concerning health and well-being, to say nothing of understanding human development generally. For example, large-scale pediatric longitudinal studies, such as those in the DREAM-BIG Consortium, on the influence of prenatal adversity factors on child psychopathology, will provide prevention data and generate future health benefits. Recent initiatives have formulated sound policy to help enable and foster data sharing practices for pediatric research. To help translate these policy initiatives into practice, we discuss how model consent clauses for pediatric research can help address some of the issues and challenges of pediatric data sharing, while enabling data sharing.
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Affiliation(s)
- Dimitri Patrinos
- Centre of Genomics and Policy, School of Biomedical Sciences, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, School of Biomedical Sciences, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David P. Laplante
- Lady Davis Institute (LDI), Montreal, QC, Canada
- Centre for Child Development and Mental Health, Jewish General Hospital, Montreal, QC, Canada
| | - Noriyeh Rahbari
- Lady Davis Institute (LDI), Montreal, QC, Canada
- Centre for Child Development and Mental Health, Jewish General Hospital, Montreal, QC, Canada
| | - Ashley Wazana
- Lady Davis Institute (LDI), Montreal, QC, Canada
- Centre for Child Development and Mental Health, Jewish General Hospital, Montreal, QC, Canada
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7
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Patrinos D, Knoppers BM, Kleiderman E, Rahbari N, Laplante DP, Wazana A. Re-contact Following Withdrawal of Minors from Research. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1087202ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Carpentieri D, Colvard A, Petersen J, Marsh W, David-Dirgo V, Huentelman M, Pirrotte P, Sivakumaran TA. Mind the Quality Gap When Banking on Dry Blood Spots. Biopreserv Biobank 2021; 19:136-142. [PMID: 33567235 DOI: 10.1089/bio.2020.0131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Dry blood spots (DBS) offer many advantages over other blood banking protocols due to the reduction of time and equipment needed for collection and the ease of processing, storage, and shipment. In addition, the sample size makes it a very attractive method when considering the banking of small pediatric samples. On that note, the Centers for Disease Control and Prevention (CDC) preanalytical standards for DBS are commonly used in the worldwide mass spectrometry-based inborn errors of metabolism screening programs. However, these guidelines may not apply for analytes and protocols not included in these programs. In fact, the availability of leftover samples and the ongoing interest in protocols outside this scenario are providing us with new DBS biobanking insights. Herein, we review the literature for indicators that should be considered in the design of prospective fit for purpose DBS biobanks, especially for those focused mostly on pediatric and OMIC platforms.
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Affiliation(s)
- David Carpentieri
- Department of Pathology and Laboratory Medicine, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Amber Colvard
- Department of Pathology, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Jackie Petersen
- Department of Pathology, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - William Marsh
- Department of Biorepository, Mayo Clinic, Phoenix, Arizona, USA
| | - Victoria David-Dirgo
- Collaborative Center for Translational Mass Spectrometry, The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - Matt Huentelman
- Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - Patrick Pirrotte
- Collaborative Center for Translational Mass Spectrometry, The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - T A Sivakumaran
- Department of Pathology, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
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9
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Conradie EH, Malherbe H, Hendriksz CJ, Dercksen M, Vorster BC. An Overview of Benefits and Challenges of Rare Disease Biobanking in Africa, Focusing on South Africa. Biopreserv Biobank 2021; 19:143-150. [PMID: 33567219 DOI: 10.1089/bio.2020.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The North-West University's Centre for Human Metabolomics (CHM) is in the process of establishing the first rare disease (RD) biobank in South Africa and Africa. The CHM Biobank's main focus is on the collection of samples and information for rare congenital disorders. Approximately 72% of all RDs have a genetic origin, of which 70% have an exclusive pediatric onset. The need for such a biobank was identified by the CHM diagnostic laboratory. Feedback toward this initiative was overwhelmingly positive at the first stakeholder meeting in August 2019. However, gaining support from the public sector and recruiting of participants have proven to be challenging. Problems experienced to date include lack of support from government and clinicians; lack of knowledge on RDs (patients and clinicians); public health care focus not directed toward RDs; patients not returning for follow-up visits; and unwillingness to participate due to fear of exploitation. The CHM Biobank's vision and goals are aligned to address a national and international research need: it will provide a valuable resource for scientists to improve what is known about these diseases; to better understand the natural history and pathophysiology; to optimize diagnostic methods; and to potentially develop treatments. The genetic variability of the South African population provides added value to the RD biobank. This review provides a brief overview of the literature on the challenges and benefits of an RD biobank and how this relates to low- and middle-income countries (LMIC) like South Africa. The aim of the review is to draw attention to the potential benefits of such an undertaking and to create awareness, at both local and global level, toward some of the unique collective considerations that an RD biobank in LMIC (also unique South African challenges) faces on an operational, collaborate, and sustainability level.
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Affiliation(s)
- Engela H Conradie
- North-West University, Human Metabolomics, Potchefstroom, South Africa
| | - Helen Malherbe
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Rare Diseases South Africa NPC, Sunninghill, South Africa
| | | | - Marli Dercksen
- North-West University, Human Metabolomics, Potchefstroom, South Africa
| | - Barend C Vorster
- North-West University, Human Metabolomics, Potchefstroom, South Africa
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Abstract
Diseases that manifest themselves in the pediatric age group frequently have a more diverse spectrum of abnormalities and a greater rarity than diseases that are primarily seen in adults. The complexity and the relatively small populations with specific diseases are factors that have hindered progress in the treatment of pediatric disorders. Personalized medical therapies that are specifically tailored for individuals with unusual or unique problems have great potential to assist in overcoming these factors that have been a bottleneck to pediatric medical success. Personalization of therapies will necessarily be data driven and will require delineation of the proteomic, genomic, epigenomic, and immune characteristics of patients in comparison to the general population. It follows that there is a need to provide researchers with accessible high-quality pediatric tissue collections to facilitate the acquisition of the molecular information needed to support personalized medicine. Because of the unusual nature of many pediatric diseases, sample pools from individual institutions are often too small to adequately power definitive studies. Thus, etiological and translational research in this area are increasingly relying on biobanking networks to provide investigators with adequate numbers of tissue samples. Several pediatric biobanking networks have been formed, which are aimed at increasing the power of research studies and desired pools of high-quality samples. However, despite the concerted efforts, these multicenter networks and collaborations have met with mixed outcomes owing to increasing complexities and heterogeneity in the biobanking arena. While there have been challenges and roadblocks, there also have been some positive outcomes that have had paradigm impacts on diagnosis, study, and treatment of specific diseases. This article highlights the need for establishing pediatric biobanks, how current efforts in pediatric biobanking are influencing the pediatric research landscape, and attempts to identify practical impediments that continue to hamper advancements for the future.
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Affiliation(s)
- Lalita Wadhwa
- Department of Congenital Heart Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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11
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Dalpé G, Thorogood A, Knoppers BM. A Tale of Two Capacities: Including Children and Decisionally Vulnerable Adults in Biomedical Research. Front Genet 2019; 10:289. [PMID: 31024616 PMCID: PMC6459892 DOI: 10.3389/fgene.2019.00289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/18/2019] [Indexed: 12/13/2022] Open
Abstract
The participation of individuals who lack decision-making capacity is essential for advancing genomics research and neuroscience, but raises ethical and legal challenges relating to vulnerability, consent, and exclusion. Capacity differences between populations and individuals, the dynamics of capacity over time, and evolving legal consent and capacity regimes all raise uncertainty for researchers, institutional review boards, and policy makers. We review international ethical and legal best practices for including children and decisionally vulnerable adults in health research. Research ethics norms and literature tend to split such groups into narrow silos, which results in inconsistency and conceptual confusion, or to lump them together, which fails to take into account morally relevant differences. Through a narrative review of international norms, we identify challenges common to both groups, while drawing out distinctions reflecting their opposite capacity trajectories. Our comparison between these two populations clarifies underlying ethical concepts and offers opportunities for critique. Children need protection to foster their long-term autonomy, while decisionally vulnerable adults need to be provided with support in order to exercise their autonomy. This leads to differences in how researchers determine who lacks capacity, who has authority to consent, and what criteria guide such decision-making. We also consider how capacity issues color contemporary research governance debates over broad consent, data protection compliance, data sharing, and the return of individual research results and incidental findings.
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Affiliation(s)
- Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
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12
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Hartsock JA, Schwartz PH, Waltz AC, Ott MA. Anticipatory Waivers of Consent for Pediatric Biobanking. Ethics Hum Res 2019; 41:14-21. [PMID: 30895753 PMCID: PMC7370310 DOI: 10.1002/eahr.500008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
As pediatric biobank research grows, additional guidance will be needed about whether researchers should always obtain consent from participants when they reach the legal age of majority. Biobanks struggle with a range of practical and ethical issues related to this question. We propose a framework for the use of anticipatory waivers of consent that is empirically rooted in research that shows that children and adolescents are often developmentally capable of meaningful deliberation about the risks and benefits of participation in research. Accordingly, bright-line legal concepts of majority or competency do not accurately capture the emerging capacity for autonomous decision-making of many pediatric research participants and unnecessarily complicate the issues about contacting participants at the age of majority to obtain consent for the continued or first use of their biospecimens that were obtained during childhood. We believe the proposed framework provides an ethically sound balance between the concern for potential exploitation of vulnerable populations, the impetus for the federal regulations governing research with children, and the need to conduct valuable research in the age of genomic medicine.
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Affiliation(s)
- Jane A Hartsock
- Faculty investigator with the Indiana University Center for Bioethics at the Indiana University School of Medicine and the director of clinical ethics for the Academic Health Center at Indiana University Health
| | - Peter H Schwartz
- Director of the Indiana University Center for Bioethics at the Indiana University School of Medicine and an associate professor of medicine at Indiana University School of Medicine
| | - Amy C Waltz
- Associate director of the Indiana University Human Subjects Office and an adjunct professor at the Indiana University Robert H. McKinney School of Law
| | - Mary A Ott
- Pediatric ethicist at the Indiana University Center for Bioethics at the Indiana University School of Medicine and an associate professor of pediatrics in the Indiana University School of Medicine
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13
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Paquette ED, Derrington SF, Shukla A, Sinha N, Oswald S, Sorce L, Michelson KN. Biobanking in the Pediatric Critical Care Setting: Adolescent/Young Adult Perspectives. J Empir Res Hum Res Ethics 2018; 13:391-401. [PMID: 29900801 PMCID: PMC6146019 DOI: 10.1177/1556264618782231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Biorepository research in children raises numerous ethical questions that are heightened in the pediatric intensive care unit (PICU) setting. We conducted a cross-sectional, interview-based study of 20 adolescent/young adult (A/YA) PICU patients and 75 parents of PICU patients to elucidate perspectives on biorepository research. A/YAs had a positive attitude toward biobanking. In young adults, comprehension was higher for knowledge of a choice to withdraw and participate in the research and lower for purpose, procedures, risks, and benefits of participation. All but one A/YA wanted to have a say in whether their samples would be used. Parent views on child assent were mixed; 55% of parents favored child involvement in decisions. Efforts should be made to improve comprehension by A/YAs and involvement of A/YAs in decisions.
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Affiliation(s)
- Erin D Paquette
- 1 Northwestern University, Chicago, IL, USA
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Sabrina F Derrington
- 1 Northwestern University, Chicago, IL, USA
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Avani Shukla
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Neha Sinha
- 3 Geisinger Medical Center, Danville, PA, USA
| | | | - Lauren Sorce
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Kelly N Michelson
- 1 Northwestern University, Chicago, IL, USA
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
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14
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Prictor M, Teare HJA, Kaye J. Equitable Participation in Biobanks: The Risks and Benefits of a "Dynamic Consent" Approach. Front Public Health 2018; 6:253. [PMID: 30234093 PMCID: PMC6133951 DOI: 10.3389/fpubh.2018.00253] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/15/2018] [Indexed: 01/28/2023] Open
Abstract
Participation in biobanks tends to favor certain groups—white, middle-class, more highly-educated—often to the exclusion of others, such as indigenous people, the socially-disadvantaged and the culturally and linguistically diverse. Barriers to participation, which include age, location, cultural sensitivities around human tissue, and issues of literacy and language, can influence the diversity of samples found in biobanks. This has implications for the generalizability of research findings from biobanks being able to be translated into the clinic. Dynamic Consent, which is a digital decision-support tool, could improve participants' recruitment to, and engagement with, biobanks over time and help to overcome some of the barriers to participation. However, there are also risks that it may deepen the “digital divide” by favoring those with knowledge and access to digital technologies, with the potential to decrease participant engagement in research. When applying a Dynamic Consent approach in biobanking, researchers should give particular attention to adaptations that can improve participant inclusivity, and evaluate the tool empirically, with a focus on equity-relevant outcome measures. This may help biobanks to fulfill their promise of enabling translational research that is relevant to all.
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Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia
| | - Harriet J A Teare
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia.,Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia.,Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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15
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Berkman BE, Howard D, Wendler D. Reconsidering the Need for Reconsent at 18. Pediatrics 2018; 142:peds.2017-1202. [PMID: 29980586 PMCID: PMC6317640 DOI: 10.1542/peds.2017-1202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/24/2022] Open
Abstract
The prevalence of research with biological specimens has led to a debate over what type of consent is needed to obtain biological specimens from minors and store them for future studies. In most cases, parental permission is needed to obtain samples from minors. In addition, almost all commentators and guidelines maintain that researchers need the consent of the donors if they want to continue to store the samples and make them available for future studies after the donors reach the age of majority. In this Ethics Rounds, we argue that this near-consensus view is mistaken on the grounds that the agreement of the parents at the time of obtaining samples provides sufficient permission to store them and use them in research even after the donors turn 18 years old.
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Affiliation(s)
- Benjamin E. Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland; and,National Human Genome Research Institute, Bethesda, Maryland
| | - Dana Howard
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland; and
| | - David Wendler
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland; and
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16
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Sundby A, Boolsen MW, Burgdorf KS, Ullum H, Hansen TF, Mors O. Attitudes of stakeholders in psychiatry towards the inclusion of children in genomic research. Hum Genomics 2018; 12:12. [PMID: 29506557 PMCID: PMC5839067 DOI: 10.1186/s40246-018-0144-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genomic sequencing of children in research raises complex ethical issues. This study aims to gain more knowledge on the attitudes towards the inclusion of children as research subjects in genomic research and towards the disclosure of pertinent and incidental findings to the parents and the child. METHODS Qualitative data were collected from interviews with a wide range of informants: experts engaged in genomic research, clinical geneticists, persons with mental disorders, relatives, and blood donors. Quantitative data were collected from a cross-sectional web-based survey among 1227 parents and 1406 non-parents who were potential stakeholders in psychiatric genomic research. RESULTS Participants generally expressed positive views on children's participation in genomic research. The informants in the qualitative interviews highlighted the age of the child as a critical aspect when disclosing genetic information. Other important aspects were the child's right to an autonomous choice, the emotional burden of knowing imposed on both the child and the parents, and the possibility of receiving beneficial clinical information regarding the future health of the child. Nevertheless, there was no consensus whether the parent or the child should receive the findings. A majority of survey stakeholders agreed that children should be able to participate in genomic research. The majority agreed that both pertinent and incidental findings should be returned to the parents and to the child when of legal age. Having children does not affect the stakeholder's attitudes towards the inclusion of children as research subjects in genomic research. CONCLUSION Our findings illustrate that both the child's right to autonomy and the parents' interest to be informed are important factors that are found valuable by the participants. In future guidelines governing children as subjects in genomic research, it would thus be essential to incorporate the child's right to an open future, including the right to receive information on adult-onset genetic disorders.
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Affiliation(s)
- Anna Sundby
- Department of Clinical Medicine, Psychosis Research Unit, Aarhus University Hospital, Skovagervej 2, 8240, Risskov, Denmark. .,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark.
| | | | | | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Folkmann Hansen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark.,Institute for Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Ole Mors
- Department of Clinical Medicine, Psychosis Research Unit, Aarhus University Hospital, Skovagervej 2, 8240, Risskov, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
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17
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Petersen I, Kaatsch P, Spix C, Kollek R. Return and Disclosure of Research Results: Parental Attitudes and Needs Over Time in Pediatric Oncology. J Pediatr 2017; 191:232-237. [PMID: 28969889 DOI: 10.1016/j.jpeds.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/22/2017] [Accepted: 08/03/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explore parental attitudes regarding the return and disclosure of research findings in pediatric cancer trials over time. STUDY DESIGN Two surveys were set up to evaluate the stability of parental attitudes. One survey was carried out among 581 parents whose child was diagnosed recently (response rate, 53.5%). A second, population-based survey was set up with a time interval of 4 years between first cancer diagnosis and survey in which 1465 parents were included (response rate, 55.1%). RESULTS Almost all surveyed parents stated a parental right to receive aggregate research results. Fifty-five percent of the parents who recently participated in trials and 62% of those asked after a multiyear time interval thought that disclosure of individual findings is in any case necessary (P = .0034). The respondents wanted to restrict the duty to disclose study results to the child according to their notion of the child's well-being, composed of child's maturity, impairment of the parent-child relationship, and the quality of the results. CONCLUSIONS Attitudes of parents regarding the return of research findings change over time. Shortly after diagnosis, parents are mainly interested in aggregate findings. Interest in individual findings appeared to increase as more time elapsed between cancer diagnosis and survey.
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Affiliation(s)
- Imme Petersen
- Hamburg University, Research Centre for Biotechnology, Society and the Environment, Research Group on Medicine and Neurosciences, Hamburg, Germany.
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Regine Kollek
- Hamburg University, Research Centre for Biotechnology, Society and the Environment, Research Group on Medicine and Neurosciences, Hamburg, Germany
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18
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McMahon C, Denaxas S. A novel metadata management model to capture consent for record linkage in longitudinal research studies. Inform Health Soc Care 2017; 44:176-188. [PMID: 29106808 PMCID: PMC6484449 DOI: 10.1080/17538157.2017.1364251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Informed consent is an important feature of longitudinal research studies as it enables the linking of the baseline participant information with administrative data. The lack of standardized models to capture consent elements can lead to substantial challenges. A structured approach to capturing consent-related metadata can address these. Objectives: a) Explore the state-of-the-art for recording consent; b) Identify key elements of consent required for record linkage; and c) Create and evaluate a novel metadata management model to capture consent-related metadata. Methods: The main methodological components of our work were: a) a systematic literature review and qualitative analysis of consent forms; b) the development and evaluation of a novel metadata model. Discussion: We qualitatively analyzed 61 manuscripts and 30 consent forms. We extracted data elements related to obtaining consent for linkage. We created a novel metadata management model for consent and evaluated it by comparison with the existing standards and by iteratively applying it to case studies. Conclusion: The developed model can facilitate the standardized recording of consent for linkage in longitudinal research studies and enable the linkage of external participant data. Furthermore, it can provide a structured way of recording consent-related metadata and facilitate the harmonization and streamlining of processes.
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Affiliation(s)
- Christiana McMahon
- a University College London, Institute of Health Informatics , London , United Kingdom.,b Farr Institute of Health Informatics Research , London , United Kingdom
| | - Spiros Denaxas
- a University College London, Institute of Health Informatics , London , United Kingdom.,b Farr Institute of Health Informatics Research , London , United Kingdom
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19
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Kuemmerle-Deschner JB, Hansmann S, Wulffraat NM, Vastert SJ, Hens K, Anton J, Avcin T, Martini A, Koné-Paut I, Uziel Y, Ravelli A, Wouters C, Shaw D, Özen S, Eikelberg A, Prakken BJ, Ruperto N, Horneff G, Constantin T, Beresford MW, Sikken M, Foster HE, Haug I, Schuller S, Jägle C, Benseler SM. Recommendations for collaborative paediatric research including biobanking in Europe: a Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative. Ann Rheum Dis 2017; 77:319-327. [PMID: 29021237 DOI: 10.1136/annrheumdis-2017-211904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/19/2017] [Accepted: 09/08/2017] [Indexed: 12/21/2022]
Abstract
Innovative research in childhood rheumatic diseases mandates international collaborations. However, researchers struggle with significant regulatory heterogeneity; an enabling European Union (EU)-wide framework is missing. The aims of the study were to systematically review the evidence for best practice and to establish recommendations for collaborative research. The Paediatric Rheumatology European Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) project enabled a scoping review and expert discussion, which then informed the systematic literature review. Published evidence was synthesised; recommendations were drafted. An iterative review process and consultations with Ethics Committees and European experts for ethical and legal aspects of paediatric research refined the recommendations. SHARE experts and patient representatives vetted the proposed recommendations at a consensus meeting using Nominal Group Technique. Agreement of 80% was mandatory for inclusion. The systematic literature review returned 1319 records. A total of 223 full-text publications plus 22 international normative documents were reviewed; 85 publications and 16 normative documents were included. A total of 21 recommendations were established including general principles (1-3), ethics (4-7), paediatric principles (8 and 9), consent to paediatric research (10-14), paediatric databank and biobank (15 and 16), sharing of data and samples (17-19), and commercialisation and third parties (20 and 21). The refined recommendations resulted in an agreement of >80% for all recommendations. The SHARE initiative established the first recommendations for Paediatric Rheumatology collaborative research across borders in Europe. These provide strong support for an urgently needed European framework and evidence-based guidance for its implementation. Such changes will promote research in children with rheumatic diseases.
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Affiliation(s)
| | - Sandra Hansmann
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, Tübingen, Germany
| | - Nico M Wulffraat
- Paediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Paediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Kristien Hens
- Department of Philosophy, University of Antwerp, Antwerp, Belgium
| | - Jordi Anton
- Pediatric Rheumatology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Tadej Avcin
- Departments of Allergy, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alberto Martini
- Department of Paediatrics, University of Genoa, Gaslini Children's Hospital, G. Gaslini Research Institute, Genoa, Italy
| | - Isabelle Koné-Paut
- Department of Paediatric Rheumatology and Haematology, CEREMAI, GHU Paris-Sud - Hôpital de Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar-Saba, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Angelo Ravelli
- Department of Paediatrics, University of Genoa, Gaslini Children's Hospital, G. Gaslini Research Institute, Genoa, Italy
| | - Carine Wouters
- Department of Microbiology and Immunology, Laboratory Paediatric Immunology, UZ Leuven Hospital, Leuven, Belgium
| | - David Shaw
- Department of Health, Ethics and Society, CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.,Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Seza Özen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Andreas Eikelberg
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, Tübingen, Germany
| | - Berent J Prakken
- Paediatric Rheumatology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Nicolino Ruperto
- Department of Paediatrics, University of Genoa, Gaslini Children's Hospital, G. Gaslini Research Institute, Genoa, Italy
| | - Gerd Horneff
- Department of General Pediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Tamas Constantin
- Reumatológia, Immunológia, Gyermekgyógyászati Klinika, Budapest, Hungary
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Institute for Translational Medicine, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Marijn Sikken
- JIA Patient Council, Department of Paediatric Rheumatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Helen E Foster
- Department of Paediatric Rheumatology, Great North Children's Hospital, Institute of Cellular Medicine Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Iris Haug
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, Tübingen, Germany
| | - Sabrina Schuller
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, Tübingen, Germany
| | - Christine Jägle
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, Tübingen, Germany
| | - Susanne M Benseler
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, Tübingen, Germany.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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20
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Christensen KD, Savage SK, Huntington NL, Weitzman ER, Ziniel SI, Bacon PL, Cacioppo CN, Green RC, Holm IA. Preferences for the Return of Individual Results From Research on Pediatric Biobank Samples. J Empir Res Hum Res Ethics 2017; 12:97-106. [PMID: 28421887 PMCID: PMC5407299 DOI: 10.1177/1556264617697839] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Discussions about disclosing individual genetic research results include calls to consider participants' preferences. In this study, parents of Boston Children's Hospital patients set preferences for disclosure based on disease preventability and severity, and could exclude mental health, developmental, childhood degenerative, and adult-onset disorders. Participants reviewed hypothetical reports and reset preferences, if desired. Among 661 participants who initially wanted all results (64%), 1% reset preferences. Among 336 participants who initially excluded at least one category (36%), 38% reset preferences. Participants who reset preferences added 0.9 categories, on average; and their mean satisfaction on 0 to 10 scales increased from 4.7 to 7.2 ( p < .001). Only 2% reduced the number of categories they wanted disclosed. Findings demonstrate the benefits of providing examples of preference options and the tendency of participants to want results disclosed. Findings also suggest that preference-setting models that do not provide specific examples of results could underestimate participants' desires for information.
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Affiliation(s)
- Kurt D. Christensen
- Brigham and Women’s Hospital, Boston (USA)
- Harvard Medical School, Boston (USA)
| | | | | | - Elissa R. Weitzman
- Harvard Medical School, Boston (USA)
- Boston Children’s Hospital, Boston (USA)
| | - Sonja I. Ziniel
- Harvard Medical School, Boston (USA)
- Boston Children’s Hospital, Boston (USA)
| | - Phoebe L. Bacon
- Johns Hopkins University School of Medicine, Baltimore (USA)
| | | | - Robert C. Green
- Brigham and Women’s Hospital, Boston (USA)
- Harvard Medical School, Boston (USA)
- Partners Personalized Medicine, Boston (USA)
| | - Ingrid A. Holm
- Harvard Medical School, Boston (USA)
- Boston Children’s Hospital, Boston (USA)
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21
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Kranendonk EJ, Hennekam RC, Ploem MC. Paediatric biobanking: Dutch experts reflecting on appropriate legal standards for practice. Eur J Pediatr 2017; 176:75-82. [PMID: 27866271 PMCID: PMC5219008 DOI: 10.1007/s00431-016-2810-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 12/01/2022]
Abstract
Large sets of data and human specimens, such as blood, tumour tissue and DNA, are deposited in biobanks for research purposes, preferably for long periods of time and with broadly defined research aims. Our research focuses on the retention of data and biological materials obtained from children. However important such paediatric biobanks may be, the privacy interests of the children involved and the related risks may not be ignored. The privacy issues arising from paediatric biobanks are the central focus of this article. We first review the international regulations that apply to biobanks and then summarise viewpoints expressed by experts in a round-table discussion. We confine ourselves here to two normative questions: (1) How much control should children's parents or legal representatives, and later the children themselves, have over the stored materials and data? (2) What should be done if research findings emerge that have serious implications for a child's health? CONCLUSION On the basis of international legal standards and the views of experts, involved in paediatric biobanking, we argue that biological material of children may only be stored in a biobank for scientific purposes if parents provide their explicit consent, the child is re-contacted at 16 or 18 years of age to reconsider storage and use of its material, and the biobank maintains a limited policy in disclosure of individual research findings to the child's parents. What is Known: • Increasingly, biological material of children is stored in biobanks for research purposes. • Clear standards on the conditions under which children's cells or tissues may be stored and used are lacking. What is New: • According to experts, storage and use of children's materials should only be allowed if performed in accordance with appropriate consent procedures and feedback policies.
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Affiliation(s)
- Elcke J. Kranendonk
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Public Health AMC, Room J2-210, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Raoul C. Hennekam
- Department of Pediatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - M. Corrette Ploem
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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22
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Brothers KB, Goldenberg AJ. Ethical and legal considerations for pediatric biobank consent: current and future perspectives. Per Med 2016; 13:597-607. [PMID: 29754545 DOI: 10.2217/pme-2016-0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Innovations in laboratory and information technologies continue to drive the expansion of pediatric biorepository research, with collections of biosamples and data continuing to grow in scale and scope. In this review, we examine the trajectory of recent developments in ethical and legal scholarship on consent to pediatric biorepository research. We focus, in particular, on issues that are likely to grow in importance in coming years, either because significant controversies remain or because they represent trends that are likely to continue into the future. Of particular interest is the evolving conception of consent as a process, the trend toward increased participant engagement and other challenges likely to raise thorny new issues in this field in the decade ahead.
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Affiliation(s)
- Kyle B Brothers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
| | - Aaron J Goldenberg
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, USA
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23
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Giesbertz NAA, Melham K, Kaye J, van Delden JJM, Bredenoord AL. Personalized assent for pediatric biobanks. BMC Med Ethics 2016; 17:59. [PMID: 27733160 PMCID: PMC5062866 DOI: 10.1186/s12910-016-0142-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/29/2016] [Indexed: 12/22/2022] Open
Abstract
Pediatric biobanking is considered important for generating biomedical knowledge and improving (pediatric) health care. However, the inclusion of children’s samples in biobanks involves specific ethical issues. One of the main concerns is how to appropriately engage children in the consent procedure. We suggest that children should be involved through a personalized assent procedure, which means that both the content and the process of assent are adjusted to the individual child. In this paper we provide guidance on how to put personalized assent into pediatric biobanking practice and consider both the content and process of personalized assent. In the discussion we argue that the assent procedure itself is formative. Investing in the procedure should be a requirement for pediatric biobank research. Although personalized assent will require certain efforts, the pediatric (biobank) community must be aware of its importance. The investment and trust earned can result in ongoing engagement, important longitudinal information, and stability in/for the research infrastructure, as well as increased knowledge among its participants about research activity. Implementing personalized assent will both respect the child and support biobank research.
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Affiliation(s)
- Noor A A Giesbertz
- Department of Medical Humanities, Division Julius Center, University Medical Center Utrecht, Office Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. .,Department of Genetics, Division Biomedical Genetics, University Medical Center Utrecht, KC.04.084.2, P.O. Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - Karen Melham
- Clinical Trials & Research Governance (CTRG) University of Oxford Joint Research Office, Block 60, Churchill Hospital, Headington, Oxford, OX3 7LE, United Kingdom
| | - Jane Kaye
- Nuffield Department of Population Health, HeLEX-Centre for Health, Law and Emerging Technologies at Oxford, University of Oxford, Ewert House, Ewert Place, Banbury Road, Summertown, Oxford, OX2 7DD, UK
| | - Johannes J M van Delden
- Department of Medical Humanities, Division Julius Center, University Medical Center Utrecht, Office Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, Division Julius Center, University Medical Center Utrecht, Office Stratenum 6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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24
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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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25
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Hens K, Peeters H, Dierickx K. Genetic testing and counseling in the case of an autism diagnosis: A caregivers perspective. Eur J Med Genet 2016; 59:452-8. [PMID: 27544064 DOI: 10.1016/j.ejmg.2016.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/14/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
The search for genes that can explain the development of autism is ongoing. At the same time, genetic counselling and genetic testing can be offered to families with a child diagnosed with autism. However, given the complexity of autism, both with respect to its aetiology as well as with respect to its heterogeneity, such genetic counselling and testing raises specific ethical questions regarding the aim and scope. In order to map these questions and opinions we interviewed 15 Belgian autism professionals. We found that they believed that genetic counselling and genetic testing have certain benefits for families confronted with an autism diagnosis, but also that direct benefit to the child is limited to those cases where a genetic finding offers a certain prognosis and intervention plan. In cases where autism is the result of a syndrome or a known genetic variant that is associated with other health problems, detection can also enable prevention of these health issues. Benefits of genetic testing, such as relief of guilt and reproductive choice, are primarily benefits to the parents, although indirectly they may affect the wellbeing of the person diagnosed. These benefits are associated with ethical questions.
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Affiliation(s)
- Kristien Hens
- Department of Philosophy, University of Antwerp, Stadscampus, Rodestraat 14, 2000 Antwerpen, Belgium.
| | | | - Kris Dierickx
- Centre for Biomedical Ethics and Law, KU Leuven, Belgium
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26
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Hens K, Peeters H, Dierickx K. The ethics of complexity. Genetics and autism, a literature review. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:305-16. [PMID: 26870917 DOI: 10.1002/ajmg.b.32432] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022]
Abstract
It is commonly believed that the etiology of autism is at least partly explained through genetics. Given the complexity of autism and the variability of the autistic phenotype, genetic research and counseling in this field are also complex and associated with specific ethical questions. Although the ethics of autism genetics, especially with regard to reproductive choices, has been widely discussed on the public fora, an in depth philosophical or bioethical reflection on all aspects of the theme seems to be missing. With this literature review we wanted to map the basic questions and answers that exist in the bioethical literature on autism genetics, research, counseling and reproduction, and provide suggestions as to how the discussion can proceed. We found 19 papers that fitted the description of "bioethics literature focusing on autism genetics," and analyzed their content to distill arguments and themes. We concluded that because of the complexity of autism, and the uncertainty with regard to its status, more ethical reflection is needed before definite conclusions and recommendations can be drawn. Moreover, there is a dearth of bioethical empirical studies querying the opinions of all parties, including people with autism themselves. Such empirical bioethical studies should be urgently done before bioethical conclusions regarding the aims and desirability of research into autism genes can be done. Also, fundamental philosophical reflection on concepts of disease should accompany research into the etiology of autism.
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Affiliation(s)
- Kristien Hens
- Department of Philosophy, University of Antwerp, Antwerpen, Belgium
| | - Hilde Peeters
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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Kong CC, Tarling TE, Strahlendorf C, Dittrick M, Vercauteren SM. Opinions of Adolescents and Parents About Pediatric Biobanking. J Adolesc Health 2016; 58:474-480. [PMID: 27013273 DOI: 10.1016/j.jadohealth.2015.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/24/2015] [Accepted: 12/08/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE A biobank is defined as "a facility for the collection, preservation, storage and supply of biological samples and associated data, which follows standardized operating procedures and provides material for scientific and clinical use." The practice of biobanking must consider the best interests of participants, which is especially complicated in the pediatric setting, where parents or guardians are responsible for consent of their children. Age of participant assent, consent, and reconsent at the age of majority are some of the issues which need to be addressed. METHODS We conducted an exploratory survey of four cohorts: (1) adolescents aged 14-18 years treated at British Columbia Children's Hospital, Vancouver, British Columbia, Canada, in the Division of Oncology, Cardiology, or Orthopedics. (2) Parents of the adolescents described in (1). (3) Adolescents aged 14-18 years from high schools in Vancouver, British Columbia, Canada. (4) Parents of the adolescents described in (3). RESULTS We show that clinic participants rated a higher willingness to donate specimens versus school participants. Furthermore, clinic participants felt assent was more important and parental consent alone was insufficient. The median suggested age for assent was 14.5 years among adolescent responses and 16 years from parental responses of both groups. School parents were the most conservative in their responses toward their child's participation in a biobank. CONCLUSIONS Adolescents, who were seen in clinics and their parents, had a more altruistic approach toward pediatric biobanking than those surveyed in the school setting. Additionally, parents are less comfortable making decisions regarding biobanking than their adolescent children.
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Affiliation(s)
- Cynthia C Kong
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamsin E Tarling
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caron Strahlendorf
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Division of Hematology/Oncology/Blood and Marrow Transplant, British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Michelle Dittrick
- Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Suzanne M Vercauteren
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Hematopathology, Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Abstract
Noor Giesbertz and colleagues consider different re-contact policy designs that could be used by biobanks to obtain permission for the continued use of samples collected from children.
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Affiliation(s)
- Noor A A Giesbertz
- Department of Medical Humanities Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Manhas KP, Page S, Dodd SX, Letourneau N, Ambrose A, Cui X, Tough SC. Parental perspectives on consent for participation in large-scale, non-biological data repositories. LIFE SCIENCES, SOCIETY AND POLICY 2016; 12:1. [PMID: 26790860 PMCID: PMC4720627 DOI: 10.1186/s40504-016-0034-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/07/2016] [Indexed: 05/13/2023]
Abstract
BACKGROUND Data sharing presents several challenges to the informed consent process. Unique challenges emerge when sharing pediatric or pregnancy-related data. Here, parent preferences for sharing non-biological data are examined. METHODS Groups (n = 4 groups, 18 participants) and individual interviews (n = 19 participants) were conducted with participants from two provincial, longitudinal pregnancy cohorts (AOB and APrON). Qualitative content analysis was applied to transcripts of semi-structured interviews. RESULTS Participants were supportive of a broad, one-time consent model or a tiered consent model. These preferences were grounded in the perceived obligations for reciprocity and accuracy. Parents want reciprocity among participants, repositories and researchers regarding respect and trust. Furthermore, parents' worry about the interrelationships between the validity of the consent processes and secondary data use. CONCLUSIONS Though parent participants agree that their research data should be made available for secondary use, they believe their consent is still required. Given their understanding that obtaining and informed consent can be challenging in the case of secondary use, parents agreed that a broad, one-time consent model was acceptable, reducing the logistical burden while maintaining respect for their contribution. This broad model also maintained participant trust in the research and secondary use of their data. The broad, one-time model also reflected parents' perspectives surrounding child involvement in the consent process. The majority of parents felt decision made during childhood were the parents responsibility and should remain in parental purview until the child reaches the age of majority.
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Affiliation(s)
- Kiran Pohar Manhas
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
| | - Stacey Page
- MacKimmie Library Tower, 2500 University Drive Northwest, Calgary, AB, T2N 1N4, Canada.
| | - Shawn X Dodd
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
| | - Nicole Letourneau
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
| | | | - Xinjie Cui
- Child and Youth Data Lab, Alberta Center for Child Family and Community Research, 9925 109 St NW, Edmonton, AB, T5J 3M9, Canada.
| | - Suzanne C Tough
- Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
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Kranendonk EJ, Ploem MC, Hennekam RCM. Regulating biobanking with children's tissue: a legal analysis and the experts' view. Eur J Hum Genet 2016; 24:30-6. [PMID: 25873015 PMCID: PMC4795222 DOI: 10.1038/ejhg.2015.59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 01/01/2023] Open
Abstract
Many current paediatric studies concern relationships between genes and environment and discuss aetiology, treatment and prevention of Mendelian and multifactorial diseases. Many of these studies depend on collection and long-term storage of data and biological material from affected children in biobanks. Stored material is a source of personal information of the donor and his family and could be used in an undesirable context, potentially leading to discrimination and interfering with a child's right to an open future. Here, we address the normative framework regarding biobanking with residual tissue of children, protecting the privacy interests of young biobank donors (0-12 years). We analyse relevant legal documents concerning storage and use of children's material for research purposes. We explore the views of 17 Dutch experts involved in paediatric biobank research and focus on informed consent for donation of leftover tissue as well as disclosure of individual research findings resulting from biobank research. The results of this analysis show that experts have no clear consensus about the appropriate rules for storage of and research with children's material in biobanks. Development of a framework that provides a fair balance between fundamental paediatric research and privacy protection is necessary.
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Affiliation(s)
- Elcke J Kranendonk
- Department of Public Health, AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Corrette Ploem
- Department of Public Health, AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul C M Hennekam
- Departments of Paediatrics and Translational Genetics, AMC, University of Amsterdam, Amsterdam, The Netherlands
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31
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Ethics of children’s participation in a Saudi biobank: an exploratory survey. Genet Med 2015; 18:806-13. [DOI: 10.1038/gim.2015.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/05/2015] [Indexed: 11/08/2022] Open
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van Teeffelen SR, Douglas CMW, van El CG, Weinreich SS, Henneman L, Radstake M, Cornel MC. Mothers' Views on Longer Storage of Neonatal Dried Blood Spots for Specific Secondary Uses. Public Health Genomics 2015; 19:25-33. [PMID: 26581038 DOI: 10.1159/000441516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neonatal dried blood spots (DBS) present a wealth of data. Currently, many countries discuss DBS storage, management and use. We collected data in the Netherlands on the awareness and views of an unheard stakeholder: mothers (-to-be). METHODS A survey was conducted on an Amsterdam pregnancy fair website in 2011. We included 1,272 women who were pregnant and/or had at least one child ≤5 years old. A descriptive analysis was used to score the awareness of and views on policies regarding the length of storage and secondary use. RESULTS 18.9% of mothers (n = 1,272) were aware of all five current DBS screening, storage and use policies. The views were positive for all ten potential specific secondary uses. Most support was given to etiology research, while test development by a company was least supported. Extending the DBS storage beyond the 5-year status quo was approved by 67.8% of the respondents, indefinite storage was approved by 54.7%. CONCLUSION Mothers indicate support of several secondary uses and prolonged storage of DBS but report a low awareness of current storage and secondary use policies. Efforts must be made to involve parents as key stakeholders in DBS policies. This could be achieved through a parent-led advisory structure.
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Affiliation(s)
- Sarah R van Teeffelen
- Section Community Genetics, Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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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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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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Lynch J, Hines J, Theodore S, Mitchell M. Lay Attitudes Toward Trust, Uncertainty, and the Return of Pediatric Research Results in Biobanking. AJOB Empir Bioeth 2015; 7:160-166. [PMID: 28050575 PMCID: PMC5201190 DOI: 10.1080/23294515.2015.1053008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Trust plays a role in participants' reactions to clinical residual biobanks. The purpose of this study is to assess whether trust in medical researchers and negative reactions of uncertainty influences the attitudes of parents of pediatric research participants toward the return of genomic research results from biobanking. METHODS Focus groups were conducted in collaboration with two community-based organizations. Participants completed a demographic questionnaire and the trust in research and intolerance of uncertainty scales. The focus groups were then conducted according to a thematic focus group guide; discussions were transcribed and analyzed by two trained coders. RESULTS Emerging themes included the importance of returning research results to both children and parents, sharing results with few limitations based on a child's age, and the desire for results even when researchers had concerns about analytic validity. Negative reactions to uncertainty appear to have influenced only one theme: the paradoxical claim by participants with stronger reactions to uncertainty that they had a "right to information." CONCLUSION Participants prefer to receive most or all of the results produced by genomic research, and they want their children, within variable age restrictions, to have access to that information as well.
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36
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Cutas D, Hens K. Preserving children's fertility: two tales about children's right to an open future and the margins of parental obligations. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:253-60. [PMID: 25189425 DOI: 10.1007/s11019-014-9596-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The sources, extent and margins of parental obligations in taking decisions regarding their children's medical care are subjects of ongoing debates. Balancing children's immediate welfare with keeping their future open is a delicate task. In this paper, we briefly present two examples of situations in which parents may be confronted with the choice of whether to authorise or demand non-therapeutic interventions on their children for the purpose of fertility preservation. The first example is that of children facing cancer treatment, and the second of children with Klinefelter syndrome. We argue that, whereas decisions of whether to preserve fertility may be prima facie within the limits of parental discretion, the right to an open future does not straightforwardly put parents under an obligation to take actions that would detect or relieve future infertility in their children-and indeed in some cases taking such actions is problematic.
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Affiliation(s)
- Daniela Cutas
- Department of Historical, Philosophical and Religious Studies, Umeå University, Umeå, Sweden,
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Vora T, Thacker N. Impacts of a biobank: Bridging the gap in translational cancer medicine. Indian J Med Paediatr Oncol 2015; 36:17-23. [PMID: 25810570 PMCID: PMC4363845 DOI: 10.4103/0971-5851.151773] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The prevalence of people affected by cancer has been steadily increasing. More and more people are being offered the chance of increased longevity. This has been possible due to advances not only in medicines and techniques but also because of the gain in understanding of cancer biology through Translational Cancer Medicine. A significant step towards obtaining this success was the establishment of successful biobanking practise. In this review we discuss about the importance of a Biobank and the various impacts that a biobank can have not only in the field of cancer but also on many other aspects. Later we discuss a method of quantitative evaluation of these impacts of a biobank.
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Affiliation(s)
- Tushar Vora
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
| | - Nirav Thacker
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
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Salvaterra E, Locatelli F, Strazzer S, Borgatti R, D''angelo G, Lenzi L. Paediatric biobanks: opinions, feelings and attitudes of parents towards the specimen donation of their sick children to a hypothetical biobank. Pathobiology 2015; 81:304-308. [PMID: 25792219 DOI: 10.1159/000362091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Over the last years, the storing of biological materials from children for research purposes in biobanks has become the subject of an intense debate in the scientific and ethical communities on a global level. Paediatric biobanks are an important resource for the development of translational research. At the same time, paediatric biobanks are ethically 'sensitive' due to the unique issues they raise. In this study, we explore opinions, feelings and attitudes of parents towards the specimen donation of their sick children to a hypothetical biobank. According to a qualitative methodology based on focus groups, we analysed parents' views, perceptions and inclinations towards typical ethical, legal and social aspects of paediatric biobanks such as proxy consent, minor assent, privacy protection and return of results. Our study confirms the need for specific policies dedicated to paediatric biobanks by highlighting how the nature of the disease affecting children may influence the parents' opinions and decisions towards the enrolment of their children in biobank-based research studies.
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Consent procedures in pediatric biobanks. Eur J Hum Genet 2014; 23:1129-34. [PMID: 25537361 PMCID: PMC4538194 DOI: 10.1038/ejhg.2014.267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/17/2014] [Accepted: 10/30/2014] [Indexed: 12/03/2022] Open
Abstract
The inclusion of children's samples in biobanks brings forward specific ethical issues. Guidelines indicate that children should be involved in the consent procedure. It is, however, unclear how to allocate an appropriate role for children. Knowledge of current practice will be helpful in addressing this issue. Therefore, we conducted an international multiple-case study on the child's role in consent procedures in pediatric biobanks. Four biobanks were included: (1) LifeLines, (2) Prevention and Incidence of Asthma and Mite Allergy (PIAMA), (3) Young-HUNT3 and (4) the Oxford Radcliffe Biobank contribution to the Children's Cancer and Leukaemia Group tissue bank (ORB/CCLG). Four themes linked to the child's role in the consent procedure emerged from the multiple-case study: (1) motives to involve the child, (2) informing the child, (3) the role of dissent, assent and consent and (4) voluntariness of children to participate. We conclude that biobank characteristics influence the biobank's motives to include children in the consent procedure. Moreover, the motives to include children influence how the children are involved in the consent procedure, and the extent to which children are able to make voluntary decisions as part of the consent procedure. This insight is valuable when designing pediatric biobank governance.
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Brothers KB, Lynch JA, Aufox SA, Connolly JJ, Gelb BD, Holm IA, Sanderson SC, McCormick JB, Williams JL, Wolf WA, Antommaria AHM, Clayton EW. Practical guidance on informed consent for pediatric participants in a biorepository. Mayo Clin Proc 2014; 89:1471-80. [PMID: 25264176 PMCID: PMC4254313 DOI: 10.1016/j.mayocp.2014.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Kyle B Brothers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY.
| | - John A Lynch
- Department of Communication, University of Cincinnati, Cincinnati, OH
| | - Sharon A Aufox
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John J Connolly
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bruce D Gelb
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ingrid A Holm
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, and Harvard Medical School, Boston, MA
| | - Saskia C Sanderson
- Department of Genetic and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer B McCormick
- Divisions of General Internal Medicine and Health Care and Policy Research and the Mayo Biomedical Ethics Program, Mayo Clinic, Rochester, MN
| | - Janet L Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, PA
| | - Wendy A Wolf
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA
| | | | - Ellen W Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
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41
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Zawati MH, Parry D, Knoppers BM. The best interests of the child and the return of results in genetic research: international comparative perspectives. BMC Med Ethics 2014; 15:72. [PMID: 25280986 PMCID: PMC4192737 DOI: 10.1186/1472-6939-15-72] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paediatric genomic research raises particularly challenging questions on whether and under what circumstances to return research results. In the paediatric context, decision-making is guided by the best interests of the child framework, as enshrined in the 1989 international Convention on the Rights of the Child. According to this Convention, rights and responsibilities are shared between children, parents, researchers, and the state. These "relational" obligations are further complicated in the context of genetic research. DISCUSSION A comparative review of international, regional and national documents on the return of research results reveals that there is a dearth of normative documents in the paediatric context. The best interests of the child framework is increasingly complicated by a growing appreciation of pediatric autonomy and the development thereof; parental rights (particularly when parents are affected by the genomic information of their children); and the right not to know. SUMMARY This comparative analysis reveals that policy-makers and legislators have responded to the above challenges in different ways. Nevertheless, in Europe as well as in Canada, there is an emerging trend towards making the return of certain results mandatory in the paediatric context, should this course of action prove to be in the best interests of the child.
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Affiliation(s)
- Ma’n H Zawati
- Centre of Genomics and Policy, McGill University, 740 Dr. Penfield Avenue, Suite 5200, Montreal, Quebec H3A 0G1 Canada
| | - David Parry
- Centre of Genomics and Policy, McGill University, 740 Dr. Penfield Avenue, Suite 5200, Montreal, Quebec H3A 0G1 Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, McGill University, 740 Dr. Penfield Avenue, Suite 5200, Montreal, Quebec H3A 0G1 Canada
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42
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Preserving children's fertility: two tales about children's right to an open future and the margins of parental obligations. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014. [PMID: 25189425 DOI: 10.1007/s11019-014-9596-3.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
The sources, extent and margins of parental obligations in taking decisions regarding their children's medical care are subjects of ongoing debates. Balancing children's immediate welfare with keeping their future open is a delicate task. In this paper, we briefly present two examples of situations in which parents may be confronted with the choice of whether to authorise or demand non-therapeutic interventions on their children for the purpose of fertility preservation. The first example is that of children facing cancer treatment, and the second of children with Klinefelter syndrome. We argue that, whereas decisions of whether to preserve fertility may be prima facie within the limits of parental discretion, the right to an open future does not straightforwardly put parents under an obligation to take actions that would detect or relieve future infertility in their children-and indeed in some cases taking such actions is problematic.
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43
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Giesbertz NAA, Bredenoord AL, van Delden JJM. Clarifying assent in pediatric research. Eur J Hum Genet 2014; 22:266-9. [PMID: 23756442 PMCID: PMC3895639 DOI: 10.1038/ejhg.2013.119] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/22/2013] [Accepted: 05/01/2013] [Indexed: 01/14/2023] Open
Abstract
Assent is a relatively young term in research ethics, but became an often mentioned ethical requirement in current pediatric research guidelines. Also, the European Society of Human Genetics considers assent an important condition for the inclusion of children in biobanks. However, although many emphasize the importance of assent, few explain how they understand the concept and few have elaborated on the underlying grounds. In this paper, we will discuss the different underlying ethical principles of assent. In the first category, assent appears to be derived from informed consent. This understanding is grounded in respect for autonomy and protection against harm. We conclude that this interpretation of assent is not of added value as a majority of children cannot be considered competent to make autonomous decisions. In addition, other safeguards are more appropriate to protect children against harm. The grounds from the second category can be classified as engagement grounds. These grounds do justice to the specifics of childhood and are of added value. Furthermore, we argue that it follows that both the content and the process of assent should be adjusted to the individual child. This can be referred to as personalized assent. Personalized assent is an appeal to the moral responsibility and integrity of the researcher.
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Affiliation(s)
- Noor A A Giesbertz
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Whole-genome sequencing in health care: recommendations of the European Society of Human Genetics. Eur J Hum Genet 2013; 21:580-4. [PMID: 23676617 DOI: 10.1038/ejhg.2013.46] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Knoppers BM, Avard D, Sénécal K, Zawati MH. Return of whole-genome sequencing results in paediatric research: a statement of the P3G international paediatrics platform. Eur J Hum Genet 2013; 22:3-5. [PMID: 23921532 DOI: 10.1038/ejhg.2013.176] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
| | - Denise Avard
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Karine Sénécal
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
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Anastasova V, Mahalatchimy A, Rial-Sebbag E, Antó Boqué JM, Keil T, Sunyer J, Bousquet J, Cambon-Thomsen A. Communication of results and disclosure of incidental findings in longitudinal paediatric research. Pediatr Allergy Immunol 2013; 24:389-94. [PMID: 23692330 DOI: 10.1111/pai.12087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Communicating results to research participants is an issue frequently discussed in terms of ethics. It has specific features when involving large-scale paediatric cohorts. High-throughput biological explorations reveal also incidental findings of medical relevance. This work analyses existing frameworks for managing such issues and proposes a policy grounded in the experience acquired in the FP7 EU project MeDALL-Mechanisms of the Development of ALLergy. METHODS A bibliographical analysis was performed using law, ethics and academic documentation. Empirical data were acquired through informed consent forms from 9 of the 13 cohorts used in MeDALL and from replies to a general questionnaire (n = 10) on ethical issues sent to consortium members. Group discussions and expert consultations were conducted during project meetings. RESULTS The notions of research results and incidental findings remain ambiguous as no agreed definition exists. The most appropriate terms are communication of results and disclosure of incidental findings. No legal norm and no specific guidance govern these issues in paediatric research at European level. Relevant policies depend on decisions in each cohort or project. The policy proposed states that these issues should be discussed during the informed consent process, with due attention to involvement of children, and a balance of interests between children, parents and society. A moral duty for researchers to communicate such information only applies if certain medical and social criteria are met. CONCLUSIONS As there is no consensus within European Birth cohorts how to deal with results and incidental findings, we propose a general policy.
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Affiliation(s)
- Velizara Anastasova
- Inserm, UMR1027, Epidemiology and analyses in Public Health, Toulouse, France
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van El CG, Cornel MC, Borry P, Hastings RJ, Fellmann F, Hodgson SV, Howard HC, Cambon-Thomsen A, Knoppers BM, Meijers-Heijboer H, Scheffer H, Tranebjaerg L, Dondorp W, de Wert GMWR. Whole-genome sequencing in health care. Recommendations of the European Society of Human Genetics. Eur J Hum Genet 2013; 21 Suppl 1:S1-S5. [PMID: 23819146 PMCID: PMC3660957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Carla G van El
- Section Community Genetics, Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Lohn Z, Adam S, Birch PH, Friedman JM. Incidental findings from clinical genome-wide sequencing: a review. J Genet Couns 2013; 23:463-73. [PMID: 23709124 DOI: 10.1007/s10897-013-9604-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 05/02/2013] [Indexed: 12/11/2022]
Abstract
There are several unresolved challenges associated with the clinical application of genome-wide sequencing technologies. One of the most discussed issues is incidental findings (IF), which are defined as discoveries made as a result of genetic testing that are unrelated to the indication for the test. The discussion surrounding IF began in the context of research, which we have used to frame consideration of IF in the clinical context. There is growing consensus that analytically valid and medically actionable IF should be offered to patients, but whether and to what extent clinicians should disclose other kinds of IF is debated. While others have systematically reviewed the literature concerning genetic IF, previous reviews focus on ethical and research-related issues and do not consider the implications for the genetic counseling profession specifically. This review discusses the practical considerations, ethical concerns and genetic counseling issues related to IF, with a particular focus on clinical genome-wide sequencing. To date, the bulk of the literature with respect to IF in the clinical context consists of commentaries, reviews and case reports. There is a need for more empirical studies to provide a foundation for institutional protocols and evidence-based clinical practice standards.
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Affiliation(s)
- Z Lohn
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada,
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Douglas CM, van El CG, Faulkner A, Cornel MC. Governing biological material at the intersection of care and research: the use of dried blood spots for biobanking. Croat Med J 2012; 53:390-7. [PMID: 22911534 PMCID: PMC3428828 DOI: 10.3325/cmj.2012.53.390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A series of governance issues currently surrounds the multiple uses and multiple users of dried blood spots (DBS) for research purposes. Internationally there is a discussion on storing DBS resulting from newborn screening for public health and using them as the basis for large biobank-like collections to facilitate biomedical research. If such a transformation were to be formalized, then DBS would sit at the intersection of care (ie, public health) and research, with the mechanisms through which such a collection could be managed not totally self-evident. What is more, a DBS collection raises questions about the fuzzy boundaries between privacy and anonymity; how to control or define quality control uses of DBS; medical vs nonmedical uses; as well as benefit sharing and stakeholder involvement. Our goal here is to explore some of the key questions relating to DBS governance by way of the bio-objects and bio-objectification concepts. By embracing - rather than resisting to - the blurring of boundaries and problems in categorization that have come to characterize bio-objects and bio-objectification processes recently described in this journal, we attempt to highlight some issues that might not be currently considered, and to point to some possible directions to go (or avoid). Building from our knowledge of the current DBS situation in the Netherlands, we outline questions concerning the uses, management, collection, and storage of DBS.
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Affiliation(s)
- Conor M.W. Douglas
- VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, Section Community Genetics, Amsterdam, the Netherlands
| | - Carla G. van El
- VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, Section Community Genetics, Amsterdam, the Netherlands
| | - Alex Faulkner
- King’s College London, Department of Political Economy, London, United Kingdom
| | - Martina C. Cornel
- VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research, Section Community Genetics, Amsterdam, the Netherlands
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Crossing the boundary between research and health care: P3G policy statement on return of results from population studies. Eur J Hum Genet 2012; 21:243-4. [PMID: 22828808 PMCID: PMC3573199 DOI: 10.1038/ejhg.2012.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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