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Watson S, Pacyna JE, Olson JE, Sharp RR. Assessing Decisional Regret Among Biobank Sample Donors. Biopreserv Biobank 2024. [PMID: 39073153 DOI: 10.1089/bio.2024.0053] [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: 07/30/2024] Open
Abstract
Background: Large biobanks that link biological specimens with specimen donors' health histories are a critical tool for precision medicine, and many health care institutions have invested significant resources in setting up and building up large collections for this purpose. As biobanks require consented participation from thousands of individual donors, much research has focused on the values and preferences of new and prospective donors who are actively contemplating an invitation to participate in the collection. Few studies, however, have focused on participants' opinions about their biobank participation in the months and years following enrollment. Methods: We conducted a survey in a large, established biobank and evaluated participants' levels of decisional regret regarding their decision to enroll in the biobank. Results: We found very low levels of decisional regret among established biobank participants. Multivariable regression analysis found that age, length of time in the biobank, lower educational attainment, inadequate health literacy, and previous invitations to research participation were all significant predictors of elevated regret. Discussion: Among those with elevated regret, several demographic factors may point to elevated likelihood of decisional regret. More research is needed to identify factors associated with long-term satisfaction with biobank participation and with elevated risk of regret and/or withdrawal from the collection.
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Affiliation(s)
- Sara Watson
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel E Pacyna
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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2
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Tokutomi T, Yoshida A, Fukushima A, Yamamoto K, Ishigaki Y, Kawame H, Fuse N, Nagami F, Suzuki Y, Sakurai-Yageta M, Uruno A, Suzuki K, Tanno K, Ohmomo H, Shimizu A, Yamamoto M, Sasaki M. The Health History of First-Degree Relatives' Dyslipidemia Can Affect Preferences and Intentions following the Return of Genomic Results for Monogenic Familial Hypercholesterolemia. Genes (Basel) 2024; 15:384. [PMID: 38540442 PMCID: PMC10970353 DOI: 10.3390/genes15030384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 06/14/2024] Open
Abstract
Genetic testing is key in modern healthcare, particularly for monogenic disorders such as familial hypercholesterolemia. This Tohoku Medical Megabank Project study explored the impact of first-degree relatives' dyslipidemia history on individual responses to familial hypercholesterolemia genomic results. Involving 214 participants and using Japan's 3.5KJPN genome reference panel, the study assessed preferences and intentions regarding familial hypercholesterolemia genetic testing results. The data revealed a significant inclination among participants with a family history of dyslipidemia to share their genetic test results, with more than 80% of participants intending to share positive results with their partners and children and 98.1% acknowledging the usefulness of positive results for personal health management. The study underscores the importance of family health history in genetic-testing perceptions, highlighting the need for family-centered approaches in genetic counseling and healthcare. Notable study limitations include the regional scope and reliance on questionnaire data. The study results emphasize the association between family health history and genetic-testing attitudes and decisions.
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Affiliation(s)
- Tomoharu Tokutomi
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Morioka 020-8505, Japan
| | - Akiko Yoshida
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Morioka 020-8505, Japan
| | - Akimune Fukushima
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Morioka 020-8505, Japan
| | - Kayono Yamamoto
- Department of Clinical Genetics, School of Medicine, Iwate Medical University, Morioka 020-8505, Japan
| | - Yasushi Ishigaki
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
| | - Hiroshi Kawame
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Nobuo Fuse
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Fuji Nagami
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Yoichi Suzuki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Mika Sakurai-Yageta
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Akira Uruno
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Kichiya Suzuki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Kozo Tanno
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
| | - Hideki Ohmomo
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
| | - Atsushi Shimizu
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Sendai 980-8573, Japan
| | - Makoto Sasaki
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Shiwa 020-3694, Japan; (A.Y.)
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Mitchell LA, Jivani K, Young MA, Jacobs C, Willis AM. Systematic review of the uptake and outcomes from returning secondary findings to adult participants in research genomic testing. J Genet Couns 2024. [PMID: 38197527 DOI: 10.1002/jgc4.1865] [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: 06/19/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024]
Abstract
The increasing use of genomic sequencing in research means secondary findings (SF) is more frequently detected and becoming a more pressing issue for researchers. This is reflected by the recent publication of multiple guidelines on this issue, calling for researchers to have a plan for managing SF prior to commencing their research. A deeper understanding of participants' experiences and outcomes from receiving SF is needed to ensure that the return of SF is conducted ethically and with adequate support. This review focuses on the uptake and outcomes of receiving actionable SF for research participants. This review included studies from January 2010 to January 2023. Databases searched included Medline, Embase, PsycINFO, and Scopus. Of the 3903 studies identified, 29 were included in the analysis. The uptake of SF ranged between 20% and 97%, and outcomes were categorized into psychological, clinical, lifestyle and behavioral, and family outcomes. The results indicate there is minimal psychological impact from receiving SF. Almost all participants greatly valued receiving SF. These findings highlight considerations for researchers when returning results, including the importance of involving genetic health professionals in consenting, results return process, and ensuring continuity of care by engaging healthcare providers.
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Affiliation(s)
- Lucas A Mitchell
- Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Karishma Jivani
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mary-Anne Young
- Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Amanda M Willis
- Clinical Translation and Engagement Platform, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Nabukenya S, Waitt C, Senyonga R, Castelnuovo B, Munabi IG, Kyaddondo D, Mwaka ES. Research Participants' Preferences for Individual Results of Pharmacogenomics Research: A Case of a Ugandan HIV Research Institute. J Empir Res Hum Res Ethics 2023; 18:218-232. [PMID: 37448227 PMCID: PMC10648306 DOI: 10.1177/15562646231187434] [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: 07/15/2023]
Abstract
Little is known about whether people living with HIV would like to receive their results from pharmacogenomics research. This study explored the factors influencing participants' preferences and the reasons for their desire to receive individual results from pharmacogenomics research. We employed a convergent parallel mixed methods study design comprising a survey of 225 research participants and 5 deliberative focus group discussions with 30 purposively selected research participants. Almost all (98%) participants wanted to receive individual pharmacogenomics research results. Reasons for the desire to receive results were reciprocity for valuable time and effort, preparing for future eventualities, and the right to information about their health. Overall, participants desire to receive feedback from pharmacogenomics research, particularly if results are well established and clinically actionable.
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Affiliation(s)
- Sylvia Nabukenya
- Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Kampala, Uganda
| | - Catriona Waitt
- Infectious Diseases Institute, Kampala, Uganda
- University of Liverpool, Liverpool, UK
| | - Ronald Senyonga
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - David Kyaddondo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Erisa S. Mwaka
- Makerere University College of Health Sciences, Kampala, Uganda
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Geiger J, Fuchs J, Starke M, Neumann M, Baber R, Nussbeck SY, Kiehntopf M, Specht C, Illig T, Hummel M, Jahns R. GBA/GBN-position on the feedback of incidental findings in biobank-based research: consensus-based workflow for hospital-based biobanks. Eur J Hum Genet 2023; 31:1066-1072. [PMID: 36732662 PMCID: PMC10474025 DOI: 10.1038/s41431-023-01299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Incidental research findings pose a considerable challenge to hospital-based research biobanks since they are acting as intermediaries between healthcare and research. In a joint action the centralized biobank ibdw (Interdisciplinary Bank of Biomaterials and Data Wuerzburg) together with local authorities drafted a coherent concept to manage incidental research findings in full compliance with relevant ethical and data privacy regulations. The concept was developed and elaborated in close collaboration with the German Biobank Alliance (GBA). Comprehensive documentation of all steps guarantees the traceability of the process. By a mandatory assessment of the findings prior to re-identification of the individual concerned, unnecessary measures can be avoided. The individual's "right not to know" is respected according to the stipulations of the informed consent. As a general principle any communication with the individual occurs exclusively through the hospital and by competent physicians with appropriate knowledge and communication skills. We propose this scheme as a blueprint for reporting workflows for incidental research findings at hospital-based biobanks.
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Affiliation(s)
- Joerg Geiger
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Joerg Fuchs
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Madeline Starke
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Neumann
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ronny Baber
- Leipzig Medical Biobank, University Leipzig, Leipzig, Germany
| | - Sara Y Nussbeck
- University Medical Center Goettingen, Central Biobank, UMG, Goettingen, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Cornelia Specht
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Hummel
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
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6
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Yoshida A, Tokutomi T, Fukushima A, Chapman R, Selita F, Kovas Y, Sasaki M. Japanese Translation and Validation of Genomic Knowledge Measure in the International Genetics Literacy and Attitudes Survey (iGLAS-GK). Genes (Basel) 2023; 14:genes14040814. [PMID: 37107572 PMCID: PMC10137569 DOI: 10.3390/genes14040814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Knowledge of genetics is essential for understanding the results of genetic testing and its implications. Recent advances in genomic research have allowed us to predict the risk of onset of common diseases based on individual genomic information. It is anticipated that more people will receive such estimates of risks based on their genomic data. However, currently, there is no measure for genetic knowledge that includes post-genome sequencing advancements in Japan. In this study, we translated the genomic knowledge measure in the International Genetics Literacy and Attitudes Survey (iGLAS-GK) into Japanese and validated it in a general Japanese adult population (n = 463). The mean score was 8.41 (SD 2.56, range 3–17). The skewness and kurtosis were 0.534 and 0.088, respectively, and the distribution showed a slightly positive skewness. Exploratory factor analysis proposed a six-factor model. Results for 16 of the 20 items of the Japanese version of the iGLAS-GK were comparable to those from previous studies in other populations. These results indicate that the Japanese version is reliable and can be used to measure the genomic knowledge of adults in the general population, and this version of the knowledge measure maintains the multidimensional structure for assessing genomic knowledge.
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7
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Lu TP, Kamatani Y, Belbin G, Park T, Hsiao CK. Editorial: Current Status and Future Challenges of Biobank Data Analysis. Front Genet 2022; 13:882611. [PMID: 35495141 PMCID: PMC9047950 DOI: 10.3389/fgene.2022.882611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tzu-Pin Lu
- Department of Public Health, College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yoichiro Kamatani
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Gillian Belbin
- Institute of Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - Chuhsing Kate Hsiao
- Department of Public Health, College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Chuhsing Kate Hsiao,
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8
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Return of individual research results from genomic research: A systematic review of stakeholder perspectives. PLoS One 2021; 16:e0258646. [PMID: 34748551 PMCID: PMC8575249 DOI: 10.1371/journal.pone.0258646] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.
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Staunton C, Kösters M, Pramstaller PP, Mascalzoni D. Return of research results (RoRR) to the healthy CHRIS cohort: designing a policy with the participants. J Community Genet 2021; 12:577-592. [PMID: 34241790 PMCID: PMC8554916 DOI: 10.1007/s12687-021-00536-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/06/2021] [Indexed: 11/30/2022] Open
Abstract
Legal, financial and organizational challenges and the absence of coherent international guidelines and legal frameworks still discourage many genetic studies to share individual research results with their participants. Studies and institutions deciding to return genetic results will need to design their own study-specific return policy after due consideration of the ethical responsibilities. The Cooperative Health Research in South Tyrol (CHRIS) study, a healthy cohort study, did not foresee the return of individual genomic results during its baseline phase. However, as it was expected that the follow-up phase would generate an increasing amount of reliable genetic results, an update of the return of research results (RoRR) policy became necessary. To inform this revision, an empirical study using mixed methods was developed to investigate the views of CHRIS research participants (20), local general practitioners (3) and the local genetic counselling service (1). During the interviews, three different examples of potential genetic results with a very diverse potential impact on participants were presented: breast cancer, Parkinson disease and Huntington disease. The CHRIS participants also completed a short questionnaire, collecting personal information and asking for a self-evaluation of their knowledge about genetics. This study made it clear that research participants want to make autonomous decisions on the disclosure or non-disclosure of their results. While the motivations for participants' decisions were very diverse, we were able to identify several common criteria that had a strong influence on their choices. Providing information on these factors is crucial to enable participants to make truly informed decisions.
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Affiliation(s)
- Ciara Staunton
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy
- School of Law, Middlesex University, Room WG35, The Burroughs, Hendon, London, NW4 4BT, UK
| | - Maria Kösters
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy
| | - Peter P Pramstaller
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy
- Department of Neurology, Central Hospital, 39100, Bolzano, Italy
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy.
- Department of Public Health and Caring Science, Uppsala University, CRB, P.O. Box 256, 751 05, Uppsala, Sweden.
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10
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Lekstutiene J, Holm S, Gefenas E. Biobanks and Individual Health Related Findings: from an Obstacle to an Incentive. SCIENCE AND ENGINEERING ETHICS 2021; 27:55. [PMID: 34379215 PMCID: PMC8526456 DOI: 10.1007/s11948-021-00330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
Despite the benefits biobanks are expected to bring, there have recently been concerns raised that the public and private non-profit biobanks still prevailing in Europe often fail to reach their initial objectives due to a variety of reasons, including a shortage of funding and insufficient utilization of collections. The necessity to find new ways to manage biobanks has been clearly recognized and one way to do this is to follow the success of some commercial direct-to-consumer genetic testing (DTC GT) companies in the biobanking field. This paper is focused on a double role the return of individual health related findings (IHRF) detected through the biobanking activities can play in the management of biobanks. These findings can be seen as an untapped opportunity to offer health related information to biobank participants. At the same time, the IHRF policy can also serve as an additional tool that can improve biobanking governance. This paper aims to consider diverse IHRF approaches as well as to explore some key ethical concerns related to them. In particular, it reveals how different accounts of personal autonomy shape consent policies related to IHRF and emphasizes ethical controversies related to the commercial DTC GT initiatives as well as some non-profit biobanks.
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Affiliation(s)
- Jurate Lekstutiene
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio 21, 03101, Vilnius, Lithuania.
| | - Søren Holm
- Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK
- Center of Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eugenijus Gefenas
- Institute of Health Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio 21, 03101, Vilnius, Lithuania
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Kawame H, Fukushima A, Fuse N, Nagami F, Suzuki Y, Sakurai-Yageta M, Yasuda J, Yamaguchi-Kabata Y, Kinoshita K, Ogishima S, Takai T, Kuriyama S, Hozawa A, Nakaya N, Nakamura T, Minegishi N, Sugawara J, Suzuki K, Tomita H, Uruno A, Kobayashi T, Aizawa Y, Tokutomi T, Yamamoto K, Ohneda K, Kure S, Aoki Y, Katagiri H, Ishigaki Y, Sawada S, Sasaki M, Yamamoto M. The return of individual genomic results to research participants: design and pilot study of Tohoku Medical Megabank Project. J Hum Genet 2021; 67:9-17. [PMID: 34234266 DOI: 10.1038/s10038-021-00952-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/08/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022]
Abstract
Certain large genome cohort studies attempt to return the individual genomic results to the participants; however, the implementation process and psychosocial impacts remain largely unknown. The Tohoku Medical Megabank Project has conducted large genome cohort studies of general residents. To implement the disclosure of individual genomic results, we extracted the potential challenges and obstacles. Major challenges include the determination of genes/disorders based on the current medical system in Japan, the storage of results, prevention of misunderstanding, and collaboration of medical professionals. To overcome these challenges, we plan to conduct multilayer pilot studies, which deal with different disorders/genes. We finally chose familial hypercholesterolemia (FH) as a target disease for the first pilot study. Of the 665 eligible candidates, 33.5% were interested in the pilot study and provided consent after an educational "genetics workshop" on the basic genetics and medical facts of FH. The genetics professionals disclosed the results to the participants. All positive participants were referred to medical care, and a serial questionnaire revealed no significant psychosocial distress after the disclosure. Return of genomic results to research participants was implemented using a well-prepared protocol. To further elucidate the impact of different disorders, we will perform multilayer pilot studies with different disorders, including actionable pharmacogenomics and hereditary tumor syndromes.
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Affiliation(s)
- Hiroshi Kawame
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan.
| | - Akimune Fukushima
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Nobuo Fuse
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Fuji Nagami
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Yoichi Suzuki
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | | | - Jun Yasuda
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | | | - Kengo Kinoshita
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Soichi Ogishima
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Takako Takai
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Atsushi Hozawa
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Tomohiro Nakamura
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Naoko Minegishi
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Junichi Sugawara
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Kichiya Suzuki
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Hiroaki Tomita
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Akira Uruno
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Tomoko Kobayashi
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Yayoi Aizawa
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Tomoharu Tokutomi
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Kayono Yamamoto
- Department of Clinical Genetics, Iwate Medical University, Iwate, Japan
| | - Kinuko Ohneda
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan.
| | - Shigeo Kure
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Yoko Aoki
- Department of Medical Genetics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hideki Katagiri
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yasushi Ishigaki
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Shojiro Sawada
- Department of Metabolism and Diabetes, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Makoto Sasaki
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Iwate, Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan.
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12
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Vears DF, Minion JT, Roberts SJ, Cummings J, Machirori M, Murtagh MJ. Views on genomic research result delivery methods and informed consent: a review. Per Med 2021; 18:295-310. [PMID: 33822658 DOI: 10.2217/pme-2020-0139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There has been little discussion of the way genomic research results should be returned and how to obtain informed consent for this. We systematically searched the empirical literature, identifying 63 articles exploring stakeholder perspectives on processes for obtaining informed consent about return of results and/or result delivery. Participants, patients and members of the public generally felt they should choose which results are returned to them and how, ranging from direct (face-to-face, telephone) to indirect (letters, emails, web-based delivery) communication. Professionals identified inadequacies in result delivery processes in the research context. Our findings have important implications for ensuring participants are supported in deciding which results they wish to receive or, if no choice is offered, preparing them for potential research outcomes.
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Affiliation(s)
- Danya F Vears
- Melbourne Law School, University of Melbourne, Carlton 3052, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville 3052, Australia.,Center for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, Leuven 3000, Belgium.,Leuven Institute for Human Genetics & Society, Leuven 3000, Belgium
| | - Joel T Minion
- Policy, Ethics & Life Sciences (PEALS) Research Centre, Newcastle University, Newcastle NE1 7RU, UK
| | - Stephanie J Roberts
- Policy, Ethics & Life Sciences (PEALS) Research Centre, Newcastle University, Newcastle NE1 7RU, UK
| | - James Cummings
- School of Art, Media & American Studies, University of East Anglia, NR4 7TJ, UK
| | - Mavis Machirori
- School of Social & Political Sciences, University of Glasgow, G12 8QQ, UK
| | - Madeleine J Murtagh
- Policy, Ethics & Life Sciences (PEALS) Research Centre, Newcastle University, Newcastle NE1 7RU, UK.,School of Social & Political Sciences, University of Glasgow, G12 8QQ, UK
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13
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Participant mothers' attitudes toward genetic analysis in a birth cohort study. J Hum Genet 2021; 66:671-679. [PMID: 33495570 PMCID: PMC8225506 DOI: 10.1038/s10038-020-00894-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 01/21/2023]
Abstract
To conduct a long-term birth cohort study that includes genetic analysis, it is crucial to understand the attitudes of participants to genetic analysis and then take appropriate approaches for addressing their ambiguous and negative attitudes. This study aimed to explore participants’ attitudes toward genetic analysis and associated background factors among mothers who were enrolled in a large Japanese birth cohort. A questionnaire was sent to participants’ households, and the responses of 1762 mothers (34.0%) were used for the study. The majority of mothers recognized genetic analysis for themselves and their children and sharing of genetic data as beneficial. A low knowledge level of genomic terminology was associated with ambiguous attitudes toward genetic analysis and data sharing. Education level was positively associated with the recognition of the benefits of genetic analysis. Concern about handling genetic information was associated with the unacceptability of data sharing. Trust was associated with the approval of genetic analysis. Most mothers preferred that genetic analysis results be returned. These findings suggest the need for multiple efforts to maximize participants’ acceptance of genetic analysis, such as utilizing an educational approach to encourage familiarity with genetics/genomics, optimizing explanations for different educational levels, and explicitly disclosing the handling policy for genetic information.
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14
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Fadda M, Fiordelli M, Amati R, Falvo I, Ibnidris A, Hurst S, Albanese E. Returning individual-specific results of a dementia prevalence study: insights from prospective participants living in Switzerland. Int J Geriatr Psychiatry 2021; 36:207-214. [PMID: 32869397 PMCID: PMC7756381 DOI: 10.1002/gps.5416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/12/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To explore prospective participants' preferences regarding the return of their individual-specific results from a dementia prevalence study (a probabilistic diagnosis of dementia). METHODS/DESIGN We conducted a qualitative study with 22 individuals aged 45 to 86 and resident in the Canton of Ticino (Switzerland). Participants had previously joined the validation phase of an epidemiological study into dementia and its impact. RESULTS We found that individuals welcome the return of their individual-specific results, provided these meet a number of validity, clinical, and personal utility criteria. They justify researchers' duty to return study findings with the principles of beneficence (eg, providing information that can help participants' medical decision-making) and justice (eg, acknowledging participants' efforts to help research by sharing their personal information). Furthermore, individuals anticipate societal benefits of the return of individual specific study findings, including improved interpersonal relationships among individuals and decreased dementia-related stigma. CONCLUSIONS Our findings suggest that researchers should address the return of individual-specific study results early on during study design and involve prospective participants in identifying both the conditions under which results should be offered and the perceived individual and societal benefits returning can have.
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Affiliation(s)
- Marta Fadda
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Maddalena Fiordelli
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland,Institute of Communication and Health, Faculty of Communication SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Rebecca Amati
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Ilaria Falvo
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Aliaa Ibnidris
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
| | - Samia Hurst
- Institute for Ethics, History and the HumanitiesUniversity of GenevaGenevaSwitzerland
| | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical SciencesUniversità della Svizzera italianaLuganoSwitzerland
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15
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Nobile H, Borry P, Moldenhauer J, Bergmann MM. Return of Results in Population Studies: How Do Participants Perceive Them? Public Health Ethics 2020. [DOI: 10.1093/phe/phaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
As a cornerstone of public health, epidemiology has lately undergone substantial changes enabled by, among other factors, the use of biobank infrastructures. In biobank-related research, the return of results to participants constitutes an important and complex ethical question. In this study, we qualitatively investigated how individuals perceive the results returned following their participation in cohort studies with biobanks. In our semi-structured interviews with 31 participants of two such German studies, we observed that some participants overestimate the nature of the personal information they will receive from the study. Although this misestimation does not seem to jeopardize the validity of the consent provided at recruitment, it may still represent a threat for participants’ trust in research and thus their long-term commitment, crucial for such studies. We argue that such misestimation may have ethical consequences on the principles guiding the reflection on the return of results in biobank research, i.e. autonomy, beneficence, non-maleficence and reciprocity. We suggest that shifting from the idea of directly benefiting participants through the return of research results could help focusing on benefiting society as a whole, thereby increasing research trustworthiness of population-based studies using biobanks.
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Affiliation(s)
- Hélène Nobile
- Department of Epidemiology, German Institute for Human Nutrition, and Centre of Biomedical Ethics and Law, Department of Public Health, KU Leuven
| | - Pascal Borry
- Centre of Biomedical Ethics and Law, Department of Public Health, KU Leuven
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16
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Horiuchi Y, Matsubayashi H, Kiyozumi Y, Nishimura S, Higashigawa S, Kado N, Nagashima T, Mizuguchi M, Ohnami S, Arai M, Urakami K, Kusuhara M, Yamaguchi K. Disclosure of secondary findings in exome sequencing of 2480 Japanese cancer patients. Hum Genet 2020; 140:321-331. [PMID: 32710294 DOI: 10.1007/s00439-020-02207-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/14/2020] [Indexed: 12/18/2022]
Abstract
High-throughput sequencing has greatly contributed to precision medicine. However, challenges remain in reporting secondary findings (SFs) of germline pathogenic variants and managing the affected patients. The aim of this study was to examine the incidence of SFs in Japanese cancer patients using whole exome sequencing (WES) and to understand patient preferences regarding SF disclosure. WES was conducted for 2480 cancer patients. Genomic data were screened and classified for variants of 59 genes listed by the American College of Medical Genetics and Genomics SF v2.0 and for an additional 13 hereditary cancer-related genes. Majority of the participants (68.9%; 1709/2480) opted for disclosure of their SFs. Thirty-two pathogenic or likely pathogenic variants, including BRCA1 (7 patients), BRCA2 (4), CHEK2 (4), PTEN (3), MLH1 (3), SDHB (2), MSH6 (1), NF1 (1), EXT2 (1), NF1 (1), NTRK1 (1), MYH7 (3), MYL2 (1), TNNT2 (1), LDLR (2), FBN1 (1), and KCNH2 (1) were recognized in 36 patients (1.5%). Twenty-eight (77.8%) patients underwent genetic counseling and received their SF results. Eighteen (64.3%) patients underwent clinical management for SFs. Genetic validation tests were administered significantly more frequently to patients with than without a SF-related personal history (P = 0.025). This was a first attempt at a large-scale systematic exome analysis in Japan; nevertheless, many cancer patients opted for disclosure of SFs and accepted or considered clinical management.
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Affiliation(s)
- Yasue Horiuchi
- Division of Genetic Counseling, Genetic Medicine Promotion, Shizuoka Cancer Center Hospital, Shizuoka, Japan.,Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hiroyuki Matsubayashi
- Division of Genetic Counseling, Genetic Medicine Promotion, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
| | - Yoshimi Kiyozumi
- Division of Genetic Counseling, Genetic Medicine Promotion, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Seiichiro Nishimura
- Division of Genetic Counseling, Genetic Medicine Promotion, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Satomi Higashigawa
- Division of Genetic Counseling, Genetic Medicine Promotion, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Nobuhiro Kado
- Division of Genetic Counseling, Genetic Medicine Promotion, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | | | - Maki Mizuguchi
- Research Institute of Shizuoka Cancer Center, Shizuoka, Japan
| | - Sumiko Ohnami
- Research Institute of Shizuoka Cancer Center, Shizuoka, Japan
| | - Makoto Arai
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kenichi Urakami
- Research Institute of Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Ken Yamaguchi
- Research Institute of Shizuoka Cancer Center, Shizuoka, Japan
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17
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Akinyemi RO, Jenkins C, Nichols M, Singh A, Wahab K, Akpalu A, Sarfo FS, Owolabi LF, Obiako R, Akinyemi J, Ojebuyi B, Adigun M, Musbahu R, Bello A, Titiloye M, Calys-Tagoe B, Ogunronbi M, Uvere E, Laryea R, Fakunle A, Adeleye O, Olorunsogbon O, Ojo A, Adesina D, Mensah N, Oguike W, Coleman N, Mande A, Uthman M, Kalaria RN, Jegede A, Owolabi M, Ovbiagele B, Arulogun O. Unraveling the Ethical, Legal, and Social Implications of Neurobiobanking and Stroke Genomic Research in Africa: A Study Protocol of the African Neurobiobank for Precision Stroke Medicine ELSI Project. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2020; 19:10.1177/1609406920923194. [PMID: 34276269 PMCID: PMC8284747 DOI: 10.1177/1609406920923194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The ethical, legal, and social implications (ELSI) of emerging neurobiobanks and data resources are unclear in an African scientific landscape with unique cultural, linguistic, and belief systems. The overarching goal of the African Neurobiobank for Precision Stroke Medicine-ELSI Project is to identify, examine, and develop novel approaches to address ELSI issues of biobanking and stroke genomic research in sub-Saharan Africa (SSA). To accomplish the goal we will (1) explore knowledge, attitude, perceptions, barriers, and facilitators influencing ELSI issues related to biobanking and stroke genomic research; (2) use information obtained to craft a community intervention program focused on ELSI issues; and (3) build capacity and careers related to genomics and biobanking for effective client/community engagement while enhancing regulatory, governance, and implementation competences in biobanking science in SSA. A community-based participatory research and mixed-methodological approach, focused on various levels of the social ecological model, will be used to identify and examine relevant ELSI issues. Contextual intervention tools, platforms, and practices will be developed to enhance community understanding and participation in stroke biobanking and genomics research activities while facilitating enduring trust, and equitable and fair utilization of biobanking resources for genetic and trans-omics research. A concurrent capacity building program related to genetic counseling and biobanking will be implemented for early career researchers. The huge potential for neurobiobanking and genomics research in Africa to advance precision medicine applicable to stroke and other neurological disorders requires addressing ELSI challenges while building sustainable research, career, and regulatory capacities in trans-omics and biobanking science.
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Affiliation(s)
- Rufus O. Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arti Singh
- KNUST Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Albert Akpalu
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Fred S. Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Babatunde Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Nigeria
| | | | - Rabiu Musbahu
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
- Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Abiodun Bello
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Musibau Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
| | | | - Mayowa Ogunronbi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Olorunyomi Olorunsogbon
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Adebayo Ojo
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Deborah Adesina
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Nathaniel Mensah
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Nathaniel Coleman
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Aliyu Mande
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
| | - Muhammed Uthman
- Department of Epidemiology and Community Health, Faculty of Clinical Sciences, University of Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- School of Medicine, University of California, San Francisco, CA, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
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18
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Sakurai-Yageta M, Kawame H, Kuriyama S, Hozawa A, Nakaya N, Nagami F, Minegishi N, Ogishima S, Takai-Igarashi T, Danjoh I, Obara T, Ishikuro M, Kobayashi T, Aizawa Y, Ishihara R, Yamamoto M, Suzuki Y. A training and education program for genome medical research coordinators in the genome cohort study of the Tohoku Medical Megabank Organization. BMC MEDICAL EDUCATION 2019; 19:297. [PMID: 31375111 PMCID: PMC6679441 DOI: 10.1186/s12909-019-1725-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Genome cohort studies are used to analyze interactions between genetic and environmental factors, providing valuable information for personalized healthcare. Large-scale and long-term cohort studies require a number of specially trained personnel, of whom those involved in obtaining informed consent play a vital role, especially during the initial phase of such studies. The Japanese Society of Human Genetics (JSHG) previously established a certification system for genome medical research coordinators (GMRCs) responsible for obtaining written consent via face-to-face explanation. Meanwhile, in the Tohoku Medical Megabank Organization (ToMMo), GMRCs are expected to play important roles not only in obtaining informed consent and conducting various assessments, but also in communicating with participants throughout the long-term follow-up. Based on the JSHG program, we therefore developed a specific education and training program for ToMMo GMRCs consisting of 17 lectures, one practical training session on the informed consent procedure, and written and interview examinations. Re-education workshops aimed at self-improvement are also carried out following certification. In this study, we evaluated the education and training program in terms of overall understanding, usefulness, and satisfaction using an anonymous questionnaire. METHODS An anonymous questionnaire addressing each aspect of the education and training program (understanding, usefulness, and satisfaction) was distributed among 152 qualified ToMMo GMRCs. Responses were received from 94 participants (61.8%). RESULTS There was a significant association between the level of overall understanding of lectures and medical qualification (nurse or clinical laboratory technologist), but not with age or educational background. The level of understanding and overall usefulness were lower in sessions related to genetics and epidemiology than those dealing with ToMMo practices. In the re-education workshops, GMRCs showed a preference for and hoped to learn more about both background knowledge and research progress in the ToMMo. CONCLUSIONS The results of our questionnaire suggest that not all ToMMo GMRCs are able to understand everything during the initial education and training program, especially in terms of genomic medicine. Continuous re-education is therefore vital in improving knowledge, skills and motivation, and preparing GMRCs for a specialist role in community-based personalized healthcare.
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Affiliation(s)
- Mika Sakurai-Yageta
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Hiroshi Kawame
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
- International Research Institute of Disaster Science, 468-1 Aramaki Aza-Aoba, Aoba-ku, Sendai, Miyagi 980-8572 Japan
| | - Atsushi Hozawa
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Fuji Nagami
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Naoko Minegishi
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Soichi Ogishima
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Takako Takai-Igarashi
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Inaho Danjoh
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Tomoko Kobayashi
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Yayoi Aizawa
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Rino Ishihara
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Yoichi Suzuki
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama, 362-8588 Japan
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19
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Lin JC, Hsiao WWW, Fan CT. Managing "incidental findings" in biobank research: Recommendations of the Taiwan biobank. Comput Struct Biotechnol J 2019; 17:1135-1142. [PMID: 31462969 PMCID: PMC6709371 DOI: 10.1016/j.csbj.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In this article, incidental findings (IF) refer to unforeseen findings made possible through biobanking research and advances in medical diagnostic technologies that raise issues regarding the obligation and/or responsibility of biobank-users and biobanks to return clinically significant information to participants. The World Medical Association (WMA) Declaration of Taipei (2016) highlights the possibility of encountering IF and requires that research on biospecimens address biobank feedback policies in their informed consent process, leaving open the possibility that the policy may be "no return". As clinicians and researchers begin to use these "resources", the possibility of finding clinically significant IF is becoming a reality. DISCUSSION In line with the WMA's Declaration of Taipei, a pragmatic approach is needed to deal with the issue of returning IF in biobank governance. Indeed, the impacts and concerns associated with the return of IF differ across different stakeholder groups and jurisdictions. Therefore, the framework governing IF return needs to be custom-built, taking into account the nature of each research project and the unique features of biobanks. To this end, in addition to facilitating biobank transparency, establishing an endurable and horizontal connection among biobanks and clinical institutions under a public health system will improve efficiency and effectiveness. Hence, subject to contemporary Taiwanese ethical and/or legal regulations, this article argues for the establishment of an updated framework for imaging-related and genetic-related IF return within the Taiwan Biobank (TWB), mainly based on a limited obligation to disclose life-threatening information revealed by imaging, but not genetic, information. SUMMARY After discussing some of the ethical, legal and social issues encountered by the TWB and accounting for the experiences of other international biobanks, we propose a systematic framework for returning IF, mainly on a "limited obligation" basis, which offers better and more comprehensive protection for biobank-participants' rights and health.
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Key Words
- Biobanks
- Bioethics
- EGF, Ethical Governance Framework
- ELSI, Ethical, Legal and Social Implications
- ESC, European Society of Cardiology
- Framework
- GNC, German National Cohort
- GP, General Practitioners
- IF, Incidental Findings
- IRBs, Institutional Review Boards
- Incidental finding
- MRI, Magnetic Resonance Imaging
- NHI, National Health Insurance
- NIH, National Institutes of Health
- P3G, Public Population Project in Genomics and Society
- TWB, Taiwan Biobank
- The WMA Declaration of Taipei (2016)
- UNESCO, United Nations Education Scientific and Cultural Organization
- WMA, World Medical Association
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Affiliation(s)
- Jui-Chu Lin
- College of Liberal Arts and Social Sciences, National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
- Law & Technology Innovation Center, National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
- Ethical, Legal and Social Implications (ELSI) of the Taiwan Biobank, Taipei, Taiwan, ROC
| | - Wesley Wei-Wen Hsiao
- Law & Technology Innovation Center, National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
- Genomics Research Center, Academia Sinica, Taipei, Taiwan, ROC
| | - Chien-Te Fan
- Institute of Law for Science and Technology, National Tsing Hua University, Hsin-Chu, Taiwan, ROC
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20
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Dyke SOM, Saulnier KM, Dupras C, Webster AP, Maschke K, Rothstein M, Siebert R, Walter J, Beck S, Pastinen T, Joly Y. Points-to-consider on the return of results in epigenetic research. Genome Med 2019; 11:31. [PMID: 31122281 PMCID: PMC6533659 DOI: 10.1186/s13073-019-0646-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
As epigenetic studies become more common and lead to new insights into health and disease, the return of individual epigenetic results to research participants, in particular in large-scale epigenomic studies, will be of growing importance. Members of the International Human Epigenome Consortium (IHEC) Bioethics Workgroup considered the potential ethical, legal, and social issues (ELSI) involved in returning epigenetic research results and incidental findings in order to produce a set of 'Points-to-consider' (P-t-C) for the epigenetics research community. These P-t-C draw on existing guidance on the return of genetic research results, while also integrating the IHEC Bioethics Workgroup's ELSI research on and discussion of the issues associated with epigenetic data as well as the experience of a return of results pilot study by the Personal Genome Project UK (PGP-UK). Major challenges include how to determine the clinical validity and actionability of epigenetic results, and considerations related to environmental exposures and epigenetic marks, including circumstances warranting the sharing of results with family members and third parties. Interdisciplinary collaboration and good public communication regarding epigenetic risk will be important to advance the return of results framework for epigenetic science.
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Affiliation(s)
- Stephanie O M Dyke
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada.
- Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 2B4, Canada.
| | - Katie M Saulnier
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada
| | - Charles Dupras
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada
| | - Amy P Webster
- UCL Cancer Institute, University College London, London, WC1E 6DD, UK
| | | | - Mark Rothstein
- Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University Medical Center, 89091, Ulm, Germany
| | - Jörn Walter
- Saarland University, 66123, Saarbrücken, Germany
| | - Stephan Beck
- UCL Cancer Institute, University College London, London, WC1E 6DD, UK
| | - Tomi Pastinen
- Department of Human Genetics, McGill University and Genome Quebec Innovation Centre, Montreal, Quebec, H3A 0G1, Canada
- Center for Pediatric Genomic Medicine, Children's Mercy Kansas City, Kansas City, MO, 64108, USA
| | - Yann Joly
- Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, Quebec, H3A 0G1, Canada
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21
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Hishiyama Y, Minari J, Suganuma N. The survey of public perception and general knowledge of genomic research and medicine in Japan conducted by the Japan Agency for Medical Research and Development. J Hum Genet 2019; 64:397-407. [PMID: 30842598 DOI: 10.1038/s10038-019-0587-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 11/09/2022]
Abstract
Japan has been proactively promoting genomic medicine initiatives as national policy. With rapid pace developments in genomic medicine, an increasing number of patients and their families will be able to access genomic information. In such circumstances, a consideration of public interests and an assessment of the general knowledge about genomic research and genomic medicine are becoming imperative. This study aims to elucidate public attitude to the handling of genetic information during research and general medicine. The results of the questionnaire survey of 3000 people have revealed the following points: (1) older participants were likely to have better knowledge of genetic information than younger ones; (2) people with better understanding of genetic information tended to care more strongly about technical issues; (3) respondents with higher literacy regarding genetic issues favored stricter rules for handling of genetic information compared to handling of ordinary medical data; and (4) research community and funding agencies should preserve and develop public trust in genomic research and medicine. These results suggest the importance of education for younger people, the need of different types of explanation and transparency aimed at individuals with different levels of knowledge about the genome, and indicate the adequacy of the current governmental guidelines.
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Affiliation(s)
- Yutaka Hishiyama
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan. .,Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan.
| | - Jusaku Minari
- Japan Agency for Medical Research and Development, Tokyo, Japan.,Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kochi, Japan
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22
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A comparison of genome cohort participants' genetic knowledge and preferences to receive genetic results before and after a genetics workshop. J Hum Genet 2018; 63:1139-1147. [PMID: 30185949 PMCID: PMC8075932 DOI: 10.1038/s10038-018-0494-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/27/2018] [Accepted: 07/08/2018] [Indexed: 11/27/2022]
Abstract
Several biobanks have begun returning genetic results to individuals, making the development of public genetic literacy an urgent task for their effective use. No research exists regarding the effects of genetic education on biobank participants, so we conducted genetics workshops with specialists, and surveyed differences in the participants’ (n = 112) preferences to receive their own genetic information by disease categories and their genetic knowledge using questionnaires before and after the workshops. Almost 90% of our participants were over 60 years old, which was similar to our previous preference research. The preference to receive five of the six categories of genetic information (lifestyle diseases, pharmacogenetics, adult-onset non-clinically actionable diseases, non-clinically actionable multifactorial diseases, and all genetic information) was slightly but significantly decreased after the genetics workshop. More participants preferred to receive genetic results regarding lifestyle diseases, pharmacogenetics, and adult-onset clinically actionable diseases after the workshop, while less participants preferred to receive information regarding adult-onset non-clinically actionable diseases, non-clinically actionable multifactorial diseases, and all genetic information. Total genetic knowledge scores significantly increased after the workshop (before: 11.89, after: 13.30, p < 0.001). Our findings suggest that genetics workshops are useful to improve the genetic literacy of genome cohort participants.
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23
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Bradbury AR, Patrick-Miller L, Egleston BL, Maxwell KN, DiGiovanni L, Brower J, Fetzer D, Bennett Gaieski J, Brandt A, McKenna D, Long J, Powers J, Stopfer JE, Nathanson KL, Domchek SM. Returning Individual Genetic Research Results to Research Participants: Uptake and Outcomes Among Patients With Breast Cancer. JCO Precis Oncol 2018; 2. [PMID: 32095738 DOI: 10.1200/po.17.00250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose Understanding the outcomes of returning individual genetic research results to participants is critical because some genetic variants are found to be associated with health outcomes and have become available for clinical testing. Materials and Methods BRCA1/2-negative women with early-onset breast cancer, multiple primary cancers, or a family history of breast cancer who participated in a gene discovery cancer registry were offered the opportunity to learn their individual genetic research results of 24 breast cancer susceptibility genes with a genetic counselor after predisclosure genetic counseling. Outcomes included uptake of research results, knowledge, informed choice, psychosocial adjustment, uncertainty, satisfaction, and uptake of clinical confirmation testing. Results Four hundred two potential participants were contacted. One hundred ninety-four participants (48%) did not respond despite multiple attempts, and 85 participants (21%) actively or passively declined. One hundred seven participants (27%) elected for predisclosure counseling and were more likely to be younger, married, and white. Ninety percent of participants who had predisclosure counseling elected to receive their genetic research results, and 89% made an informed choice. Knowledge increased significantly after predisclosure counseling, and anxiety, intrusive cancer-specific distress, uncertainty, and depression declined significantly after receipt of results. General anxiety and intrusive cancer-specific distress declined significantly for both participants with a positive result and those with a negative result. Sixty-four percent of participants had clinical confirmation testing when recommended, including all participants with a mutation in a high-penetrance gene. Conclusion Uptake of genetic research results may be lower than anticipated by hypothetical reports and small select studies. Participants who elected to receive research results with genetic providers did not experience increases in distress or uncertainty, but not all patients return for confirmation testing.
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Affiliation(s)
- Angela R Bradbury
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Linda Patrick-Miller
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Brian L Egleston
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Kara N Maxwell
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Laura DiGiovanni
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Jamie Brower
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Dominique Fetzer
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Jill Bennett Gaieski
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Amanda Brandt
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Danielle McKenna
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Jessica Long
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Jacquelyn Powers
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Jill E Stopfer
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Katherine L Nathanson
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
| | - Susan M Domchek
- Angela R. Bradbury, Kara N. Maxwell, Laura DiGiovanni, Jamie Brower, Dominique Fetzer, Jill Bennett Gaieski, Amanda Brandt, Danielle McKenna, Jessica Long, Jacquelyn Powers, Jill E. Stopfer, Katherine L. Nathanson, and Susan M. Domchek, Perelman School of Medicine at the University of Pennsylvania; Brian L. Egleston, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA; and Linda Patrick-Miller, The University of Chicago, Chicago, IL
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