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Wagner AL, Zhang F, Ryan KA, Xing E, Nong P, Kardia SLR, Platt J. US Residents' Preferences for Sharing of Electronic Health Record and Genetic Information: A Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1301-1307. [PMID: 36736697 PMCID: PMC10956475 DOI: 10.1016/j.jval.2023.01.015] [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] [Received: 09/21/2022] [Revised: 12/25/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The aim to this study was to assess preferences for sharing of electronic health record (EHR) and genetic information separately and to examine whether there are different preferences for sharing these 2 types of information. METHODS Using a population-based, nationally representative survey of the United States, we conducted a discrete choice experiment in which half of the subjects (N = 790) responded to questions about sharing of genetic information and the other half (N = 751) to questions about sharing of EHR information. Conditional logistic regression models assessed relative preferences across attribute levels of where patients learn about health information sharing, whether shared data are deidentified, whether data are commercialized, how long biospecimens are kept, and what the purpose of sharing the information is. RESULTS Individuals had strong preferences to share deidentified (vs identified) data (odds ratio [OR] 3.26, 95% confidence interval 2.68-3.96) and to be able to opt out of sharing information with commercial companies (OR 4.26, 95% confidence interval 3.42-5.30). There were no significant differences regarding how long biospecimens are kept or why the data are being shared. Individuals had a stronger preference for opting out of sharing genetic (OR 4.26) versus EHR information (OR 2.64) (P = .002). CONCLUSIONS Hospital systems and regulatory bodies should consider patient preferences for sharing of personal medical records or genetic information. For both genetic and EHR information, patients strongly prefer their data to be deidentified and to have the choice to opt out of sharing information with commercial companies.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Felicia Zhang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Eric Xing
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Paige Nong
- Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jodyn Platt
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, USA
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Ssebunnya GM. Towards an appropriate African framework for public engagement with human genome editing: a call to synergistic action. Wellcome Open Res 2023; 7:302. [PMID: 37485292 PMCID: PMC10359742 DOI: 10.12688/wellcomeopenres.18579.2] [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: 05/02/2023] [Indexed: 07/25/2023] Open
Abstract
The CRISPR-Cas9 system has revolutionised the biotechnology of human genome editing. Human germline gene editing promises exponential benefits to many in Africa and elsewhere, especially those affected by the highly prevalent monogenic disorders - for which, thanks to CRISPR, a relatively safe heritable radical therapy is a real possibility. Africa evidently presents a unique opportunity for empirical research in human germline gene editing because of its high prevalence of monogenic disorders. Critically, however, germline gene editing has raised serious ethical concerns especially because of the significant risks of inadvertent and intentional misuse of its transgenerational heritability. Calls for due prudence have become even more pronounced in the wake of the 2018 case of He Jiankui's 'CRISPR'd babies'. Meanwhile, Africa is seriously lagging in articulating its position on human genome editing. Conspicuously, there has been little to no attempt at comprehensively engaging the African public in discussions on the promises and concerns about human genome editing. Thus, the echoing key question remains as to how Africa should prudently embrace and govern this revolutionary biotechnology. In this article, therefore, I lay the groundwork for the possible development of an appropriate African framework for public engagement with human genome editing and call upon all stakeholders to urgent synergistic action. I particularly highlight the World Health Organisation's possible leadership role in promptly establishing the requisite expert working group for this urgent need.
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Affiliation(s)
- Gerald Michael Ssebunnya
- Padre Pio Medical Centre, Gaborone, Botswana
- Africa Institute for Human Dignity, Gaborone, Botswana
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Ssebunnya GM. Towards an appropriate African framework for public engagement with human genome editing: a call to synergistic action. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18579.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The CRISPR-Cas9 system has revolutionised the biotechnology of human genome editing. Human germline gene editing promises exponential benefits to many in Africa and elsewhere, especially those affected by the highly prevalent monogenic disorders - for which, thanks to CRISPR, a relatively safe heritable radical therapy is now possible. Africa evidently presents a unique opportunity for empirical research in human germline gene editing because of its high prevalence of monogenic disorders. Critically, however, germline gene editing has raised serious ethical concerns especially because of the significant risks of inadvertent and intentional misuse of its transgenerational heritability. Calls for due prudence have become even more pronounced in the wake of the 2018 case of He Jiankui’s ‘CRISPR’d babies’. Meanwhile, Africa is seriously lagging in articulating its position on human genome editing. Conspicuously, there has been little to no attempt at comprehensively engaging the African public in discussions on the promises and concerns about human genome editing. Thus, the echoing key question remains as to how Africa should prudently embrace and govern this revolutionary biotechnology. In this article, therefore, I lay the groundwork for the possible development of an appropriate African framework for public engagement with human genome editing and call upon all stakeholders to urgent synergistic action. I particularly highlight the World Health Organisation’s possible leadership role in promptly establishing the requisite expert working group for this urgent need.
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Abstract
Biobanks and health data repositories provide rich reservoirs of information for use in biomedical research. These repositories depend on participants donating identifiable health data and biospecimens that may be used in perpetuity by unlimited numbers of researchers for unnamed research topics. Since 1991, U.S. federal regulatory provisions, collectively known as the Common Rule, have required informed consent of participants in federally funded human subjects research, but recent changes to the Common Rule now sanction "broad consent" in the repository research context. Broad consent is not defined in the revised Common Rule; thus, researchers and their institutions are left to determine ad hoc what broad consent means and requires. Without leadership and guidance from the U.S. Department of Health and Human Services, stakeholders with potential conflicts of interest will reach their own conclusions and craft new and varied standards for consent. The result will be uneven protections for participants.
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Affiliation(s)
- Lisa E Smilan
- Visiting scholar at the Institute of Law, Psychiatry, and Public Policy at the University of Virginia and a member of the National Institutes of Health Intramural Institutional Review Board
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Milne R, Sorbie A, Dixon-Woods M. What can data trusts for health research learn from participatory governance in biobanks? JOURNAL OF MEDICAL ETHICS 2022; 48:323-328. [PMID: 33741681 PMCID: PMC9046739 DOI: 10.1136/medethics-2020-107020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 05/13/2023]
Abstract
New models of data governance for health data are a focus of growing interest in an era of challenge to the social licence. In this article, we reflect on what the data trust model, which is founded on principles of participatory governance, can learn from experiences of involving and engagement of members of the public and participants in the governance of large-scale biobanks. We distinguish between upstream and ongoing governance models, showing how they require careful design and operation if they are to deliver on aspirations for deliberation and participation. Drawing on this learning, we identify a set of considerations important to future design for data trusts as they seek to ensure just, proportionate and fair governance. These considerations relate to the timing of involvement of participants, patterns of inclusion and exclusion, and responsiveness to stakeholder involvement and engagement. We emphasise that the evolution of governance models for data should be matched by a commitment to evaluation.
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Affiliation(s)
- Richard Milne
- Society and Ethics Research, Wellcome Genome Campus, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Annie Sorbie
- Mason Institute for Medicine, Life Sciences and the Law, Edinburgh Law School, University of Edinburgh, Edinburgh, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
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Waljee AK, Ryan KA, Krenz CD, Ioannou GN, Beste LA, Tincopa MA, Saini SD, Su GL, Arasim ME, Roman PT, Nallamothu BK, De Vries R. Eliciting patient views on the allocation of limited healthcare resources: a deliberation on hepatitis C treatment in the Veterans Health Administration. BMC Health Serv Res 2020; 20:369. [PMID: 32357873 PMCID: PMC7193376 DOI: 10.1186/s12913-020-05211-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to the development of highly effective but expensive new medications, policymakers, payors, and health systems are considering novel and pragmatic ways to provide these medications to patients. One approach is to target these treatments to those most likely to benefit. However, to maximize the fairness of these policies, and the acceptance of their implementation, the values and beliefs of patients should be considered. The provision of treatments for chronic hepatitis C (CHC) in the resource-constrained context of the Veterans Health Administration (VHA) offered a real-world example of this situation, providing the opportunity to test the value of using Democratic Deliberation (DD) methods to solicit the informed opinions of laypeople on this complex issue. METHODS We recruited Veterans (n = 30) from the VHA to attend a DD session. Following educational presentations from content experts, participants engaged in facilitated small group discussions to: 1) identify strategies to overcome CHC treatment barriers and 2) evaluate, vote on, and modify/improve two CHC treatment policies - "first come, first served" (FCFS) and "sickest first" (SF). We used transcripts and facilitators' notes to identify key themes from the small group discussions. Additionally, participants completed pre- and post-DD surveys. RESULTS Most participants endorsed the SF policy over the FCFS policy, emphasizing the ethical and medical appropriateness of treating the sickest first. Concerns about SF centered on the difficulty of implementation (e.g., how is "sickest" determined?) and unfairness to other Veterans. Proposed modifications focused on: 1) the need to consider additional health factors, 2) taking behavior and lifestyle into account, 3) offering education and support, 4) improving access, and 5) facilitating better decision-making. CONCLUSIONS DD offered a robust and useful method for addressing the allocation of the scarce resource of CHC treatment. Participants were able to develop a modified version of the SF policy and offered diverse recommendations to promote fairness and improve quality of care for Veterans. DD is an effective approach for incorporating patient preferences and gaining valuable insights for critical healthcare policy decisions in resource-limited environments.
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Affiliation(s)
- Akbar K. Waljee
- VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
- Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI 48109-5362 USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109-2800 USA
| | - Kerry A. Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road, North Campus Research Complex, Bldg. 14, G016, Ann Arbor, MI 48109-2800 USA
| | - Chris D. Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road, North Campus Research Complex, Bldg. 14, G016, Ann Arbor, MI 48109-2800 USA
| | - George N. Ioannou
- Veterans Affairs Puget Sound Healthcare System, 1660 South Columbian Way, Seattle, WA 98108 USA
- Division of Gastroenterology, Department of Medicine, University of Washington, 1959 NE Pacific St., Box 356424, Seattle, WA 98195-6424 USA
| | - Lauren A. Beste
- Division of Gastroenterology, Department of Medicine, University of Washington, 1959 NE Pacific St., Box 356424, Seattle, WA 98195-6424 USA
- Division of General Internal Medicine, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98104 USA
| | - Monica A. Tincopa
- Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI 48109-5362 USA
| | - Sameer D. Saini
- VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
- Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI 48109-5362 USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109-2800 USA
| | - Grace L. Su
- VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
- Michigan Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI 48109-5362 USA
| | - Maria E. Arasim
- VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
| | - Patti T. Roman
- VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
| | - Brahmajee K. Nallamothu
- VA Ann Arbor Health Services Research and Development Center of Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
- Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), 2800 Plymouth Road, North Campus Research Complex (NCRC), Building 16, Ann Arbor, MI 48109-2800 USA
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, 1500 East Medical Center Drive, SPC 5856, Ann Arbor, MI 48109-5362 USA
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road, North Campus Research Complex, Bldg. 14, G016, Ann Arbor, MI 48109-2800 USA
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De Vries RG, Ryan KA, Gordon L, Krenz CD, Tomlinson T, Jewell S, Kim SYH. Biobanks and the Moral Concerns of Donors: A Democratic Deliberation. QUALITATIVE HEALTH RESEARCH 2019; 29:1942-1953. [PMID: 30095038 DOI: 10.1177/1049732318791826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Do members of the public believe that biobanks should accommodate the moral concerns of donors about the types of research done with their biospecimens? The answer to this question is critical to the future of genomic and precision medicine, endeavors that rely on a public willing to share their biospecimens and medical data. To explore public attitudes regarding the requirements of consent for biobank donations, we organized three democratic deliberations involving 180 participants. The deliberative sessions involved small group discussions informed by presentations given by experts in both biobank research and ethics. We found that participants had a sophisticated understanding of the ethical problems of biobank consent and the complexity of balancing donor concerns while promoting research important to the future of health care. Our research shows how deliberative methods can offer policy makers creative ideas for accommodating the moral concerns of donors in the biobank consent process.
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Affiliation(s)
| | - Kerry A Ryan
- University of Michigan, Ann Arbor, Michigan, USA
| | - Linda Gordon
- Michigan State University, East Lansing, Michigan, USA
| | | | - Tom Tomlinson
- Michigan State University, East Lansing, Michigan, USA
| | - Scott Jewell
- Van Andel Institute, Grand Rapids, Michigan, USA
| | - Scott Y H Kim
- National Institutes of Health, Bethesda, Maryland, USA
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Jagsi R, Griffith KA, Jones RD, Krenz C, Gornick M, Spence R, De Vries R, Hawley ST, Zon R, Bolte S, Sadeghi N, Schilsky RL, Bradbury AR. Effect of Public Deliberation on Patient Attitudes Regarding Consent and Data Use in a Learning Health Care System for Oncology. J Clin Oncol 2019; 37:3203-3211. [PMID: 31577472 DOI: 10.1200/jco.19.01693] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We sought to generate informed and considered opinions regarding acceptable secondary uses of deidentified health information and consent models for oncology learning health care systems. METHODS Day-long democratic deliberation sessions included 217 patients with cancer at four geographically and sociodemographically diverse sites. Patients completed three surveys (at baseline, immediately after deliberation, and 1-month follow-up). RESULTS Participants were 67.3% female, 21.7% black, and 6.0% Hispanic. The most notable changes in perceptions after deliberation related to use of deidentified medical-record data by insurance companies. After discussion, 72.3% of participants felt comfortable if the purpose was to make sure patients receive recommended care (v 79.5% at baseline; P = .03); 24.9% felt comfortable if the purpose was to determine eligibility for coverage or reimbursement (v 50.9% at baseline; P < .001). The most notable change about secondary research use related to believing it was important that doctors ask patients at least once whether researchers can use deidentified medical-records data for future research. The proportion endorsing high importance decreased from baseline (82.2%) to 68.7% immediately after discussion (P < .001), and remained decreased at 73.1% (P = .01) at follow-up. At follow-up, non-Hispanic whites were more likely to consider it highly important to be able to conduct medical research with deidentified electronic health records (96.8% v 87.7%; P = .01) and less likely to consider it highly important for doctors to get a patient's permission each time deidentified medical record information is used for research (23.2% v 51.6%; P < .001). CONCLUSION This research confirms that most patients wish to be asked before deidentified medical records are used for research. Policies designed to realize the potential benefits of learning health care systems can, and should be, grounded in informed and considered public opinion.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Robin Zon
- Michiana Hematology-Oncology PC, Mishawaka, IN
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Bravo G, Trottier L, Rodrigue C, Arcand M, Downie J, Dubois MF, Kaasalainen S, Hertogh CM, Pautex S, Van den Block L. Comparing the attitudes of four groups of stakeholders from Quebec, Canada, toward extending medical aid in dying to incompetent patients with dementia. Int J Geriatr Psychiatry 2019; 34:1078-1086. [PMID: 31034669 DOI: 10.1002/gps.5111] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/17/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The Canadian province of Quebec has recently legalized medical aid in dying (MAID) for competent patients who satisfy strictly defined criteria. The province is considering extending the practice to incompetent patients. We compared the attitudes of four groups of stakeholders toward extending MAID to incompetent patients with dementia. METHODS We conducted a province-wide postal survey in random samples of older adults, informal caregivers of persons with dementia, nurses, and physicians caring for patients with dementia. Clinical vignettes featuring a patient with Alzheimer's disease were used to measure the acceptability of extending MAID to incompetent patients with dementia. Vignettes varied according to the stage of the disease (advanced or terminal) and type of request (written or oral only). We used the generalized estimating equation (GEE) approach to compare attitudes across groups and vignettes. RESULTS Response rates ranged from 25% for physicians to 69% for informal caregivers. In all four groups, the proportion of respondents who felt it was acceptable to extend MAID to an incompetent patient with dementia was highest when the patient was at the terminal stage, showed signs of distress, and had written a MAID request prior to losing capacity. In those circumstances, this proportion ranged from 71% among physicians to 91% among informal caregivers. CONCLUSION We found high support in Quebec for extending the current MAID legislation to incompetent patients with dementia who have reached the terminal stage, appear to be suffering, and had requested MAID in writing while still competent.
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Affiliation(s)
- Gina Bravo
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lise Trottier
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Claudie Rodrigue
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marcel Arcand
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada.,Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jocelyn Downie
- Schulich School of Law, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marie-France Dubois
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sharon Kaasalainen
- Department of Family Medicine, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Cees M Hertogh
- Department of General Practice and Elderly Care Medicine, EMGO+ Institute for Health and Care Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Sophie Pautex
- Department of Community Medicine and Primary Care, Geneva University Hospital, Geneva, Switzerland
| | - Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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