1
|
Vigezzi GP, Maggioni E, Bert F, de Vito C, Siliquini R, Odone A. Who is (not) vaccinated? A proposal for a comprehensive immunization information system. Hum Vaccin Immunother 2024; 20:2386739. [PMID: 39103249 DOI: 10.1080/21645515.2024.2386739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/27/2024] [Indexed: 08/07/2024] Open
Abstract
The role of immunization in public health is crucial, offering widespread protection against infectious diseases and underpinning societal well-being. However, achieving optimal vaccination coverage is impeded by vaccine hesitancy, a significant challenge that necessitates comprehensive strategies to understand and mitigate its effects. We propose the integration of Population Health Management principles with Immunization Information Systems (IISs) to address vaccine hesitancy more effectively. Our approach leverages systematic health determinants analysis to identify at-risk populations and tailor interventions, thereby promoting vaccination coverage and public health responses. We call for the development of an enhanced version of the Italian National Vaccination Registry, which aims to facilitate real-time tracking of individuals' vaccination status while improving data accuracy and interoperability among healthcare systems. This registry is designed to overcome current barriers by ensuring robust data protection, addressing cultural and organizational challenges, and integrating behavioral insights to foster informed public health campaigns. Our proposal aligns with the Italian National Vaccination Prevention Plan 2023-2025 and emphasizes proactive, evidence-based strategies to increase vaccination uptake and contrast the spread of vaccine-preventable diseases. The ultimate goal is to establish a data-driven, ethically sound framework that enhances public health outcomes and addresses the complexities of vaccine hesitancy within the Italian context and beyond.
Collapse
Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Elena Maggioni
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Fabrizio Bert
- Department of Public Health and Pediatrics Sciences, University of Torino, Torino, Italy
| | - Corrado de Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Roberta Siliquini
- Department of Public Health and Pediatrics Sciences, University of Torino, Torino, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Medical Direction, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
2
|
Sahan K, Wijesurendra R, Preiss D, Mafham M, Sheehan M. Towards an understanding of the ethics of electronic consent in clinical trials. Trials 2024; 25:545. [PMID: 39152507 PMCID: PMC11329992 DOI: 10.1186/s13063-024-08330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 07/08/2024] [Indexed: 08/19/2024] Open
Abstract
There are good practical reasons to use electronic consent (e-consent) in randomised trials, especially when conducting large-scale clinical trials to answer population-level health research questions. However, determining ethical reasons for e-consent is not so clear and depends on a proper understanding of what e-consent means when used in clinical trials and its ethical significance. Here we focus on four features of ethical significance which give rise to a range of ethical considerations relating to e-consent and merit further focused ethics research.
Collapse
Affiliation(s)
- Katherine Sahan
- Ethox Centre, Oxford Population Health, University of Oxford, Big Data Institute, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Rohan Wijesurendra
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - David Preiss
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Marion Mafham
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Mark Sheehan
- Ethox Centre, Oxford Population Health, University of Oxford, Big Data Institute, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK.
| |
Collapse
|
3
|
Isasi R, Bentzen HB, Fabbri M, Fuhr A, Glover JC, Mah N, Mascalzoni D, Mueller S, Seltmann S, Kurtz A. Dynamic governance: A new era for consent for stem cell research. Stem Cell Reports 2024:S2213-6711(24)00214-5. [PMID: 39151430 DOI: 10.1016/j.stemcr.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 08/19/2024] Open
Abstract
Governance infrastructures streamline scientific and ethical provenance verification of human pluripotent stem cell (SC) lines. Yet, scientific developments (e.g., SC-derived embryo models, organoids) challenge research governance approaches to stored biospecimens, questioning the validity of informed consent (IC) models. Likewise, e-health platforms are driving major transformations in data processing, prompting a reappraisal of IC. Given these developments, participatory research platforms are identified as effective tools to promote longitudinal engagement, interactive decision-making, and dynamic governance. Learning from European initiatives piloting dynamic IC for biobanking and SC research, this Perspective explores the benefits and challenges of implementing dynamic IC and governance for SC.
Collapse
Affiliation(s)
- Rosario Isasi
- Interdisciplinary Stem Cell Institute and Dr. John T. Macdonald Foundation Department of Human Genetics, Miami, FL, USA.
| | - Heidi B Bentzen
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway and Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Morris Fabbri
- Interdisciplinary Stem Cell Institute and Dr. John T. Macdonald Foundation Department of Human Genetics, Miami, FL, USA
| | - Antonie Fuhr
- Fraunhofer Institute für Biomedizinische Technik (IBMT), Joseph-von-Fraunhofer Weg 1, 66280 Sulzbach, Germany
| | - Joel C Glover
- Department of Molecular Medicine, University of Oslo, and Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | - Nancy Mah
- Fraunhofer Institute für Biomedizinische Technik (IBMT), Joseph-von-Fraunhofer Weg 1, 66280 Sulzbach, Germany
| | - Deborah Mascalzoni
- Centre for Research Ethics and Bioethics (CRB), Uppsala University, Uppsala, Sweden
| | - Sabine Mueller
- Fraunhofer Institute für Biomedizinische Technik (IBMT), Joseph-von-Fraunhofer Weg 1, 66280 Sulzbach, Germany
| | - Stefanie Seltmann
- Fraunhofer Institute für Biomedizinische Technik (IBMT), Joseph-von-Fraunhofer Weg 1, 66280 Sulzbach, Germany
| | - Andreas Kurtz
- Fraunhofer Institute für Biomedizinische Technik (IBMT), Joseph-von-Fraunhofer Weg 1, 66280 Sulzbach, Germany
| |
Collapse
|
4
|
Bruns A, Winkler EC. Dynamic consent: a royal road to research consent? JOURNAL OF MEDICAL ETHICS 2024:jme-2024-110153. [PMID: 39048154 DOI: 10.1136/jme-2024-110153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
In recent years, the principle of informed consent has come under significant pressure with the rise of biobanks and data infrastructures for medical research. Study-specific consent is unfeasible in the context of biobank and data infrastructure research; and while broad consent facilitates research, it has been criticised as being insufficient to secure a truly informed consent. Dynamic consent has been promoted as a promising alternative approach that could help patients and research participants regain control over the use of their biospecimen and health data in medical research. Critical voices have focused mainly on concerns around its implementation; but little has been said about the argument that dynamic consent is morally superior to broad consent as a way to respect people's individual autonomy. In this paper, we identify two versions of this argument-an information-focused version and a control-focused version-and then argue that both fail to establish the moral superiority of dynamic over broad consent. In particular, we argue that since autonomous choices are a certain species of choices, it is neither obvious that dynamic consent would meaningfully enhance people's autonomy, nor that it is morally justifiable to act on every kind of consent choice enabled by dynamic consent.
Collapse
Affiliation(s)
- Andreas Bruns
- Section of Translational Medical Ethics, National Center for Tumor Diseases, Department of Medical Oncology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Eva C Winkler
- Section of Translational Medical Ethics, National Center for Tumor Diseases, Department of Medical Oncology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| |
Collapse
|
5
|
Song R. Waiving the consent requirement to mitigate bias in observational precision medicine research. Int J Equity Health 2024; 23:142. [PMID: 39026212 PMCID: PMC11256561 DOI: 10.1186/s12939-024-02221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
Consent bias is a type of selection bias in biomedical research where those consenting to the research differ systematically from those not consenting. It is particularly relevant in precision medicine research because the complexity of these studies prevents certain subgroups from understanding, trusting, and consenting to the research. Because consent bias distorts research findings and causes inequitable distribution of research benefits, scholars propose two types of schemes to reduce consent bias: reforming existing consent models and removing the consent requirement altogether. This study explores the possibility of waiving consent in observational studies using existing data, because they involve fewer risks to participants than clinical trials if privacy safeguards are strengthened. It suggests that data protection mechanisms such as security enhancement and data protection impact assessment should be conducted to protect data privacy of participants in observational studies without consent.
Collapse
Affiliation(s)
- Ruifeng Song
- Faculty of Law, The University of Hong Kong, Pokfulam, Hong Kong, China.
| |
Collapse
|
6
|
Xin M, Li Q, Wang D, Wang Z. Organoids for Cancer Research: Advances and Challenges. Adv Biol (Weinh) 2024:e2400056. [PMID: 38977414 DOI: 10.1002/adbi.202400056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/04/2024] [Indexed: 07/10/2024]
Abstract
As 3D culture technology advances, new avenues have opened for the development of physiological human cancer models. These preclinical models provide efficient ways to translate basic cancer research into clinical tumor therapies. Recently, cancer organoids have emerged as a model to dissect the more complex tumor microenvironment. Incorporating cancer organoids into preclinical programs have the potential to increase the success rate of oncology drug development and recapitulate the most efficacious treatment regimens for cancer patients. In this review, four main types of cancer organoids are introduced, their applications, advantages, limitations, and prospects are discussed, as well as the recent application of single-cell RNA-sequencing (scRNA-seq) in exploring cancer organoids to advance this field.
Collapse
Affiliation(s)
- Miaomaio Xin
- Assisted Reproductive Center, Women's & Children's Hospital of Northwest, Xi'an, Shanxi Province, 710000, China
- University of South Bohemia in Ceske Budejovice, Vodnany, 38925, Czech Republic
| | - Qian Li
- Changsha Medical University, Changsha, Hunan Province, 410000, China
| | - Dongyang Wang
- Assisted Reproductive Center, Women's & Children's Hospital of Northwest, Xi'an, Shanxi Province, 710000, China
| | - Zheng Wang
- Medical Center of Hematology, the Second Affiliated Hospital, Army Medical University, Chongqing, Sichuan Province, 404100, China
| |
Collapse
|
7
|
Staunton C, Biasiotto R, Tschigg K, Mascalzoni D. Artificial Intelligence Needs Data: Challenges Accessing Italian Databases to Train AI. Asian Bioeth Rev 2024; 16:423-435. [PMID: 39022381 PMCID: PMC11250977 DOI: 10.1007/s41649-024-00282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 07/20/2024] Open
Abstract
Population biobanks are an increasingly important infrastructure to support research and will be a much-needed resource in the delivery of personalised medicine. Artificial intelligence (AI) systems can process and cross-link very large amounts of data quickly and be used not only for improving research power but also for helping with complex diagnosis and prediction of diseases based on health profiles. AI, therefore, potentially has a critical role to play in personalised medicine, and biobanks can provide a lot of the necessary baseline data related to healthy populations that will enable the development of AI tools. To develop these tools, access to personal data, and in particular, sensitive data, is required. Such data could be accessed from biobanks. Biobanks are a valuable resource for research but accessing and using the data contained within such biobanks raise a host of legal, ethical, and social issues (ELSI). This includes the appropriate consent to manage the collection, storage, use, and sharing of samples and data, and appropriate governance models that provide oversight of secondary use of samples and data. Biobanks have developed new consent models and governance tools to enable access that address some of these ELSI-related issues. In this paper, we consider whether such governance frameworks can enable access to biobank data to develop AI. As Italy has one of the most restrictive regulatory frameworks on the use of genetic data in Europe, we examine the regulatory framework in Italy. We also look at the proposed changes under the European Health Data Space (EHDS). We conclude by arguing that currently, regulatory frameworks are misaligned and unless addressed, accessing data within Italian biobanks to train AI will be severely limited.
Collapse
Affiliation(s)
- Ciara Staunton
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- School of Law, University of KwaZulu-Natal, Durban, South Africa
| | - Roberta Biasiotto
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Center for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
8
|
Kaye J, Shah N, Kogetsu A, Coy S, Katirai A, Kuroda M, Li Y, Kato K, Yamamoto BA. Moving beyond Technical Issues to Stakeholder Involvement: Key Areas for Consideration in the Development of Human-Centred and Trusted AI in Healthcare. Asian Bioeth Rev 2024; 16:501-511. [PMID: 39022370 PMCID: PMC11250765 DOI: 10.1007/s41649-024-00300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/02/2024] [Accepted: 05/30/2024] [Indexed: 07/20/2024] Open
Abstract
Discussion around the increasing use of AI in healthcare tends to focus on the technical aspects of the technology rather than the socio-technical issues associated with implementation. In this paper, we argue for the development of a sustained societal dialogue between stakeholders around the use of AI in healthcare. We contend that a more human-centred approach to AI implementation in healthcare is needed which is inclusive of the views of a range of stakeholders. We identify four key areas to support stakeholder involvement that would enhance the development, implementation, and evaluation of AI in healthcare leading to greater levels of trust. These are as follows: (1) aligning AI development practices with social values, (2) appropriate and proportionate involvement of stakeholders, (3) understanding the importance of building trust in AI, (4) embedding stakeholder-driven governance to support these activities.
Collapse
Affiliation(s)
- Jane Kaye
- Centre for Health, Law, and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, UK
- Melbourne Law School, University of Melbourne, Melbourne, VIC Australia
| | - Nisha Shah
- Centre for Health, Law, and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, UK
| | - Atsushi Kogetsu
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sarah Coy
- Centre for Health, Law, and Emerging Technologies (HeLEX), Faculty of Law, University of Oxford, Oxford, UK
| | - Amelia Katirai
- Research Center on Ethical, Legal, and Social Issues, Osaka University, Osaka, Japan
| | - Machie Kuroda
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yan Li
- Center for Global Initiatives, Osaka University, Osaka, Japan
| | - Kazuto Kato
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | |
Collapse
|
9
|
Lesmann H, Hustinx A, Moosa S, Klinkhammer H, Marchi E, Caro P, Abdelrazek IM, Pantel JT, Hagen MT, Thong MK, Binti Mazlan RA, Tae SK, Kamphans T, Meiswinkel W, Li JM, Javanmardi B, Knaus A, Uwineza A, Knopp C, Tkemaladze T, Elbracht M, Mattern L, Jamra RA, Velmans C, Strehlow V, Jacob M, Peron A, Dias C, Nunes BC, Vilella T, Pinheiro IF, Kim CA, Melaragno MI, Weiland H, Kaptain S, Chwiałkowska K, Kwasniewski M, Saad R, Wiethoff S, Goel H, Tang C, Hau A, Barakat TS, Panek P, Nabil A, Suh J, Braun F, Gomy I, Averdunk L, Ekure E, Bergant G, Peterlin B, Graziano C, Gaboon N, Fiesco-Roa M, Spinelli AM, Wilpert NM, Phowthongkum P, Güzel N, Haack TB, Bitar R, Tzschach A, Rodriguez-Palmero A, Brunet T, Rudnik-Schöneborn S, Contreras-Capetillo SN, Oberlack A, Samango-Sprouse C, Sadeghin T, Olaya M, Platzer K, Borovikov A, Schnabel F, Heuft L, Herrmann V, Oegema R, Elkhateeb N, Kumar S, Komlosi K, Mohamed K, Kalantari S, Sirchia F, Martinez-Monseny AF, Höller M, Toutouna L, Mohamed A, Lasa-Aranzasti A, Sayer JA, Ehmke N, Danyel M, Sczakiel H, Schwartzmann S, Boschann F, Zhao M, Adam R, Einicke L, Horn D, Chew KS, KAM CC, Karakoyun M, Pode-Shakked B, Eliyahu A, Rock R, Carrion T, Chorin O, Zarate YA, Conti MM, Karakaya M, Tung ML, Chandra B, Bouman A, Lumaka A, Wasif N, Shinawi M, Blackburn PR, Wang T, Niehues T, Schmidt A, Roth RR, Wieczorek D, Hu P, Waikel RL, Ledgister Hanchard SE, Elmakkawy G, Safwat S, Ebstein F, Krüger E, Küry S, Bézieau S, Arlt A, Olinger E, Marbach F, Li D, Dupuis L, Mendoza-Londono R, Houge SD, Weis D, Chung BHY, Mak CC, Kayserili H, Elcioglu N, Aykut A, Şimşek-Kiper PÖ, Bögershausen N, Wollnik B, Bentzen HB, Kurth I, Netzer C, Jezela-Stanek A, Devriendt K, Gripp KW, Mücke M, Verloes A, Schaaf CP, Nellåker C, Solomon BD, Nöthen MM, Abdalla E, Lyon GJ, Krawitz PM, Hsieh TC. GestaltMatcher Database - A global reference for facial phenotypic variability in rare human diseases. RESEARCH SQUARE 2024:rs.3.rs-4438861. [PMID: 38903062 PMCID: PMC11188141 DOI: 10.21203/rs.3.rs-4438861/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
The most important factor that complicates the work of dysmorphologists is the significant phenotypic variability of the human face. Next-Generation Phenotyping (NGP) tools that assist clinicians with recognizing characteristic syndromic patterns are particularly challenged when confronted with patients from populations different from their training data. To that end, we systematically analyzed the impact of genetic ancestry on facial dysmorphism. For that purpose, we established the GestaltMatcher Database (GMDB) as a reference dataset for medical images of patients with rare genetic disorders from around the world. We collected 10,980 frontal facial images - more than a quarter previously unpublished - from 8,346 patients, representing 581 rare disorders. Although the predominant ancestry is still European (67%), data from underrepresented populations have been increased considerably via global collaborations (19% Asian and 7% African). This includes previously unpublished reports for more than 40% of the African patients. The NGP analysis on this diverse dataset revealed characteristic performance differences depending on the composition of training and test sets corresponding to genetic relatedness. For clinical use of NGP, incorporating non-European patients resulted in a profound enhancement of GestaltMatcher performance. The top-5 accuracy rate increased by +11.29%. Importantly, this improvement in delineating the correct disorder from a facial portrait was achieved without decreasing the performance on European patients. By design, GMDB complies with the FAIR principles by rendering the curated medical data findable, accessible, interoperable, and reusable. This means GMDB can also serve as data for training and benchmarking. In summary, our study on facial dysmorphism on a global sample revealed a considerable cross ancestral phenotypic variability confounding NGP that should be counteracted by international efforts for increasing data diversity. GMDB will serve as a vital reference database for clinicians and a transparent training set for advancing NGP technology.
Collapse
Affiliation(s)
- Hellen Lesmann
- Institute of Human Genetics, University of Bonn, Bonn, NRW, Germany
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Alexander Hustinx
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Shahida Moosa
- Division of Molecular Biology and Human Genetics, Stellenbosch University and Medical Genetics, Tygerberg Hospital, Stellenbosch, South Africa
| | - Hannah Klinkhammer
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, NRW, Germany
| | - Elaine Marchi
- New York State Institute for Basic Research in Developmental Disabilities, New York State, Albany, New York, USA
| | - Pilar Caro
- Institute of Human Genetics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Ibrahim M. Abdelrazek
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Alexandria, Egypt
| | - Jean Tori Pantel
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, NRW, Germany
- Centre for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, NRW, Germany
| | - Merle ten Hagen
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Meow-Keong Thong
- Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Sok Kun Tae
- Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | | | - Jing-Mei Li
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Behnam Javanmardi
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Alexej Knaus
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Annette Uwineza
- College of Medicine and Health Sciences, University of Rwanda, and University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Cordula Knopp
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, NRW, Germany
| | - Tinatin Tkemaladze
- Department of Molecular and Medical Genetics, Tbilisi State Medical University, Tbilisi, Georgia
- Givi Zhvania Pediatric Academic Clinic, Tbilisi State Medical University, Georgia
| | - Miriam Elbracht
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, NRW, Germany
| | - Larissa Mattern
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, NRW, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Clara Velmans
- Institute of Human Genetics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany
| | - Vincent Strehlow
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Maureen Jacob
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Angela Peron
- Medical Genetics, Meyer Children’s Hospital IRCCS, Firenze, Italy
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, Università degli Studi di Firenze, Italy
| | - Cristina Dias
- Department of Medical Genetics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK
- Neural Stem Cell Biology Laboratory, The Francis Crick Institute, UK
- Department of Medical & Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, UK
| | - Beatriz Carvalho Nunes
- Genetics Division, Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thainá Vilella
- Genetics Division, Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Chong Ae Kim
- Genetics Unit, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Isabel Melaragno
- Genetics Division, Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Hannah Weiland
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Sophia Kaptain
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Karolina Chwiałkowska
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Bialystok, Poland
- IMAGENE.ME SA, Bialystok, Poland
| | - Miroslaw Kwasniewski
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Bialystok, Poland
- IMAGENE.ME SA, Bialystok, Poland
| | - Ramy Saad
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK
- Department of Genetics and Genomic Medicine, UCL Institute of Child Health, London UK
| | - Sarah Wiethoff
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, NRW, Germany
| | - Himanshu Goel
- School of Medicine and Public Health, University of Newcastle, Callaghan NSW, Australia
| | - Clara Tang
- Kabuki Syndrome Foundation, Northbrook, IL, USA
| | - Anna Hau
- Hunter Genetics, Hunter New England Health Service, Newcastle, Australia
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Przemysław Panek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Amira Nabil
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Alexandria, Egypt
| | - Julia Suh
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, NRW, Germany
| | - Frederik Braun
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, NRW, Germany
| | - Israel Gomy
- Department of Genetics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Sao Paulo, Brazil
| | - Luisa Averdunk
- Department of General Pediatrics and Neonatology, University Children’s Hospital, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany
| | - Ekanem Ekure
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Gaber Bergant
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana
| | | | - Nagwa Gaboon
- Medical Genetics Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Medical Genetics Department, Armed Forces College of Medicine, Cairo, Egypt
| | - Moisés Fiesco-Roa
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, México City, Mexico
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, México City, Mexico
| | | | - Nina-Maria Wilpert
- NeuroCure Cluster of Excellence; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-10117 Berlin, Germany
- Department of Neuropediatrics, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, D-13353 Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, D-10117 Berlin, German
| | - Prasit Phowthongkum
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
- Division of Medical Genetics and Genomics, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nergis Güzel
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, NRW, Germany
| | - Tobias B. Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Rana Bitar
- Pediatric Gastroenterology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Khalifa University, Abu Dhabi, United Arab Emirates
| | - Andreas Tzschach
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Agusti Rodriguez-Palmero
- Paediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Theresa Brunet
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | | | | | - Ava Oberlack
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - Carole Samango-Sprouse
- Department of Pediatrics, George Washington University, 2121 I St. NW, Washington D.C. 2005
- Department of Human and Molecular Genetics, Florida International University, 11200 SW 8th Street, AHC2 Miami, Florida 22199
- Department of Research, The Focus Foundation, 820 W. Central Ave. #190, Davidsonville, MD 21035
| | - Teresa Sadeghin
- Department of Research, The Focus Foundation, 2772 Rutland Road P.O. Box 190, Davidsonville, MD 21035
| | - Margaret Olaya
- Department of Research, The Focus Foundation, 2772 Rutland Road P.O. Box 190, Davidsonville, MD 21035
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Franziska Schnabel
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Lara Heuft
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Vera Herrmann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Renske Oegema
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nour Elkhateeb
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sheetal Kumar
- Institute of Human Genetics, University of Bonn, Bonn, NRW, Germany
| | - Katalin Komlosi
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Khoushoua Mohamed
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Alexandria, Egypt
| | - Silvia Kalantari
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Fabio Sirchia
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Medical Genetics Unit, IRCCS San Matteo Foundation, Pavia, Italy
| | - Antonio F. Martinez-Monseny
- Department of Clinical Genetics, SJD Barcelona Children’s Hospital, Esplugues del Llobregat (Barcelona), Spain
| | - Matthias Höller
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Louiza Toutouna
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Amal Mohamed
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Alexandria, Egypt
| | - Amaia Lasa-Aranzasti
- Medicine Genetics Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Vall d’Hebron Hospital Universitari, Barcelona, Catalunya, Spain
- Department of Clinical and Molecular Genetics, Vall d’Hebron Barcelona Hospital Campus, Vall d’Hebron Hospital Universitari, Barcelona, Catalunya, Spain
| | - John A. Sayer
- Biosciences Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, UK
- Renal Services, The Newcastle Upon Tyne NHS Hospitals Foundation Trust, Freeman Road, Newcastle Upon Tyne, UK
| | - Nadja Ehmke
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Magdalena Danyel
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Henrike Sczakiel
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sarina Schwartzmann
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Felix Boschann
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Max Zhao
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ronja Adam
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Lara Einicke
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Denise Horn
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kee Seang Chew
- Department of Paediatrics, Faculty of Medicine, University Malaya, 59100 Kuala Lumpur, Malaysia
| | - Choy Chen KAM
- Department of Paediatrics, Faculty of Medicine, University Malaya, 59100 Kuala Lumpur, Malaysia
| | - Miray Karakoyun
- Ege University, Faculty of Medicine, Department of Pediatric Gastroenterology Hepatology and Nutrition, Izmir, Turkey
| | - Ben Pode-Shakked
- The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel
- The faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviva Eliyahu
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Rachel Rock
- Metabolic Diseases Clinic, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center
- National Newborn Screening Program, Public Health Services, Ministry of Health Tel-Hashomer, Israel
| | - Teresa Carrion
- Rare diseases Unit, Pediatric Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Odelia Chorin
- The Institute of Rare Diseases, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yuri A. Zarate
- Department of Pediatrics, Section of Genetics and Metabolism, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR, USA
- Division of Genetics and Metabolism, University of Kentucky, Lexington, KY, USA
| | | | - Mert Karakaya
- Institute of Human Genetics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany
| | - Moon Ley Tung
- University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA 52242, USA
- Division of Medical Genetics and Genomics, Stead Family Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Bharatendu Chandra
- University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA 52242, USA
- Division of Medical Genetics and Genomics, Stead Family Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Arjan Bouman
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aime Lumaka
- Center for Human Genetics, Faculty of Medicine, University of Kinshasa, Kinshasa, DR Congo
| | - Naveed Wasif
- Institute of Human Genetics, University of Ulm, Ulm, Baden-Württemberg, Germany
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Marwan Shinawi
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrick R. Blackburn
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Tianyun Wang
- Department of Medical Genetics, Center for Medical Genetics, Peking University Health Science Center, Beijing 100191, China
- Neuroscience Research Institute, Peking University; Key Laboratory for Neuroscience, Ministry of Education of China & National Health Commission of China, Beijing 100191, China
- Autism Research Center, Peking University Health Science Center, Beijing 100191, China
| | - Tim Niehues
- Department of Pediatrics, Helios Klinik Krefeld, Krefeld 47805, Germany
| | - Axel Schmidt
- Institute of Human Genetics, University of Bonn, Bonn, NRW, Germany
| | - Regina Rita Roth
- Institute of Human Genetics, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| | - Dagmar Wieczorek
- Institute of Human Genetics, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| | - Ping Hu
- Medical Genomics Unit, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, USA
| | - Rebekah L. Waikel
- Medical Genomics Unit, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, USA
| | | | - Gehad Elmakkawy
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Alexandria, Egypt
| | - Sylvia Safwat
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Alexandria, Egypt
| | - Frédéric Ebstein
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Service de Génétique Médicale, F-44000 Nantes, France
| | - Elke Krüger
- Insitute for Medical Biochemistry and Molecular Biology, University of Greifswald, Greifswald, Greifswald, Germany
| | - Sébastien Küry
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Service de Génétique Médicale, F-44000 Nantes, France
| | - Stéphane Bézieau
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Service de Génétique Médicale, F-44000 Nantes, France
| | - Annabelle Arlt
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Eric Olinger
- Center for Human Genetics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Felix Marbach
- Institute of Human Genetics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Dong Li
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lucie Dupuis
- Department to Paediatrics, Division of Clinical and Metabolic Genetics, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - Roberto Mendoza-Londono
- Department to Paediatrics, Division of Clinical and Metabolic Genetics, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - Sofia Douzgou Houge
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Denisa Weis
- Institue for Medical Genetics, Kepler University Hospital, Linz, Austria
| | - Brian Hon-Yin Chung
- Hong Kong Genome Institute, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Christopher C.Y. Mak
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Hülya Kayserili
- Medical Genetics Department, Koç University School of Medicine (KUSoM), 34010, Istanbul, Türkiye
| | - Nursel Elcioglu
- Department of Pediatric Genetics, Marmara University School of Medicine, Istanbul, Türkiye
| | - Ayca Aykut
- Department of Medical Genetics, Ege University Faculty of Medicine, Izmir, Türkiye
| | | | - Nina Bögershausen
- Institut of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Bernd Wollnik
- Institut of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Heidi Beate Bentzen
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingo Kurth
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, NRW, Germany
| | - Christian Netzer
- Institute of Human Genetics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany
| | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | | | - Karen W. Gripp
- Division of Medical Genetics, A.I. du Pont Hospital for Children/Nemours, USA, Wilmington, Delaware, USA
| | - Martin Mücke
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, NRW, Germany
- Centre for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, NRW, Germany
| | - Alain Verloes
- Department of Clinical Genetics, Robert-Debré Hospital, Paris, France
| | - Christian P. Schaaf
- Institute of Human Genetics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Christoffer Nellåker
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, UK
| | - Benjamin D. Solomon
- Medical Genomics Unit, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, USA
| | - Markus M. Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, NRW, Germany
| | - Ebtesam Abdalla
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Alexandria, Egypt
| | - Gholson J. Lyon
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York, United States of America
- George A. Jervis Clinic, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York, United States of America
- Biology PhD Program, The Graduate Center, The City University of New York, New York, United States of America
| | - Peter M. Krawitz
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| | - Tzung-Chien Hsieh
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, NRW, Germany
| |
Collapse
|
10
|
Zenker S, Strech D, Jahns R, Müller G, Prasser F, Schickhardt C, Schmidt G, Semler SC, Winkler E, Drepper J. [Nationally standardized broad consent in practice: initial experiences, current developments, and critical assessment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:637-647. [PMID: 38639817 PMCID: PMC11166792 DOI: 10.1007/s00103-024-03878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The digitalization in the healthcare sector promises a secondary use of patient data in the sense of a learning healthcare system. For this, the Medical Informatics Initiative's (MII) Consent Working Group has created an ethical and legal basis with standardized consent documents. This paper describes the systematically monitored introduction of these documents at the MII sites. METHODS The monitoring of the introduction included regular online surveys, an in-depth analysis of the introduction processes at selected sites, and an assessment of the documents in use. In addition, inquiries and feedback from a large number of stakeholders were evaluated. RESULTS The online surveys showed that 27 of the 32 sites have gradually introduced the consent documents productively, with a current total of 173,289 consents. The analysis of the implementation procedures revealed heterogeneous organizational conditions at the sites. The requirements of various stakeholders were met by developing and providing supplementary versions of the consent documents and additional information materials. DISCUSSION The introduction of the MII consent documents at the university hospitals creates a uniform legal basis for the secondary use of patient data. However, the comprehensive implementation within the sites remains challenging. Therefore, minimum requirements for patient information and supplementary recommendations for best practice must be developed. The further development of the national legal framework for research will not render the participation and transparency mechanisms developed here obsolete.
Collapse
Affiliation(s)
- Sven Zenker
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek), Kaufmännische Direktion, Universitätsklinikum Bonn, Bonn, Deutschland.
- AG Angewandte Medizininformatik (AMI), Institut für Medizinische Biometrie, Informatik und Epidemiologie (IMBIE), Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland.
- AG Angewandte Mathematische Physiologie (AMP), Klinik & Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek) Kaufmännische Direktion, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Daniel Strech
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Roland Jahns
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw), Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Müller
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Fabian Prasser
- Center for Health Data Science, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Schickhardt
- Sektion Translationale Medizinethik, KKE Angewandte Tumor-Immunität, Nationales Centrum für Tumorerkrankungen (NCT), Deutsches Krebsforschungszentrum (DKFZ) Heidelberg und Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Georg Schmidt
- Klinik und Poliklinik für Innere Medizin I. Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Sebastian C Semler
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
| | - Eva Winkler
- Sektion Translationale Medizinethik, Abteilung Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Universität Heidelberg, Heidelberg, Deutschland
| | - Johannes Drepper
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
| |
Collapse
|
11
|
van Rijssel TI, van Thiel GJMW, van Delden JJM. The Ethics of Decentralized Clinical Trials and Informed Consent: Taking Technologies' Soft Impacts into Account. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00483-1. [PMID: 38764063 DOI: 10.1007/s10728-024-00483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials.
Collapse
Affiliation(s)
- Tessa I van Rijssel
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Ghislaine J M W van Thiel
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
12
|
Norton BY, Liu J, Lewis SA, Magee H, Kruer TN, Dinh R, Bakhtiari S, Nordlie SH, Shetty S, Heim J, Nishiyama Y, Arango J, Johnson D, Seabrooke L, Shub M, Rosenberg R, Shusterman M, Wisniewski S, Cooper B, Rothwell E, Fahey MC, Shrader MW, Lennon N, Oleszek J, Pierce W, Fleming H, Belthur M, Tinto J, Noritz G, Glader L, Steffan K, Walker W, Grenard D, Aravamuthan B, Bjornson K, Joseph M, Gross P, Kruer MC. Development and validation of a stakeholder-driven, self-contained electronic informed consent platform for trio-based genomic research studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.01.24306461. [PMID: 39040210 PMCID: PMC11261908 DOI: 10.1101/2024.05.01.24306461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Increasingly long and complex informed consents have yielded studies demonstrating comparatively low participant comprehension and satisfaction with traditional face-to-face approaches. In parallel, interest in electronic consents for clinical and research genomics has steadily increased, yet limited data are available for trio-based genomic discovery studies. We describe the design, development, implementation, and validation of an electronic iConsent application for trio-based genomic research deployed to support genomic studies of cerebral palsy. iConsent development incorporated stakeholder perspectives including researchers, patient advocates, institutional review board members, and genomic data-sharing considerations. The iConsent platform integrated principles derived from prior electronic consenting research and elements of multimedia learning theory. Participant comprehension was assessed in an interactive teachback format. The iConsent application achieved nine of ten proposed desiderata for effective patient-focused electronic consenting for genomic research. Overall, participants demonstrated high comprehension and retention of key human subjects' considerations. Enrollees reported high levels of satisfaction with the iConsent, and we found that participant comprehension, iConsent clarity, privacy protections, and study goal explanations were associated with overall satisfaction. Although opportunities exist to optimize iConsent, we show that such an approach is feasible, can satisfy multiple stakeholder requirements, and can realize high participant satisfaction and comprehension while increasing study reach.
Collapse
Affiliation(s)
- Bethany Y Norton
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - James Liu
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Sara A Lewis
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Helen Magee
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Tyler N Kruer
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Rachael Dinh
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Somayeh Bakhtiari
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Sandra H. Nordlie
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Sheetal Shetty
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
- Programs in Behavioral Health, Biomedical Informatics, Molecular & Cellular Biology, and Neuroscience, Arizona State University, Tempe, AZ, USA
| | - Jennifer Heim
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Yumi Nishiyama
- Programs in Behavioral Health, Biomedical Informatics, Molecular & Cellular Biology, and Neuroscience, Arizona State University, Tempe, AZ, USA
| | - Jorge Arango
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Darcy Johnson
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Lee Seabrooke
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Mitchell Shub
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Robert Rosenberg
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | | | - Stephen Wisniewski
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Blair Cooper
- Cerebral Palsy Research Network, Greenville, SC, USA
| | - Erin Rothwell
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - M. Wade Shrader
- Department of Orthopaedics, AI DuPont Children’s Hospital, Wilmington, DE, USA
| | - Nancy Lennon
- Department of Orthopaedics, AI DuPont Children’s Hospital, Wilmington, DE, USA
| | - Joyce Oleszek
- Department of Physical Medicine & Rehabilitation, Colorado Children’s Hospital, Aurora, CO, USA
| | - Wendy Pierce
- Department of Physical Medicine & Rehabilitation, Colorado Children’s Hospital, Aurora, CO, USA
| | - Hannah Fleming
- Department of Physical Medicine & Rehabilitation, Colorado Children’s Hospital, Aurora, CO, USA
| | - Mohan Belthur
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Jennifer Tinto
- Division of Complex Care, Department of Pediatrics, Nationwide Children’s, Colombus, OH, USA
| | - Garey Noritz
- Division of Complex Care, Department of Pediatrics, Nationwide Children’s, Colombus, OH, USA
| | - Laurie Glader
- Division of Complex Care, Department of Pediatrics, Nationwide Children’s, Colombus, OH, USA
| | - Kelsey Steffan
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - William Walker
- Department of Pediatrics, Division of Developmental Medicine, Seattle Children’s, Seattle, WA, USA
| | - Deborah Grenard
- Department of Pediatrics, Division of Developmental Medicine, Seattle Children’s, Seattle, WA, USA
| | | | - Kristie Bjornson
- Department of Pediatrics, Division of Developmental Medicine, Seattle Children’s, Seattle, WA, USA
| | - Malin Joseph
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Paul Gross
- Cerebral Palsy Research Network, Greenville, SC, USA
| | - Michael C Kruer
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
- Programs in Behavioral Health, Biomedical Informatics, Molecular & Cellular Biology, and Neuroscience, Arizona State University, Tempe, AZ, USA
| | | |
Collapse
|
13
|
Lipinski S, Sünkel U, Totzeck C, Dresler T, Baskow I, Bea M, Hannig R, Dziobek I. [Patient and public involvement at the German Center for Mental Health: achievements and challenges]. DER NERVENARZT 2024; 95:458-466. [PMID: 38506976 PMCID: PMC11068695 DOI: 10.1007/s00115-024-01630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Patient and public involvement (PPI) describes the participation of patients and relatives, i.e., experts by experience (EE), in the research process. The PPI has not been widely adopted in the fields of medicine and clinical psychology in Germany and there is a notable absence of institutional support. The German Center for Mental Health (DZPG), which has been under construction since May 2023, aims to achieve nationwide and cross-center implementation of PPI, constituting one of its primary objectives. Participation of EE is to be implemented in the DZPG at all levels of decision-making. OBJECTIVES The article describes the origins, development and challenges associated with the implementation of participation structures and projects in the DZPG. The central political PPI committee in the DZPG, the Trilogue Center Council (TZR), developed a comprehensive PPI strategy for the DZPG in almost 3 years of work, before the beginning of the financial support of the DZPG. Among various measures, the strategy entails establishing a far-reaching representation for EE in all decision-making bodies of the DZPG, to involve EE as reviewers in evaluating research proposals, to integrate participatory elements into all studies of the DZGG and to foster user-initiated research endeavors. The implementation of the strategy is ensured by a cross-center PPI infrastructure, the Center for PPI, and scientific PPI consultants. The Center for PPI's tasks include supporting the voice of the EE and developing instruments and guidelines for participatory research, bringing together EE and researchers for joint DZPG projects as well as the documentation and quality assurance for participatory research. One of the particular challenges for the successful implementation of the PPI strategy is the limited experience with PPI in Germany in the field of mental health research and the widespread lack of structural implementation. Currently developed solution strategies include training for researchers and EE to communicate the benefits and pathways in the realization of PPI and thus enable shared decision-making and research. In addition, extensive access to knowledge and resources for EE will be created and uniform remuneration regulations for EE will be developed. CONCLUSION A PPI strategy at the DZPG has been successfully developed and is currently being implemented by the cross-center infrastructure Center for PPI.
Collapse
Affiliation(s)
- Silke Lipinski
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Klinische Psychologie Sozialer Interaktion, Institut für Psychologie, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland
- Aspies e. V., Berlin, Deutschland
| | - Ulrike Sünkel
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Aspies e. V., Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Christina Totzeck
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Forschungs- und Behandlungszentrum für psychische Gesundheit (FBZ), Ruhr-Universität Bochum, Bochum, Deutschland
| | - Thomas Dresler
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
- LEAD Graduate School & Research Network, Universität Tübingen, Tübingen, Deutschland
| | - Irina Baskow
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Myriam Bea
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- ADHS Deutschland e. V., Berlin, Deutschland
| | - Rüdiger Hannig
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Bundesverband der Angehörigen psychisch erkrankter Menschen e. V., Bonn, Deutschland
| | - Isabel Dziobek
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG), .
- Klinische Psychologie Sozialer Interaktion, Institut für Psychologie, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland.
| |
Collapse
|
14
|
Staunton C, Shabani M, Mascalzoni D, Mežinska S, Slokenberga S. Ethical and social reflections on the proposed European Health Data Space. Eur J Hum Genet 2024; 32:498-505. [PMID: 38355959 PMCID: PMC11061131 DOI: 10.1038/s41431-024-01543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
The COVID-19 pandemic demonstrated the benefits of international data sharing. Data sharing enabled the health care policy makers to make decisions based on real-time data, it enabled the tracking of the virus, and importantly it enabled the development of vaccines that were crucial to mitigating the impact of the virus. This data sharing is not the norm as data sharing needs to navigate complex ethical and legal rules, and in particular, the fragmented application of the General Data Protection Regulation (GDPR). The introduction of the draft regulation for a European Health Data Space (EHDS) in May 2022 seeks to address some of these legal issues. If passed, it will create an obligation to share electronic health data for certain secondary purposes. While there is a clear need to address the legal complexities involved with data sharing, it is critical that any proposed reforms are in line with ethical principles and the expectations of the data subjects. In this paper we offer a critique of the EHDS and offer some recommendations for this evolving regulatory space.
Collapse
Affiliation(s)
- Ciara Staunton
- Institute for Biomedicine, Eurac Research, Bolzano, Italy.
- School of Law, University of Kwazulunatal, Durban, South Africa.
| | - Mahsa Shabani
- Faculty of Law and Criminology, Ghent University, Gent, Belgium
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Bolzano, Italy
- Department of Public Health and Caring Science, Uppsala University, CRB, P.O. Box 256, 751 05, Uppsala, Sweden
| | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | | |
Collapse
|
15
|
Staunton C, Edgcumbe A, Abdulrauf L, Gooden A, Ogendi P, Thaldar D. Cross-border data sharing for research in Africa: An analysis of the data protection and research ethics requirements in 12 jurisdictions. RESEARCH SQUARE 2024:rs.3.rs-4217849. [PMID: 38699320 PMCID: PMC11065056 DOI: 10.21203/rs.3.rs-4217849/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background In recent years, there has been a notable uptake in genomic and health-related research activities across the African continent. Similarly, there has been increased introduction of data protection legislation that affects the sharing of personal data such as health data and genomic data, including for research. Many of these statutes have stricter requirements when sharing personal data across borders. Consequently, the cross-border sharing of health data that includes genetic data requires careful navigation of the pertinent data protection legislation, in particular concerning the sharing of such data for research purposes. To help researchers navigate these legal frameworks, 12 African countries were analysed to develop country guides on cross-border data sharing. Results Of the 12 countries that were analysed, ten have data protection laws in place (Botswana, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe), while two countries (Cameroon and The Gambia) do not. With the exception of Ghana, all countries with data protection statutes or bills had additional requirements to be met when sharing personal data across borders. Consent and adequacy are the most common grounds for justifying the sharing of personal data across borders. Conclusion Given the limitations of the current models of consent, consent is not a suitable basis to transfer large quantities of data for research. Adequacy is a common ground, but there are national differences in the implementation of this ground. Researchers must therefore analyse each national legal framework and make decisions on a case-by-case and country-by-country basis.
Collapse
|
16
|
Prinsen L. Introducing dynamic consent for improved trust and privacy in research involving human biological material and associated data in South Africa. Front Genet 2024; 15:1272924. [PMID: 38633409 PMCID: PMC11021646 DOI: 10.3389/fgene.2024.1272924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Biomedical research using human biological material and data is essential for improving human health, but it requires the active participation of many human volunteers in addition to the distribution of data. As a result, it has raised numerous vexing questions related to trust, privacy and consent. Trust is essential in biomedical research as it relates directly to the willingness of participants to continue participating in research. Privacy and the protection of personal information also influence trust. Informed consent has proven to be insufficient as it cannot overcome the informational deficit between primary and unknown future uses of material and data and is therefore not fully informed and invalid. Broad consent is also problematic as it takes full control of samples and data flow from the research participant and inherently requires that a participant must trust that the researcher will use their material or data in a manner that they would find acceptable. This paper attempts to offer some insight into how these related issues can be overcome. It introduces dynamic consent as a consent model in research involving human biological material and its associated data. Dynamic consent is explained, as well as its claims of superiority in instances where future research is possible. It is also shown how dynamic consent contributes to better control of the samples and data by the research participant, and how trust may be improved by using this consent model. Dynamic consent's co-existence with and support of the South African Protection of Personal Information Act of 2013 is also assessed. The limitations of dynamic consent are also discussed.
Collapse
Affiliation(s)
- Larisse Prinsen
- Department of Public Law, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
17
|
Rivas Velarde MC, Lovis C, Ienca M, Samer C, Hurst S. Consent as a compositional act - a framework that provides clarity for the retention and use of data. Philos Ethics Humanit Med 2024; 19:2. [PMID: 38443971 PMCID: PMC10916011 DOI: 10.1186/s13010-024-00152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Informed consent is one of the key principles of conducting research involving humans. When research participants give consent, they perform an act in which they utter, write or otherwise provide an authorisation to somebody to do something. This paper proposes a new understanding of the informed consent as a compositional act. This conceptualisation departs from a modular conceptualisation of informed consent procedures. METHODS This paper is a conceptual analysis that explores what consent is and what it does or does not do. It presents a framework that explores the basic elements of consent and breaks it down into its component parts. It analyses the consent act by first identifying its basic elements, namely: a) data subjects or legal representative that provides the authorisation of consent; b) a specific thing that is being consented to; and c) specific agent(s) to whom the consent is given. RESULTS This paper presents a framework that explores the basic elements of consent and breaks it down into its component parts. It goes beyond only providing choices to potential research participants; it explains the rationale of those choices or consenting acts that are taking place when speaking or writing an authorisation to do something to somebody. CONCLUSIONS We argue that by clearly differentiating the goals, the procedures of implementation, and what is being done or undone when one consent, one can better face the challenges of contemporary data-intensive biomedical research, particularly regarding the retention and use of data. Conceptualising consent as a compositional act enhances more efficient communication and accountability and, therefore, could enable more trustworthy acts of consent in biomedical science.
Collapse
Affiliation(s)
- Minerva C Rivas Velarde
- Geneva School of Health Science, University of Applied Sciences Geneva HES-SO, Geneva, Switzerland.
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospital of Geneva, Geneva, Switzerland
| | - Marcello Ienca
- Institute for Ethics and History of Medicine, Department of Clinical Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
- College of Humanities, Swiss Federal Institute of Technology in Lausanne, Lausanne, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities (iEH2), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
18
|
Freye M, Buchner B. [Legal regulation of digital public health interventions-hindrance or stimulus?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:285-291. [PMID: 38329530 DOI: 10.1007/s00103-024-03835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
The potential benefits of digital health technologies in population-based health research depend mainly on whether and to what extent these technologies can be based on the processing of personal health data. However, there needs to be more certainty in the application and interpretation of the relevant legal regulations on the processing of research data using digital health technologies. Research practice primarily uses consent as a legitimation basis for data processing, although the information model of the German and European legislator, with its ambitious requirements for voluntary and informed consent, is unrealistic and needs to be revised. Even the concepts of broad consent, dynamic consent, and meta consent, which represent alternatives to the classic consent solution, cannot remedy all the deficits of the consent model.In order to guarantee the informational self-determination of the persons concerned and, at the same time, keep an eye on the interests of research in the public health sector, data protection for research purposes must be further developed. Solutions should not only be tailored to consent behavior but must also consider the legitimization of research data processing without consent or aim to remove the personal reference of the data irretrievably. To date, the law has only fulfilled its task of striking an appropriate balance between the interests of all stakeholders to a limited extent. However, improvement is in sight, especially given current regulatory initiatives and new legal solutions. This discussion article illustrates the ambivalent role of law: on the one hand, health data protection law is often perceived as an obstacle to innovation, but on the other hand, law can pave the way for digital health technologies if further developed.
Collapse
Affiliation(s)
- Merle Freye
- Institut für Informations‑, Gesundheits- und Medizinrecht, Universität Bremen, Universitätsallee GW1, 28359, Bremen, Deutschland.
- Leibniz Science Campus Digital Public Health (LSC DiPH) Bremen, Bremen, Deutschland.
| | - Benedikt Buchner
- Lehrstuhl für Bürgerliches Recht, Haftungsrecht und Recht der Digitalisierung, Universität Augsburg, Augsburg, Deutschland
| |
Collapse
|
19
|
Savulescu J, Giubilini A, Vandersluis R, Mishra A. Ethics of artificial intelligence in medicine. Singapore Med J 2024; 65:150-158. [PMID: 38527299 PMCID: PMC7615805 DOI: 10.4103/singaporemedj.smj-2023-279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 03/27/2024]
Abstract
ABSTRACT This article reviews the main ethical issues that arise from the use of artificial intelligence (AI) technologies in medicine. Issues around trust, responsibility, risks of discrimination, privacy, autonomy, and potential benefits and harms are assessed. For better or worse, AI is a promising technology that can revolutionise healthcare delivery. It is up to us to make AI a tool for the good by ensuring that ethical oversight accompanies the design, development and implementation of AI technology in clinical practice.
Collapse
Affiliation(s)
- Julian Savulescu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alberto Giubilini
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Robert Vandersluis
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Abhishek Mishra
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| |
Collapse
|
20
|
Charles WM, van der Waal MB, Flach J, Bisschop A, van der Waal RX, Es-Sbai H, McLeod CJ. Blockchain-Based Dynamic Consent and its Applications for Patient-Centric Research and Health Information Sharing: Protocol for an Integrative Review. JMIR Res Protoc 2024; 13:e50339. [PMID: 38315514 PMCID: PMC10877491 DOI: 10.2196/50339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Blockchain has been proposed as a critical technology to facilitate more patient-centric research and health information sharing. For instance, it can be applied to coordinate and document dynamic informed consent, a procedure that allows individuals to continuously review and renew their consent to the collection, use, or sharing of their private health information. Such has been suggested to facilitate ethical, compliant longitudinal research, and patient engagement. However, blockchain-based dynamic consent is a relatively new concept, and it is not yet clear how well the suggested implementations will work in practice. Efforts to critically evaluate implementations in health research contexts are limited. OBJECTIVE The objective of this protocol is to guide the identification and critical appraisal of implementations of blockchain-based dynamic consent in health research contexts, thereby facilitating the development of best practices for future research, innovation, and implementation. METHODS The protocol describes methods for an integrative review to allow evaluation of a broad range of quantitative and qualitative research designs. The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) framework guided the review's structure and nature of reporting findings. We developed search strategies and syntax with the help of an academic librarian. Multiple databases were selected to identify pertinent academic literature (CINAHL, Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science) and gray literature (Electronic Theses Online Service, ProQuest Dissertations and Theses, Open Access Theses and Dissertations, and Google Scholar) for a comprehensive picture of the field's progress. Eligibility criteria were defined based on PROSPERO (International Prospective Register of Systematic Reviews) requirements and a criteria framework for technology readiness. A total of 2 reviewers will independently review and extract data, while a third reviewer will adjudicate discrepancies. Quality appraisal of articles and discussed implementations will proceed based on the validated Mixed Method Appraisal Tool, and themes will be identified through thematic data synthesis. RESULTS Literature searches were conducted, and after duplicates were removed, 492 articles were eligible for screening. Title and abstract screening allowed the removal of 312 articles, leaving 180 eligible articles for full-text review against inclusion criteria and confirming a sufficient body of literature for project feasibility. Results will synthesize the quality of evidence on blockchain-based dynamic consent for patient-centric research and health information sharing, covering effectiveness, efficiency, satisfaction, regulatory compliance, and methods of managing identity. CONCLUSIONS The review will provide a comprehensive picture of the progress of emerging blockchain-based dynamic consent technologies and the rigor with which implementations are approached. Resulting insights are expected to inform best practices for future research, innovation, and implementation to benefit patient-centric research and health information sharing. TRIAL REGISTRATION PROSPERO CRD42023396983; http://tinyurl.com/cn8a5x7t. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50339.
Collapse
Affiliation(s)
- Wendy M Charles
- Health Administration Program, Business School, University of Colorado, Denver, Denver, CO, United States
- Healthcare Informatics Program, University of Denver, Denver, CO, United States
| | - Mark B van der Waal
- Triall, Maarssen, Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | | | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| |
Collapse
|
21
|
Molldrem S, Smith AKJ, Subrahmanyam V. Toward Consent in Molecular HIV Surveillance?: Perspectives of Critical Stakeholders. AJOB Empir Bioeth 2024; 15:66-79. [PMID: 37768111 DOI: 10.1080/23294515.2023.2262967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND The emergence of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs as key features of the United States (US) HIV strategy since 2018 has caused major controversies. HIV surveillance programs that re-use individuals' routinely collected clinical HIV data do not require consent on the basis that the public benefit of these programs outweighs individuals' rights to opt out. However, criticisms of MHS/CDR have questioned whether expanded uses of HIV genetic sequence data for prevention reach beyond traditional public health ethics frameworks. This study aimed to explore views on consent within MHS/CDR among critical stakeholders. METHODS In 2021 we interviewed 26 US HIV stakeholders who identified as being critical or concerned about the rollout of MHS/CDR. Stakeholders included participants belonging to networks of people living with HIV, other advocates, academics, and public health professionals. This analysis focused on identifying the range of positions among critical and concerned stakeholders on consent affordances, opt-outs, how to best inform people living with HIV about how data about them are used in public health programs, and related ethical issues. RESULTS Participants were broadly supportive of introducing some forms of consent into MHS/CDR. However, they differed on the specifics of implementing consent. While some participants did not support introducing consent affordances, all supported the idea that people living with HIV should be informed about how HIV surveillance and prevention is conducted and how individuals' data are used. CONCLUSIONS MHS/CDR has caused sustained controversy. Among critical stakeholders, consent is generally desirable but contested, although the right for people living with HIV to be informed was centrally supported. In an era of big data-driven public health interventions and routine uses of HIV genetic sequence data in surveillance and prevention, CDC and other agencies should revisit public health ethics frameworks and consider the possibility of consent processes.
Collapse
Affiliation(s)
- Stephen Molldrem
- Institute for Bioethics and Health Humanities, The University of Texas Medical Branch, Galveston, TX, USA
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Vishnu Subrahmanyam
- Institute for Bioethics and Health Humanities, The University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
22
|
Greaves K, King A, Bourne Z, Welsh J, Morgan M, Tolosa MX, Bonner C, Stanton T, Fryer M, Korda R. Participant characteristics and reasons for non-consent to health information linkage for research: experiences from the ATHENA COVID-19 study. BMC Med Inform Decis Mak 2024; 24:22. [PMID: 38262998 PMCID: PMC10807191 DOI: 10.1186/s12911-023-02370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/07/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The linkage of primary care, hospital and other health registry data is a global goal, and a consent-based approach is often used. Understanding the attitudes of why participants take part is important, yet little is known about reasons for non-participation. The ATHENA COVID-19 feasibility study investigated: 1) health outcomes of people diagnosed with COVID-19 in Queensland, Australia through primary care health data linkage using consent, and 2) created a cohort of patients willing to be re-contacted in future to participate in clinical trials. This report describes the characteristics of participants declining to participate and reasons for non-consent. METHODS Patients diagnosed with COVID-19 from January 1st, 2020, to December 31st, 2020, were invited to consent to having their primary healthcare data extracted from their GP into a Queensland Health database and linked to other data sets for ethically approved research. Patients were also asked to consent to future recontact for participation in clinical trials. Outcome measures were proportions of patients consenting to data extraction, permission to recontact, and reason for consent decline. RESULTS Nine hundred and ninety-five participants were approached and 842(85%) reached a consent decision. 581(69%), 615(73%) and 629(75%) consented to data extraction, recontact, or both, respectively. Mean (range) age of consenters and non-consenters were 50.6(22-77) and 46.1(22-77) years, respectively. Adjusting for age, gender and remoteness, older participants were more likely to consent than younger (aOR 1.02, 95%CI 1.01 to 1.03). The least socio-economically disadvantaged were more likely to consent than the most disadvantaged (aOR 2.20, 95% 1.33 to 3.64). There was no difference in consent proportions regarding gender or living in more remote regions. The main reasons for non-consent were 'not interested in research' (37%), 'concerns about privacy' (15%), 'not registered with a GP' (8%) and 'too busy/no time' (7%). 'No reason' was given in 20%. CONCLUSION Younger participants and the more socio-economically deprived are more likely to non-consent to primary care data linkage. Lack of patient interest in research, time required to participate and privacy concerns, were the most common reasons cited for non-consent. Future health care data linkage studies addressing these issues may prove helpful.
Collapse
Affiliation(s)
- Kim Greaves
- Sunshine Coast University Hospital, Queensland Health, 6 Doherty Street, Birtinya, QLD, 4575, Australia.
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT 2600, Australia.
| | - Amanda King
- Sunshine Coast University Hospital, Queensland Health, 6 Doherty Street, Birtinya, QLD, 4575, Australia.
| | - Zoltan Bourne
- Hinterland Health, Maple Street, Maleny, QLD, 4551, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT 2600, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4229, Australia
| | - M Ximena Tolosa
- Queensland Department of Health, Communicable Disease Branch, 15 Butterfield St, Herston, QLD, 4001, Australia
| | - Carissa Bonner
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia
| | - Tony Stanton
- Sunshine Coast University Hospital, Queensland Health, 6 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Michael Fryer
- Sunshine Coast University Hospital, Queensland Health, 6 Doherty Street, Birtinya, QLD, 4575, Australia
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, Australian National University, Canberra, ACT 2600, Australia
| |
Collapse
|
23
|
Roberts W, McKee S, Miranda R, Barnett N. Navigating ethical challenges in psychological research involving digital remote technologies and people who use alcohol or drugs. AMERICAN PSYCHOLOGIST 2024; 79:24-38. [PMID: 38236213 PMCID: PMC10798215 DOI: 10.1037/amp0001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Digital and remote technologies (DRT) are increasingly being used in scientific investigations to objectively measure human behavior during day-to-day activities. Using these devices, psychologists and other behavioral scientists can investigate health risk behaviors, such as drug and alcohol use, by closely examining the causes and consequences of monitored behaviors as they occur naturalistically. There are, however, complex ethical issues that emerge when using DRT methodologies in research with people who use substances. These issues must be identified and addressed so DRT devices can be incorporated into psychological research with this population in a manner that comports the ethical standards of the American Psychological Association. In this article, we discuss the ethical ramifications of using DRT in behavioral studies with people who use substances. Drawing on allied fields with similar ethical issues, we make recommendations to researchers who wish to incorporate DRT into their own research. Major topics include (a) threats to and methods for protecting participant and nonparticipant privacy, (b) shortcomings of traditional informed consent in DRT research, (c) researcher liabilities introduced by real-time continuous data collection, (d) threats to distributive justice arising from computational tools often used to manage and analyze DRT data, and (e) ethical implications of the "digital divide." We conclude with a more optimistic discussion of how DRT may provide safer alternatives to gold standard paradigms in substance use research, allowing researchers to test hypotheses that were previously prohibited on ethical grounds. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale University School of Medicine
| | - Sherry McKee
- Department of Psychiatry, Yale University School of Medicine
| | - Robert Miranda
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Nancy Barnett
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| |
Collapse
|
24
|
De Sutter E, Barbier L, Borry P, Geerts D, Ioannidis JP, Huys I. Personalized and longitudinal electronic informed consent in clinical trials: How to move the needle? Digit Health 2024; 10:20552076231222361. [PMID: 38269372 PMCID: PMC10807334 DOI: 10.1177/20552076231222361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
Changes in the clinical trials landscape have been driven by advancements in digital technology. The use of electronic informed consent to inform research participants and to obtain their consent electronically has the potential to improve participant-researcher interactions over time, facilitate clinical trial participation, and increase efficiency in clinical trial conduct. A personalized electronic informed consent platform that enables long-term interactions with the research team could function as a tool to empower participant engagement in clinical trials. However, significant challenges persist impeding successful and widespread implementation. This Perspective provides insights into the opportunities and challenges for the implementation of electronic informed consent in clinical trials. It sets out key recommendations to promote the implementation of this innovative approach to the informed consent process, including the creation of uniform electronic informed consent platforms at regional and national level.
Collapse
Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Liese Barbier
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - David Geerts
- KU Leuven Digital Society Institute, KU Leuven, Leuven, Belgium
| | - John P.A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
25
|
Haas MA, Madelli EO, Brown R, Prictor M, Boughtwood T. Evaluation of CTRL: a web application for dynamic consent and engagement with individuals involved in a cardiovascular genetic disorders cohort. Eur J Hum Genet 2024; 32:61-68. [PMID: 37709947 PMCID: PMC10772119 DOI: 10.1038/s41431-023-01454-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
There has been keen interest in whether dynamic consent should be used in health research but few real-world studies have evaluated its use. Australian Genomics piloted and evaluated CTRL ('control'), a digital consent tool incorporating granular, dynamic decision-making and communication for genomic research. Individuals from a Cardiovascular Genetic Disorders Flagship were invited in person (prospective cohort) or by email (retrospective cohort) to register for CTRL after initial study recruitment. Demographics, consent choices, experience surveys and website analytics were analysed using descriptive statistics. Ninety-one individuals registered to CTRL (15.5% of the prospective cohort and 11.8% of the retrospective cohort). Significantly more males than females registered when invited retrospectively, but there was no difference in age, gender, or education level between those who did and did not use CTRL. Variation in individual consent choices about secondary data use and return of results supports the desirability of providing granular consent options. Robust conclusions were not drawn from satisfaction, trust, decision regret and knowledge outcome measures: differences between CTRL and non-CTRL cohorts did not emerge. Analytics indicate CTRL is acceptable, although underutilised. This is one of the first studies evaluating uptake and decision making using online consent tools and will inform refinement of future designs.
Collapse
Affiliation(s)
- Matilda A Haas
- Australian Genomics, Parkville, VIC, 3052, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
| | - Evanthia O Madelli
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Rosie Brown
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Tiffany Boughtwood
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| |
Collapse
|
26
|
Swietlik EM, Fay M, Morrell NW. Understanding what drives genetic study participation: Perspectives of patients, carers, and relatives. Pulm Circ 2024; 14:e12346. [PMID: 38361979 PMCID: PMC10867872 DOI: 10.1002/pul2.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/17/2024] Open
Abstract
Genetic research's growing importance in understanding pulmonary arterial hypertension (PAH) and developing effective treatments prompted the RAPID-PAH study. This study sought feedback from stakeholders who participated in two genomic studies to enhance genetic study delivery and clinical integration. Stakeholders from nine UK PH centres, representing various roles, ages, genders, and mutation statuses, took part in 53 semi-structured interviews and focus groups. Transcripts were thematically coded using inductive analysis. Clustering analysis was conducted to identify patient groups that shared attitudes. In this paper, we focus on patients', carers', and relatives' perspectives. The key interview themes revealed insights into participants' attitudes toward genetic research and testing more generally, expertise and knowledge of the disease itself, motivations and barriers to participating in genetic research, awareness of and interest in consent procedures and the use of personal and genetic data, as well as the process of communicating individual genetic results. Factors influencing genetic research participation included altruistic motives, personal diagnostic experiences, and family-related hopes. Clustering analysis produced distinct clusters based on the presence of barriers and motivators for research participation; however, hardly any patients shared identical sets of attitudes, emphasising the need for personalised approaches to recruitment. Most patients reported poor engagement with study-related materials. Patients who received individual genetic results expressed satisfaction with the process, whereas those who did not were disappointed with the lack of feedback. Reflecting on patient perspectives, we offer recommendations to improve the genetic study delivery process. Enhancing genetic research integration into clinical practice requires tailored engagement, clear communication, and support from healthcare stakeholders.
Collapse
Affiliation(s)
- Emilia M. Swietlik
- Department of Medicine, The Victor Phillip Dahdaleh Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
- Department of Pulmonology, Collegium MedicumUniversity of Warmia and Mazury in OlsztynOlsztynPoland
| | | | - Nicholas W. Morrell
- Department of Medicine, The Victor Phillip Dahdaleh Heart and Lung Research InstituteUniversity of CambridgeCambridgeUK
| |
Collapse
|
27
|
Constantin A, Faya Robles A, Rial-Sebbag E. Chapitre 5. From individuals to social: The needs for a global ethics overview in pharmacogenomics. JOURNAL INTERNATIONAL DE BIOETHIQUE ET D'ETHIQUE DES SCIENCES 2024; 34:85-102. [PMID: 38423983 DOI: 10.3917/jibes.343.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
As a part of personalized medicine, pharmacogenomics (PGx) allows practitioners to provide the right drug for a given patient, in accordance with the result of a genetic test. This practice raises many ethical issues that are discussed in the literature, sometimes within the larger context of personalized medicine. This article is based on a literature review that is original insofar as it is interdisciplinary and based on an approach that articulates individual and social rights. Here, we propose to reconsider some classic ethical issues, such as informed consent, incidental findings and data protection which are raised by genetic testing and also by PGx in the same or in a different way. We also analyse broader collective issues around racialization and health equality. Our purpose is to contribute in drawing links and parallels between individual rights and collective rights using a social approach. This analysis discusses these ethical issues in research and in clinical setting, understanding the treatment of the individual in his dual quality of patient and research participant.
Collapse
|
28
|
Maseme M, Gardner J, Mahomed S. Broad consent for biobank research in South Africa - Towards an enabling ethico-legal framework. Glob Bioeth 2023; 35:2288331. [PMID: 38179086 PMCID: PMC10763822 DOI: 10.1080/11287462.2023.2288331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
Broad consent is permitted by the South African National Department of Health Ethics Guidelines but appears to be prohibited by section 13(1) of the Protection of Personal Information Act 4 of 2013. Additionally, the Act mandates that all personal data (including biobank sample data) be collected for lawful, explicit, and clearly defined purposes. There is possibility for ambiguity in interpretation because of this discrepancy between the two instruments. Given the association between the transfer of samples and data, the long-term nature of biobanking, which makes it impractical to provide too much or enough information because it is simply not available at the time of sample collection, and the various ways that the Protection of Personal Information Act 4 of 2013 have been interpreted, we aim to demonstrate that South Africa's current regulatory framework should appropriately permit broad consent use for biobank research where the transfer of samples and their associated data are contemplated. In summary, the proposed amendments include removing regulatory ambiguity regarding broad consent use, ensuring adequate safeguards for research participants by specifying rules for data access and personal information processing, and incorporating consent form information requirements into the national Consent Template.
Collapse
Affiliation(s)
- Mantombi Maseme
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Biobank, National Health Laboratory Service, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jillian Gardner
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Safia Mahomed
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Law, University of South Africa, Pretoria, South Africa
| |
Collapse
|
29
|
MOLLDREM STEPHEN, SMITH ANTHONYKJ, McCLELLAND ALEXANDER. Advancing Dialogue About Consent and Molecular HIV Surveillance in the United States: Four Proposals Following a Federal Advisory Panel's Call for Major Reforms. Milbank Q 2023; 101:1033-1046. [PMID: 37380617 PMCID: PMC10726778 DOI: 10.1111/1468-0009.12663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Policy Points Molecular HIV surveillance and cluster detection and response (MHS/CDR) programs have been a core public health activity in the United States since 2018 and are the "fourth pillar" of the Ending the HIV Epidemic initiative launched in 2019. MHS/CDR has caused controversy, including calls for a moratorium from networks of people living with HIV. In October 2022, the Presidential Advisory Council on HIV/AIDS (PACHA) adopted a resolution calling for major reforms. We analyze the policy landscape and present four proposals to federal stakeholders pertaining to PACHA's recommendations about incorporating opt-outs and plain-language notifications into MHS/CDR programs.
Collapse
Affiliation(s)
- STEPHEN MOLLDREM
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch
| | | | | |
Collapse
|
30
|
Lorenzo D, Esquerda M, Bofarull M, Cusi V, Roig H, Bertran J, Carrera J, Torralba F, Cambra FJ, Vila M, Garriga M, Palau F. The reuse of genetic information in research and informed consent. Eur J Hum Genet 2023; 31:1393-1397. [PMID: 37699995 PMCID: PMC10689789 DOI: 10.1038/s41431-023-01457-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/28/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Important advances in genetics research have been made in recent years. Such advances have facilitated the availability of huge amounts of genetic information that could potentially be reused beyond the original purpose for which such information was obtained. Any such reuse must meet certain ethical criteria to ensure that the dignity, integrity, and autonomy of the individual from whom that information was obtained are protected. The aim of this paper is to reflect on these criteria through a critical analysis of the literature. To guarantee these values, ethical criteria need to be established in several respects. For instance, the question must be posed whether the information requires special attention and protection (so-called genetic exceptionalism). Another aspect to bear in mind is the most appropriate type of consent to be given by the person involved, on the one hand favouring research and the reuse of genetic information while on the other protecting the autonomy of that person. Finally, there is a need to determine what protection such reuse should have in order to avoid detrimental consequences and protect the rights of the individual. The main conclusions are that genetic information requires special care and protection (genetic exceptionalism) and that broad consent is the most practical and trustworthy type of consent for the reuse of genetic information.
Collapse
Affiliation(s)
- David Lorenzo
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
- EUI San Joan de Deu, Barcelona, Spain
| | - Montse Esquerda
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain.
- Sant Joan de Deu Terres de Lleida, Lleida, Spain.
| | | | - Victoria Cusi
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Helena Roig
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Joan Bertran
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Joan Carrera
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francesc Torralba
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francisco José Cambra
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
- Hospital Universitari Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Martí Vila
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Martina Garriga
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francesc Palau
- Department of Genetic Medicine and Pediatric Institut of Rare Diseases, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Enfermedades Raras, ISCIII, Madrid, Spain
- Division of Pediatrics, University of Barcelona School of Medicine and Health Sciences, Barcelona, Spain
| |
Collapse
|
31
|
Lee AR, Koo D, Kim IK, Lee E, Kim HH, Yoo S, Kim JH, Choi EK, Lee HY. Identifying facilitators of and barriers to the adoption of dynamic consent in digital health ecosystems: a scoping review. BMC Med Ethics 2023; 24:107. [PMID: 38041034 PMCID: PMC10693132 DOI: 10.1186/s12910-023-00988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Conventional consent practices face ethical challenges in continuously evolving digital health environments due to their static, one-time nature. Dynamic consent offers a promising solution, providing adaptability and flexibility to address these ethical concerns. However, due to the immaturity of the concept and accompanying technology, dynamic consent has not yet been widely used in practice. This study aims to identify the facilitators of and barriers to adopting dynamic consent in real-world scenarios. METHODS This scoping review, conducted in December 2022, adhered to the PRISMA Extension for Scoping Reviews guidelines, focusing on dynamic consent within the health domain. A comprehensive search across Web of Science, PubMed, and Scopus yielded 22 selected articles based on predefined inclusion and exclusion criteria. RESULTS The facilitators for the adoption of dynamic consent in digital health ecosystems were the provision of multiple consent modalities, personalized alternatives, continuous communication, and the dissemination of up-to-date information. Nevertheless, several barriers, such as consent fatigue, the digital divide, complexities in system implementation, and privacy and security concerns, needed to be addressed. This study also investigated current technological advancements and suggested considerations for further research aimed at resolving the remaining challenges surrounding dynamic consent. CONCLUSIONS Dynamic consent emerges as an ethically advantageous method for digital health ecosystems, driven by its adaptability and support for continuous, two-way communication between data subjects and consumers. Ethical implementation in real-world settings requires the development of a robust technical framework capable of accommodating the diverse needs of stakeholders, thereby ensuring ethical integrity and data privacy in the evolving digital health landscape.
Collapse
Affiliation(s)
- Ah Ra Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dongjun Koo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Il Kon Kim
- School of Computer Science & Engineering, College of IT Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Eunjoo Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Ho Kim
- Department of Pediatrics, Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Eun Kyung Choi
- Department of Medical Humanities and Medical Education, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Ho-Young Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| |
Collapse
|
32
|
Cornelis C, Dondorp W, Bolt I, de Wert G, van Summeren M, Brilstra E, Knoers N, Bredenoord AL. Uncertain futures and unsolicited findings in pediatric genomic sequencing: guidelines for return of results in cases of developmental delay. BMC Med Ethics 2023; 24:98. [PMID: 37951889 PMCID: PMC10640744 DOI: 10.1186/s12910-023-00977-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Massively parallel sequencing techniques, such as whole exome sequencing (WES) and whole genome sequencing (WGS), may reveal unsolicited findings (UFs) unrelated to the diagnostic aim. Such techniques are frequently used for diagnostic purposes in pediatric cases of developmental delay (DD). Yet policy guidelines for informed consent and return of UFs are not well equipped to address specific moral challenges that may arise in these children's situations. DISCUSSION In previous empirical studies conducted by our research group, we found that it is sometimes uncertain how children with a DD will develop and whether they could come to possess capacities for autonomous decision-making in the future. Parents sometimes felt this brought them into a Catch-22 like situation when confronted with choices about UFs before undergoing WES in trio-analysis (both the parents' and child's DNA are sequenced). An important reason for choosing to consent to WES was to gain more insight into how their child might develop. However, to make responsible choices about receiving or declining knowledge of UFs, some idea of their child's future development of autonomous capacities is needed. This undesirable Catch-22 situation was created by the specific policy configuration in which parents were required to make choices about UFs before being sequencing (trio-analysis). We argue that this finding is relevant for reconfiguring current policies for return of UFs for WES/WGS and propose guidelines that encompass two features. First, the informed consent process ought to be staged. Second, differing guidelines are required for withholding/disclosing a UF in cases of DD appropriate to the level of confidence there is about the child's future developmental of autonomous capacities. CONCLUSION When combined with a dynamic consent procedure, these two features of our guidelines could help overcome significant moral challenges that present themselves in the situations of children undergoing genomic sequencing for clarifying a DD.
Collapse
Affiliation(s)
- Candice Cornelis
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.
- Julius Center, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Wybo Dondorp
- Department of Health, Ethics & Society, Maastricht University, Maastricht, the Netherlands
| | - Ineke Bolt
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Guido de Wert
- Department of Health, Ethics & Society, Maastricht University, Maastricht, the Netherlands
| | - Marieke van Summeren
- Department of General Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eva Brilstra
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nine Knoers
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Genetics, University Medical Centre Groningen, Groningen, the Netherlands
| | - Annelien L Bredenoord
- Julius Center, Department of Medical Humanities, University Medical Center Utrecht, Utrecht, the Netherlands
- Erasmus University Rotterdam, Erasmus School of Philosophy, Rotterdam, the Netherlands
| |
Collapse
|
33
|
Sulaieva ON, Artamonova O, Dudin O, Semikov R, Urakov D, Zakharash Y, Kacharian A, Strilka V, Mykhalchuk I, Haidamak O, Serdyukova O, Kobyliak N. Ethical navigation of biobanking establishment in Ukraine: learning from the experience of developing countries. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109129. [PMID: 37945338 DOI: 10.1136/jme-2023-109129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
Building a biobank network in developing countries is essential to foster genomic research and precision medicine for patients' benefit. However, there are serious barriers to establishing biobanks in low-income and middle-income countries (LMICs), including Ukraine. Here, we outline key barriers and essential milestones for the successful expansion of biobanks, genomic research and personalised medicine in Ukraine, drawing from the experience of other LMICs. A lack of legal and ethical governance in conjunction with limited awareness about biobanking and community distrust are the principal threats to establishing biobanks. The experiences of LMICs suggest that Ukraine urgently needs national guidelines covering ethical and legal aspects of biospecimen-related research. National guidelines must be consistent with international ethical recommendations for safeguarding participants' rights, welfare and privacy. Additionally, efforts to educate and engage physicians and patient communities are essential for achieving biobanking goals and benefits for precision medicine and future patients.
Collapse
Affiliation(s)
- Oksana N Sulaieva
- Department of Pathology, Medical Laboratory CSD, Kyiv, Ukraine
- Doctorate in Bioethics, Neiswanger Institute for Bioethics, Loyola University Chicago, Chicago, Illinois, USA
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
| | | | - Oleksandr Dudin
- Department of Pathology, Medical Laboratory CSD, Kyiv, Ukraine
| | - Rostyslav Semikov
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
- Audubon Bioscience, Kyiv, Ukraine
| | - Dmytro Urakov
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
| | | | | | | | - Ivan Mykhalchuk
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
- Audubon Bioscience, Kyiv, Ukraine
| | | | - Olena Serdyukova
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
- Audubon Bioscience, Kyiv, Ukraine
| | - Nazarii Kobyliak
- Department of Pathology, Medical Laboratory CSD, Kyiv, Ukraine
- Department of Endocrinology, Bogomolets National Medical University, Kyiv, Ukraine
| |
Collapse
|
34
|
Wickramarachchi A, Hosking B, Jain Y, Grimes J, O'Brien MJ, Wright T, Burgess MA, Lin VSK, Reisinger F, Hofmann O, Lawley M, Wilson LOW, Twine NA, Bauer DC. Scalable genomic data exchange and analytics with sBeacon. Nat Biotechnol 2023; 41:1510-1512. [PMID: 37709914 DOI: 10.1038/s41587-023-01972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Anuradha Wickramarachchi
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Westmead, New South Wales, Australia
| | - Brendan Hosking
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Westmead, New South Wales, Australia
| | - Yatish Jain
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Westmead, New South Wales, Australia
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, New South Wales, Australia
| | - John Grimes
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Queensland, Australia
| | - Mitchell J O'Brien
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Westmead, New South Wales, Australia
| | - Tracey Wright
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Queensland, Australia
| | - Mark A Burgess
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Canberra, Australian Capital Territory, Australia
| | - Victor San Kho Lin
- Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Florian Reisinger
- Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Oliver Hofmann
- Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Lawley
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Queensland, Australia
| | - Laurence O W Wilson
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Westmead, New South Wales, Australia
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Natalie A Twine
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Westmead, New South Wales, Australia
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Denis C Bauer
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, New South Wales, Australia.
- Department of Biomedical Sciences, Macquarie University, Macquarie Park, New South Wales, Australia.
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, South Australia, Australia.
| |
Collapse
|
35
|
Blom JMC, Rivi V, Tascedda F, Pani L. The nexus of social alliances and diverse moral domains: a bedrock for participatory clinical research. Front Med (Lausanne) 2023; 10:1250247. [PMID: 37849486 PMCID: PMC10577180 DOI: 10.3389/fmed.2023.1250247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Johanna M. C. Blom
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Veronica Rivi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Tascedda
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Consorzio Interuniversitario per le Biotecnologie, Trieste, Italy
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, United States
| |
Collapse
|
36
|
Arregui Egido L, Villalobos-Quesada M. Improving the Practice of Obtaining Informed Consent for Biobanking in Clinical Settings. Biopreserv Biobank 2023; 21:442-449. [PMID: 36173759 DOI: 10.1089/bio.2021.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Biobanks form key research support infrastructures that ensure the highest sample quality for scientific research. Their activity must align closely and proportionally to the interests of researchers, donors, and society. Informed consent (IC) is a central tool to guarantee the protection of donors' rights and interests. Aim: This study aimed to analyze the challenges of obtaining IC for biobanking in clinical settings and ways to improve this process. Methods: Biobank Bellvitge University Hospital HUB-ICO-IDIBELL in Barcelona received 8671 IC forms between 2017 and 2020. The mistakes that caused IC forms to be rejected by the Biobank were analyzed. In addition, interventions aimed at physicians to improve the IC process were evaluated through a calculation of the relative risk (RR). Finally, physicians who submitted samples to the Biobank, most of whom are involved in research activities, were surveyed about the barriers to collecting IC and how to improve this process. Results: During 2017-2020, 19.6% of IC forms were rejected. The most relevant cause of rejection was the use of outdated IC forms, followed by missing patient information or mistakes having been made by the physician. Evaluation of the rejection rates before and after interventions to improve the IC process suggests significant improvement (27.7% before interventions (January 2017-May 2018) compared to 9.6% after interventions (February-December 2020), RR 0.4 95% CI 0.34-0.47; p < 0.0001). According to the physicians, the most important barrier to collecting IC is the time constraint, and they consider digitalization as a viable solution. Conclusions: Our research offers a view of the less well-understood practical challenges that physicians and biobanks face when collecting IC in clinical settings. It suggests that, despite multiple challenges, continuous monitoring, training, and information programs for physicians are key to optimizing the IC process in clinical settings.
Collapse
Affiliation(s)
- Laura Arregui Egido
- HUB-ICO-IDIBELL Biobank, Bellvitge Medical Research Institute (IDIBELL), Barcelona, Spain
- Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - María Villalobos-Quesada
- Bioethics and Law Observatory, University of Barcelona, Barcelona, Spain
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
37
|
Oikawa M, Takimoto Y, Akabayashi A. Attitudes of the Public Toward Consent for Biobank Research in Japan. Biopreserv Biobank 2023; 21:518-526. [PMID: 36576410 DOI: 10.1089/bio.2022.0041] [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: 12/29/2022] Open
Abstract
Background: Parallel to the rapid advancement of biological and information technologies, the role and forms of biobank research have been constantly changing. The ethical, legal, and social implications of consent in biobank research are in a state of flux. This study aimed to clarify current Japanese public preferences regarding the consent model and explore how public attitudes are determined. Methods: We conducted an online, population-based quantitative survey among Japanese residents aged between 20 and 69 years. Statistical analyses consisted of univariate and multivariate logistic regression. Results: Of the 1580 respondents, 60.9% preferred autonomy-based consent (specific or dynamic consent) and 23.9% preferred broad-type consent (opt-out or broad consent). Marital status, gender, and privacy concerns were significantly associated with the preference for a consent model. Conclusions: Our results demonstrated the public's current preference for autonomy-based consent, including dynamic consent. However, our findings also revealed that approximately half of the respondents considered broad consent as somewhat preferable.
Collapse
Affiliation(s)
- Masanori Oikawa
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - Yoshiyuki Takimoto
- Department of Biomedical Ethics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Akira Akabayashi
- Department of Biomedical Ethics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
38
|
Yao Y, Yang F. Overcoming personal information protection challenges involving real-world data to support public health efforts in China. Front Public Health 2023; 11:1265050. [PMID: 37808971 PMCID: PMC10559907 DOI: 10.3389/fpubh.2023.1265050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
In the information age, real-world data-based evidence can help extrapolate and supplement data from randomized controlled trials, which can benefit clinical trials and drug development and improve public health decision-making. However, the legitimate use of real-world data in China is limited due to concerns over patient confidentiality. The use of personal information is a core element of data governance in public health. In China's public health data governance, practical problems exist, such as balancing personal information protection and public value conflict. In 2021, China adopted the Personal Information Protection Law (PIPL) to provide a consistent legal framework for protecting personal information, including sensitive medical health data. Despite the PIPL offering critical legal safeguards for processing health data, further clarification is needed regarding specific issues, including the meaning of "separate consent," cross-border data transfer requirements, and exceptions for scientific research. A shift in the law and regulatory framework is necessary to advance public health research further and realize the potential benefits of combining real-world evidence and digital health while respecting privacy in the technological and demographic change era.
Collapse
Affiliation(s)
| | - Fei Yang
- School of Law, China Jiliang University, Hangzhou, China
| |
Collapse
|
39
|
Natri HM, Chapman CR, Heraty S, Dwyer P, Walker N, Kapp SK, Dron HA, Martinez-Agosto JA, Mikkola L, Doherty M. Ethical challenges in autism genomics: Recommendations for researchers. Eur J Med Genet 2023; 66:104810. [PMID: 37478903 DOI: 10.1016/j.ejmg.2023.104810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023]
Abstract
Equitable and just genetic research and clinical translation require an examination of the ethical questions pertaining to vulnerable and marginalized communities. Autism research and advocate communities have expressed concerns over current practices of genetics research, urging the field to shift towards paradigms and practices that ensure benefits and avoid harm to research participants and the wider autistic community. Building upon a framework of bioethical principles, we provide the background for the concerns and present recommendations for ethically sustainable and justice-oriented genetic and genomic autism research. With the primary goal of enhancing the health, well-being, and autonomy of autistic persons, we make recommendations to guide priority setting, responsible research conduct, and informed consent practices. Further, we discuss the ethical challenges particularly pertaining to research involving highly vulnerable individuals and groups, such as those with impaired cognitive or communication ability. Finally, we consider the clinical translation of autism genetics studies, including the use of genetic testing. These guidelines, developed by an interdisciplinary working group comprising autistic and non-autistic individuals, will aid in leveraging the potential of genetics research to enhance the quality of life of autistic individuals and are widely applicable across stigmatized traits and vulnerable communities.
Collapse
Affiliation(s)
- Heini M Natri
- Translational Genomics Research Institute (TGen), Phoenix, AZ, 85004, USA.
| | - Carolyn R Chapman
- Department of Population Health (Division of Medical Ethics), NYU Grossman School of Medicine, New York, NY, 10016, USA; Center for Human Genetics and Genomics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Síofra Heraty
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, University of London, Birkbeck, London, WC1E 7HX, UK
| | - Patrick Dwyer
- Center for Mind and Brain, UC Davis, Davis, CA, 95618, USA; Department of Psychology, UC Davis, Davis, CA, 95618, USA; MIND Institute, UC Davis Health, Sacramento, CA, 95817, USA
| | - Nick Walker
- California Institute of Integral Studies, San Francisco, CA, 94103, USA
| | - Steven K Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, Hampshire, PO1 2UP, UK
| | - Heather A Dron
- Sterilization and Social Justice Lab, UCLA Institute for Genetics and Society, Los Angeles, CA, 90095, USA
| | | | - Lea Mikkola
- Turku Bioscience Center, InFLAMES Research Flagship Center, University of Turku, Turku, 20520, Finland
| | - Mary Doherty
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| |
Collapse
|
40
|
Khalid MI, Ahmed M, Kim J. Enhancing Data Protection in Dynamic Consent Management Systems: Formalizing Privacy and Security Definitions with Differential Privacy, Decentralization, and Zero-Knowledge Proofs. SENSORS (BASEL, SWITZERLAND) 2023; 23:7604. [PMID: 37688060 PMCID: PMC10490780 DOI: 10.3390/s23177604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
Dynamic consent management allows a data subject to dynamically govern her consent to access her data. Clearly, security and privacy guarantees are vital for the adoption of dynamic consent management systems. In particular, specific data protection guarantees can be required to comply with rules and laws (e.g., the General Data Protection Regulation (GDPR)). Since the primary instantiation of the dynamic consent management systems in the existing literature is towards developing sustainable e-healthcare services, in this paper, we study data protection issues in dynamic consent management systems, identifying crucial security and privacy properties and discussing severe limitations of systems described in the state of the art. We have presented the precise definitions of security and privacy properties that are essential to confirm the robustness of the dynamic consent management systems against diverse adversaries. Finally, under those precise formal definitions of security and privacy, we have proposed the implications of state-of-the-art tools and technologies such as differential privacy, blockchain technologies, zero-knowledge proofs, and cryptographic procedures that can be used to build dynamic consent management systems that are secure and private by design.
Collapse
Affiliation(s)
- Muhammad Irfan Khalid
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno Fisciano, 84084 Fisciano, Italy
| | - Mansoor Ahmed
- ADAPT Centre, Innovative Value Institute, Maynooth University, W23 A3HY Maynooth, Ireland;
| | - Jungsuk Kim
- Research Laboratory, Cellico Inc., Seongnam-si 13449, Gyeonggi-do, Republic of Korea
- Department of Biomedical Engineering, Gachon University, Seongnam-si 13120, Gyeonggi-do, Republic of Korea
| |
Collapse
|
41
|
Sanchini V, Marelli L, Monturano M, Bonizzi G, Peruzzotti G, Orecchia R, Pravettoni G. A comprehensive ethics and data governance framework for data-intensive health research: Lessons from an Italian cancer research institute. Account Res 2023:1-18. [PMID: 37608751 DOI: 10.1080/08989621.2023.2248884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Virginia Sanchini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Luca Marelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
- European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | | | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
42
|
Meyer MN, Basl J, Choffnes D, Wilson C, Lazer DMJ. Enhancing the ethics of user-sourced online data collection and sharing. NATURE COMPUTATIONAL SCIENCE 2023; 3:660-664. [PMID: 38177316 DOI: 10.1038/s43588-023-00490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Michelle N Meyer
- Department of Bioethics and Decision Sciences, Geisinger Health System, Danville, PA, USA
- Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger Health System, Danville, PA, USA
| | - John Basl
- Department of Philosophy and Religion, Northeastern University, Boston, MA, USA
- Ethics Institute, Northeastern University, Boston, MA, USA
| | - David Choffnes
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
- Cybersecurity and Privacy Institute, Northeastern University, Boston, MA, USA
| | - Christo Wilson
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
- Cybersecurity and Privacy Institute, Northeastern University, Boston, MA, USA
| | - David M J Lazer
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA.
- College of Social Sciences and Humanities, Northeastern University, Boston, MA, USA.
- Network Science Institute, Northeastern University, Boston, MA, USA.
- The Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.
| |
Collapse
|
43
|
Graham M. Data for sale: trust, confidence and sharing health data with commercial companies. JOURNAL OF MEDICAL ETHICS 2023; 49:515-522. [PMID: 34330796 PMCID: PMC10359563 DOI: 10.1136/medethics-2021-107464] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Powered by 'big health data' and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need not, and should not, be based on trust. Rather, they should be based on confidence. I begin by elucidating the differences between trust, reliability, and confidence, and argue that trust is not the appropriate attitude to adopt when it comes to sharing data with commercial companies. I argue that what we really should want is confidence in a system of data sharing. I then provide an outline of what a confidence-worthy system of data sharing with commercial companies might look like, and conclude with some remarks about the role of trust within this system.
Collapse
Affiliation(s)
- Mackenzie Graham
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| |
Collapse
|
44
|
Akyüz K, Goisauf M, Chassang G, Kozera Ł, Mežinska S, Tzortzatou-Nanopoulou O, Mayrhofer MT. Post-identifiability in changing sociotechnological genomic data environments. BIOSOCIETIES 2023:1-28. [PMID: 37359141 PMCID: PMC10042674 DOI: 10.1057/s41292-023-00299-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 03/30/2023]
Abstract
Data practices in biomedical research often rely on standards that build on normative assumptions regarding privacy and involve 'ethics work.' In an increasingly datafied research environment, identifiability gains a new temporal and spatial dimension, especially in regard to genomic data. In this paper, we analyze how genomic identifiability is considered as a specific data issue in a recent controversial case: publication of the genome sequence of the HeLa cell line. Considering developments in the sociotechnological and data environment, such as big data, biomedical, recreational, and research uses of genomics, our analysis highlights what it means to be (re-)identifiable in the postgenomic era. By showing how the risk of genomic identifiability is not a specificity of the HeLa controversy, but rather a systematic data issue, we argue that a new conceptualization is needed. With the notion of post-identifiability as a sociotechnological situation, we show how past assumptions and ideas about future possibilities come together in the case of genomic identifiability. We conclude by discussing how kinship, temporality, and openness are subject to renewed negotiations along with the changing understandings and expectations of identifiability and status of genomic data.
Collapse
Affiliation(s)
- Kaya Akyüz
- Department of Science and Technology Studies, University of Vienna, Universitätsstraße 7/Stiege II/6, Stock (NIG), 1010 Vienna, Austria
- BBMRI-ERIC, Graz, Austria
| | - Melanie Goisauf
- Department of Science and Technology Studies, University of Vienna, Universitätsstraße 7/Stiege II/6, Stock (NIG), 1010 Vienna, Austria
- BBMRI-ERIC, Graz, Austria
| | - Gauthier Chassang
- CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Plateforme GenoToul Societal “Ethique et Biosciences”, Toulouse, France
| | | | - Signe Mežinska
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
- BBMRI.LV, Riga, Latvia
| | | | | |
Collapse
|
45
|
Park JK, Lu CY. Polygenic Scores in the Direct-to-Consumer Setting: Challenges and Opportunities for a New Era in Consumer Genetic Testing. J Pers Med 2023; 13:jpm13040573. [PMID: 37108959 PMCID: PMC10144199 DOI: 10.3390/jpm13040573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Direct-to-consumer (DTC) genetic tests have generated considerable scholarly attention and public intrigue. Although the current consumer genetic testing regime relies on the reporting of individual variants of interest to consumers, there has recently been interest in the possibility of integrating polygenic scores (PGS), which aggregate genetic liability for disease across the entire genome. While PGS have thus far been extensively explored as clinical and public health tools, the use of PGS in consumer genetic testing has not yet received systematic attention, even though they are already in use for some consumer genetic tests. In this narrative review, we highlight the ethical, legal, and social implications of the use of PGS in DTC genetic tests and synthesize existing solutions to these concerns. We organize these concerns into three domains: (1) industry variation; (2) privacy and commercialization; and (3) patient safety and risk. While previously expressed concerns in these domains will remain relevant, the emergence of PGS-based DTC genetic tests raises challenges that will require novel approaches.
Collapse
Affiliation(s)
- Jin K Park
- Harvard Medical School, Boston, MA 02115, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02115, USA
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW 2077, Australia
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| |
Collapse
|
46
|
Weil CJ. Ethical, Legal, and Policy Issues Surrounding Biospecimen Research Conducted or Supported in the USA. Biopreserv Biobank 2023; 21:14-22. [PMID: 35138936 DOI: 10.1089/bio.2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rapid and dramatic advances in molecular sequencing technology, as well as medical discoveries from genome-wide association and other precision medicine studies, have highlighted the longstanding ethical and legal challenges research biobanks consistently face. Whose authority is needed to conduct research with excised tissue, and how that authority may be exercised with respect and transparency, are central questions. This review article explores how scholars have addressed ethical and legal controversies such as the proper breadth and scope of consent for collection and future research use of biological specimens and data, the importance of disclosing individual research results and secondary findings, and collecting cadaver tissue from deceased persons. This article focuses on the legal and regulatory environment for conducting and/or supporting biospecimen research in the United States of America. It takes the position that proper biobank governance strategies, which ensure accountability and model respect toward biospecimen contributors, as well as transparency in communications between participants and researchers, reduce the likelihood of downstream legal disputes.
Collapse
Affiliation(s)
- Carol J Weil
- Consultant, Human research protections and Bioethics, Bethesda, Maryland, USA
| |
Collapse
|
47
|
Masiye F, Jaoko W, Rennie S. Stakeholder views on informed consent models for future use of biological samples in Malawi and South Africa. BMC Med Ethics 2023; 24:4. [PMID: 36658544 PMCID: PMC9854061 DOI: 10.1186/s12910-023-00882-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current advances in biomedical research have introduced new ethical challenges in obtaining informed consent in low and middle-income settings. For example, there are controversies about the use of broad consent in the collection of biological samples for use in future biomedical research. However, few studies have explored preferred informed consent models for future use of biological samples in Malawi and South Africa. Therefore, we conducted an empirical study to understand preferred consent models among key stakeholders in biomedical studies that involve collection of biological samples in Malawi and South Africa. The main objective of the study was to explore views of key stakeholders on current policies on informed consent in Malawi and South Africa. METHODS This was a qualitative study involving in-depth interviews and focus group discussions. Thirty-four in-depth interviews and 6 focus group discussions were conducted with REC members, Funders, Policymakers, CAB members and Research Participants in Malawi and South Africa to gather their views on models of informed consent. The study was conducted in Cape Town, South Africa, and Blantyre and Lilongwe in Malawi. RESULTS Most key stakeholders preferred broad consent and tiered consent to specific consent. Some participants expressed a strong preference for specific consent to other models of informed consent in biomedical research. Few participants did not have any preference for a consent model, opting for any consent model which provides adequate information about the proposed research and what their national consent regulations require. Finally, very few participants preferred blanket consent to other informed consent models. CONCLUSIONS This study aimed to help fill the gap in the scientific literature on key stakeholder views on consent models for future use of biological samples in Malawi and South Africa. The findings of the study have provided some evidence that may support policies on permissible consent models for future use of biological samples in sub-Saharan Africa considering the differences in informed consent regulations and guidelines. Finally, the findings can inform ongoing discussions on permissible consent models to be used for future use of biological samples.
Collapse
Affiliation(s)
- Francis Masiye
- grid.493103.c0000 0004 4901 9642Malawi University of Science and Technology, Ndata Farm, Thyolo, Malawi ,grid.11956.3a0000 0001 2214 904XCentre for Medical Ethics and Law, Stellenbosch University, Cape Town, South Africa
| | - Walter Jaoko
- grid.11956.3a0000 0001 2214 904XCentre for Medical Ethics and Law, Stellenbosch University, Cape Town, South Africa ,grid.10604.330000 0001 2019 0495University of Nairobi, Nairobi, Kenya
| | - Stuart Rennie
- grid.11956.3a0000 0001 2214 904XCentre for Medical Ethics and Law, Stellenbosch University, Cape Town, South Africa ,grid.410711.20000 0001 1034 1720University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
48
|
Muller SHA, van Thiel GJMW, Mostert M, van Delden JJM. Dynamic consent, communication and return of results in large-scale health data reuse: Survey of public preferences. Digit Health 2023; 9:20552076231190997. [PMID: 37599899 PMCID: PMC10434987 DOI: 10.1177/20552076231190997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Dynamic consent forms a comprehensive, tailored approach for interacting with research participants. We conducted a survey study to inquire how research participants evaluate the elements of consent, information provision, communication and return of results within dynamic consent in a hypothetical health data reuse scenario. We distributed a digital questionnaire among a purposive sample of patient panel members. Data were analysed using descriptive and nonparametric inferential statistics. Respondents favoured the potential to manage changing consent preferences over time. There was much agreement between people favouring closer and more specific control over data reuse approval and those in favour of broader approval, facilitated by an opt-out system or an independent data reuse committee. People want to receive more information about reuse, outcomes and return of results. Respondents supported an interactive model of research participation, welcoming regular, diverse and interactive forms of communication, like a digital communication platform. Approval for reuse and providing meaningful information, including meaningful return of results, are intricately related to facilitating better communication. Respondents favoured return of actionable research results. These findings emphasize the potential of dynamic consent for enabling participants to maintain control over how their data are being used for which purposes by whom. Allowing different options to shape a dynamic consent interface in health data reuse in a personalized manner is pivotal to accommodate plurality in a flexible though robust manner. Interaction via dynamic consent enables participants to tailor the elements of participation they deem relevant to their own preferences, engaging diverse perspectives, interests and preferences.
Collapse
Affiliation(s)
- Sam HA Muller
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ghislaine JMW van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno Mostert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes JM van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
49
|
Müller S. Is there a civic duty to support medical AI development by sharing electronic health records? BMC Med Ethics 2022; 23:134. [PMID: 36496427 PMCID: PMC9736708 DOI: 10.1186/s12910-022-00871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
Medical artificial intelligence (AI) is considered to be one of the most important assets for the future of innovative individual and public health care. To develop innovative medical AI, it is necessary to repurpose data that are primarily generated in and for the health care context. Usually, health data can only be put to a secondary use if data subjects provide their informed consent (IC). This regulation, however, is believed to slow down or even prevent vital medical research, including AI development. For this reason, a number of scholars advocate a moral civic duty to share electronic health records (EHRs) that overrides IC requirements in certain contexts. In the medical AI context, the common arguments for such a duty have not been subjected to a comprehensive challenge. This article sheds light on the correlation between two normative discourses concerning informed consent for secondary health record use and the development and use of medical AI. There are three main arguments in favour of a civic duty to support certain developments in medical AI by sharing EHRs: the 'rule to rescue argument', the 'low risks, high benefits argument', and the 'property rights argument'. This article critiques all three arguments because they either derive a civic duty from premises that do not apply to the medical AI context, or they rely on inappropriate analogies, or they ignore significant risks entailed by the EHR sharing process and the use of medical AI. Given this result, the article proposes an alternative civic responsibility approach that can attribute different responsibilities to different social groups and individuals and that can contextualise those responsibilities for the purpose of medical AI development.
Collapse
Affiliation(s)
- Sebastian Müller
- grid.10388.320000 0001 2240 3300Center for Life Ethics/Heinrich Hertz Chair TRA4, University of Bonn, Schaumburg- Lippe-Straße 5-7, 53113 Bonn, Germany
| |
Collapse
|
50
|
Mascalzoni D, Melotti R, Pattaro C, Pramstaller PP, Gögele M, De Grandi A, Biasiotto R. Ten years of dynamic consent in the CHRIS study: informed consent as a dynamic process. Eur J Hum Genet 2022; 30:1391-1397. [PMID: 36064788 PMCID: PMC9441838 DOI: 10.1038/s41431-022-01160-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/13/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
The Cooperative Health Research in South Tyrol (CHRIS) is a longitudinal study in Northern Italy, using dynamic consent since its inception in 2011. The CHRIS study collects health data and biosamples for research, and foresees regular follow-ups over time. We describe the experience with the CHRIS study dynamic consent, providing an overview of its conceptualization and implementation, and of the participant-centered strategies used to assess and improve the process, directly linked to participation and communication. In order to comply with high ethical standards and to allow broadness in the areas of research, CHRIS dynamic consent was conceived as an interactive process: based on a strong governance and an ongoing tailored communication with participants, it aims to promote autonomy and to develop a trust-based engaged relationship with participants, also relevant for retention. Built within an online platform, the consent allows granular choices, which can be changed over time. In a process of co-production, participants views have been investigated and kept into account in policy development. Participants showed a high degree of participation, thus enabling the consolidation of the CHRIS resources. Even though a low change rate was reported in the baseline, participants valued the possibility of changing their informed consent choices. Communication (language-tailored, ongoing, multimedia) was important for participants, and for participation and retention. In our experience, dynamic consent was proven to be a flexible consent model, which allowed to meet ethical and legal standards for participation in research, and to accommodate participants' and researchers' needs.
Collapse
Affiliation(s)
- Deborah Mascalzoni
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy ,grid.8993.b0000 0004 1936 9457Center for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Roberto Melotti
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Cristian Pattaro
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Peter Paul Pramstaller
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Martin Gögele
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Alessandro De Grandi
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Roberta Biasiotto
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy. .,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| |
Collapse
|