1
|
Wolf SM, Green RC. Return of Results in Genomic Research Using Large-Scale or Whole Genome Sequencing: Toward a New Normal. Annu Rev Genomics Hum Genet 2023; 24:393-414. [PMID: 36913714 PMCID: PMC10497726 DOI: 10.1146/annurev-genom-101122-103209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
Collapse
Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
| |
Collapse
|
2
|
Roane JL, Mio M, Viner J, Bettridge A, Heyn C, Roifman I, Selkirk B, Kertes P, MacIntosh BJ, Thayalasuthan V, Detzler G, Endre R, Jimenez-Juan L, Henry B, Murray BJ, Goldstein BI. Incidental Findings Among Youth Participating in Multimodal Imaging Research: Characteristics of Findings and Description of a Management Approach. Front Pediatr 2022; 10:875934. [PMID: 35813368 PMCID: PMC9259791 DOI: 10.3389/fped.2022.875934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022] Open
Abstract
Research imaging in healthy and clinical youth populations yields incidental findings that require a management strategy. Our primary objective was to document the frequency and nature of incidental findings within a research group integrating multiple imaging modalities. A second objective was to describe the evolution of an approach to handling incidental findings. A case example was included to display the intricacies of some of these scenarios. Youth, ages 13-20 years, with bipolar disorder, familial risk for bipolar disorder, or healthy controls, obtained one or a combination of neuroimaging, cardio-thoracic imaging, retinal imaging, and carotid imaging. All images were systematically reviewed for incidental findings. Overall, of 223 participants (n = 102 healthy controls), 59% (n = 131) had a brain magnetic resonance imaging (MRI) incidental finding and 27% (n = 60) had at least one incidental brain finding requiring non-urgent follow-up. In addition, of 109 participants with chest/cardiac MRI and carotid ultrasound, 3% (n = 3) had chest findings, 2% (n = 2) had cardiac findings, and 1% (n = 1) had a carotid finding. Of 165 youth with retinal imaging, 1% (n = 2) had incidental findings. While the vast majority of these incidental findings were of a non-serious, non-urgent nature, there were noteworthy exceptions. Imaging research groups need a system that emphasizes the value of clinical review of research images and one that is collaborative and responsive in order to inform follow-up plans. Rating systems that have been developed and used in neuroimaging for the classification of incidental findings can be adapted for use in areas other than the brain. Regardless of severity, incidental findings may raise anxiety in youth participants and their parents. The optimal threshold is one that balances transparency with utility.
Collapse
Affiliation(s)
- Jessica L Roane
- Sunnybrook Research Institute, Toronto, ON, Canada.,Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Megan Mio
- Sunnybrook Research Institute, Toronto, ON, Canada.,Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Jacqueline Viner
- Department of Classics, University of Toronto, Toronto, ON, Canada
| | - Ariel Bettridge
- Sunnybrook Research Institute, Toronto, ON, Canada.,Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Chinthaka Heyn
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Idan Roifman
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Beth Selkirk
- Department of Ophthalmology & Vision Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Peter Kertes
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Ophthalmology & Vision Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Ophthalmology & Visions Sciences, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | | | - Garry Detzler
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ruby Endre
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Laura Jimenez-Juan
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Blair Henry
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian J Murray
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Sunnybrook Research Institute, Toronto, ON, Canada.,Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Shen FX, Wolf SM, Bhavnani S, Deoni S, Elison JT, Fair D, Garwood M, Gee MS, Geethanath S, Kay K, Lim KO, Lockwood Estrin G, Luciana M, Peloquin D, Rommelfanger K, Schiess N, Siddiqui K, Torres E, Vaughan JT. Emerging ethical issues raised by highly portable MRI research in remote and resource-limited international settings. Neuroimage 2021; 238:118210. [PMID: 34062266 PMCID: PMC8382487 DOI: 10.1016/j.neuroimage.2021.118210] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 11/18/2022] Open
Abstract
Smaller, more affordable, and more portable MRI brain scanners offer exciting opportunities to address unmet research needs and long-standing health inequities in remote and resource-limited international settings. Field-based neuroimaging research in low- and middle-income countries (LMICs) can improve local capacity to conduct both structural and functional neuroscience studies, expand knowledge of brain injury and neuropsychiatric and neurodevelopmental disorders, and ultimately improve the timeliness and quality of clinical diagnosis and treatment around the globe. Facilitating MRI research in remote settings can also diversify reference databases in neuroscience, improve understanding of brain development and degeneration across the lifespan in diverse populations, and help to create reliable measurements of infant and child development. These deeper understandings can lead to new strategies for collaborating with communities to mitigate and hopefully overcome challenges that negatively impact brain development and quality of life. Despite the potential importance of research using highly portable MRI in remote and resource-limited settings, there is little analysis of the attendant ethical, legal, and social issues (ELSI). To begin addressing this gap, this paper presents findings from the first phase of an envisioned multi-staged and iterative approach for creating ethical and legal guidance in a complex global landscape. Section 1 provides a brief introduction to the emerging technology for field-based MRI research. Section 2 presents our methodology for generating plausible use cases for MRI research in remote and resource-limited settings and identifying associated ELSI issues. Section 3 analyzes core ELSI issues in designing and conducting field-based MRI research in remote, resource-limited settings and offers recommendations. We argue that a guiding principle for field-based MRI research in these contexts should be including local communities and research participants throughout the research process in order to create sustained local value. Section 4 presents a recommended path for the next phase of work that could further adapt these use cases, address ethical and legal issues, and co-develop guidance in partnership with local communities.
Collapse
Affiliation(s)
- Francis X Shen
- Professor of Law and Faculty Member, Graduate Program in Neuroscience, University of Minnesota; Instructor in Psychology, Harvard Medical School; Executive Director, MGH Center for Law, Brain & Behavior USA.
| | - Susan M Wolf
- McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; Professor of Medicine; Chair, Consortium on Law and Values in Health, Environment & the Life Sciences, University of Minnesota USA
| | - Supriya Bhavnani
- Co-Principal Investigator, Child Development Group, Sangath, New Delhi, India
| | - Sean Deoni
- Associate Professor of Pediatrics (Research), Associate Professor of Diagnostic Imaging (Research), Brown University; Senior Program Officer, Maternal, Newborn & Child Health Discovery & Tools, Discovery & Translational Sciences, Bill & Melinda Gates Foundation USA
| | - Jed T Elison
- Associate Professor, Institute of Child Development, Department of Pediatrics, University of Minnesota USA
| | - Damien Fair
- Redleaf Endowed Director, Masonic Institute for the Developing Brain; Professor, Institute of Child Development, College of Education and Human Development; Professor, Department of Pediatrics, Medical School, University of Minnesota USA
| | - Michael Garwood
- Malcolm B. Hanson Professor of Radiology, Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota USA
| | - Michael S Gee
- Vice-Chair of Clinical Operations, Chief of Pediatric Radiology, Pediatric Imaging Research Center Director, Massachusetts General Hospital; Co-Director, Mass General Imaging Global Health Educational Programs USA
| | - Sairam Geethanath
- Associate Research Scientist, Columbia Magnetic Resonance Research Center, Columbia University USA
| | - Kendrick Kay
- Assistant Professor, Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota USA
| | - Kelvin O Lim
- Professor, Vice-Chair of Research, Drs. T. J. and Ella M. Arneson Land-Grant Chair in Human Behavior, Department of Psychiatry and Behavioral Sciences, University of Minnesota USA
| | - Georgia Lockwood Estrin
- Sir Henry Wellcome Postdoctoral Research Fellow, Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London UK
| | - Monica Luciana
- Professor, Department of Psychology; Adjunct Faculty Member, Institute of Child Development; Core Faculty Member, Center for Neurobehavioral Development, University of Minnesota USA
| | | | - Karen Rommelfanger
- Director, Neuroethics Program, Center for Ethics; Associate Professor, Departments of Neurology and Psychiatry and Behavioral Sciences, School of Medicine, Emory University USA
| | - Nicoline Schiess
- Technical Officer, Brain Health Unit, World Health Organization Switzerland
| | - Khan Siddiqui
- Chief Medical Officer and Chief Strategy Officer, Hyperfine USA
| | - Efraín Torres
- PhD Candidate in the Department of Biomedical Engineering, NSF GRFP Fellow, University of Minnesota; Garwood Lab member USA
| | - J Thomas Vaughan
- Professor in the Departments of Biomedical Engineering and Radiology, Director of the Columbia Magnetic Resonance Research Center; Principal and Investigator and MR Platform Director of the Zuckerman Institute, Columbia University; Director of the High Field Imaging Lab, Nathan Kline Institute USA
| |
Collapse
|
4
|
Soumaré A, Beguedou N, Laurent A, Brochet B, Bordes C, Mournet S, Mellet E, Pereira E, Pollet C, Lachaize M, Mougin M, Tsuchida A, Loiseau H, Tourdias T, Tzourio C, Mazoyer B, Debette S. Prevalence, Severity, and Clinical Management of Brain Incidental Findings in Healthy Young Adults: MRi-Share Cross-Sectional Study. Front Neurol 2021; 12:675244. [PMID: 34093421 PMCID: PMC8173138 DOI: 10.3389/fneur.2021.675244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives: Young adults represent an increasingly large proportion of healthy volunteers in brain imaging research, but descriptions of incidental findings (IFs) in this age group are scarce. We aimed to assess the prevalence and severity of IFs on brain MRIs of healthy young research participants aged 18-35 years, and to describe the protocol implemented to handle them. Methods: The study population comprised 1,867 participants aged 22.1 ± 2.3 years (72% women) from MRi-Share, the cross-sectional brain MRI substudy of the i-Share student cohort. IFs were flagged during the MRI quality control. We estimated the proportion of participants with IFs [any, requiring medical referral, potentially serious (PSIFs) as defined in the UK biobank]: overall, by type and severity of the final diagnosis, as well as the number of IFs. Results: 78/1,867 participants had at least one IF [4.2%, 95% Confidence Interval (CI) 3.4-5.2%]. IFs requiring medical referral (n = 38) were observed in 36/1,867 participants (1.9%, 1.4-2.7%), and represented 47.5% of the 80 IFs initially flagged. Referred IFs were retrospectively classified as PSIFs in 25/1,867 participants (1.3%, 0.9-2.0%), accounting for 68.4% of anomalies referred (26/38). The most common final diagnosis was cysts or ventricular abnormalities in all participants (9/1,867; 0.5%, 0.2-0.9%) and in those with referred IFs (9/36; 25.0%, 13.6-41.3%), while it was multiple sclerosis or radiologically isolated syndrome in participants with PSIFs (5/19; 26.3%, 11.5-49.1%) who represented 0.1% (0.0-0.4%) and 0.2% (0.03-0.5%) of all participants, respectively. Final diagnoses were considered serious in 11/1,867 participants (0.6%, 0.3-1.1%). Among participants with referred IFs, 13.9% (5/36) required active intervention, while 50.0% (18/36) were put on clinical surveillance. Conclusions: In a large brain imaging study of young healthy adults participating in research we observed a non-negligible frequency of IFs. The etiological pattern differed from what has been described in older adults.
Collapse
Affiliation(s)
- Aïcha Soumaré
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Naka Beguedou
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Alexandre Laurent
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Bruno Brochet
- Department of Neurology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Constance Bordes
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Sandy Mournet
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Emmanuel Mellet
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Edwige Pereira
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Clothilde Pollet
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Morgane Lachaize
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Marie Mougin
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Ami Tsuchida
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Hugues Loiseau
- Department of Neurosurgery, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Thomas Tourdias
- Department of Diagnostic and Therapeutic Radiology and Neuroimaging, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
- Magendie Neurocenter INSERM-U1215, University of Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
- Department of Medical Information, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Bernard Mazoyer
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
- Department of Diagnostic and Therapeutic Radiology and Neuroimaging, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Stéphanie Debette
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
- Department of Neurology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| |
Collapse
|
5
|
Clark DB, Fisher CB, Bookheimer S, Brown SA, Evans JH, Hopfer C, Hudziak J, Montoya I, Murray M, Pfefferbaum A, Yurgelun-Todd D. Biomedical ethics and clinical oversight in multisite observational neuroimaging studies with children and adolescents: The ABCD experience. Dev Cogn Neurosci 2017; 32:143-154. [PMID: 28716389 PMCID: PMC5745294 DOI: 10.1016/j.dcn.2017.06.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/24/2017] [Accepted: 06/26/2017] [Indexed: 02/01/2023] Open
Abstract
Observational neuroimaging studies with children and adolescents may identify neurological anomalies and other clinically relevant findings. Planning for the management of this information involves ethical considerations that may influence informed consent, confidentiality, and communication with participants about assessment results. Biomedical ethics principles include respect for autonomy, beneficence, non-maleficence, and justice. Each project presents unique challenges. The Adolescent Brain and Cognitive Development study (ABCD) collaborators have systematically developed recommendations with written guidelines for identifying and responding to potential risks that adhere to biomedical ethics principles. To illustrate, we will review the ABCD approach to three areas: (1) hazardous substance use; (2) neurological anomalies; and (3) imminent potential for self-harm or harm to others. Each ABCD site is responsible for implementing procedures consistent with these guidelines in accordance with their Institutional Review Board approved protocols, state regulations, and local resources. To assure that each site has related plans and resources in place, site emergency procedures manuals have been developed, documented and reviewed for adherence to ABCD guidelines. This article will describe the principles and process used to develop these ABCD bioethics and medical oversight guidelines, the concerns and options considered, and the resulting approaches advised to sites.
Collapse
Affiliation(s)
- Duncan B. Clark
- 3811 O’Hara Street, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15215, United States,Corresponding author.
| | - Celia B. Fisher
- 441 East Fordham Road, Dealy Hall, Fordham University, Bronx, NY 10458, United States
| | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA 90095, United States
| | - Sandra A. Brown
- Department of Psychology and Psychiatry, UC San Diego, 9500 Gilman Drive (MC 0043), La Jolla, CA 92093, United States
| | - John H. Evans
- Department of Sociology, UC San Diego, 9500 Gilman Drive (0533), La Jolla, CA 92093, United States
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado, Denver School of Medicine, 12469 E 17th Place (Bldg 400), Mail Stop F478, Aurora CO 80045, United States
| | - James Hudziak
- UHC Campus, St. Joe’s Room 3213, Box 364SJ 3, 1 South Prospect, Burlington, VT 05401, United States
| | - Ivan Montoya
- Office of the DTMC Director, National Institute on Drug Abuse, 6001 Executive Boulevard, Bethesda, MD, United States
| | - Margaret Murray
- Office of the Director, National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, Rockville, MD, United States
| | - Adolf Pfefferbaum
- Neuroscience Program, SRI International, 333 Ravenswood Ave., Menlo Park, CA 94025, United States
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, 501 Chipeta Way, Salt Lake City, UT 84108, United States
| |
Collapse
|
6
|
Takashima K, Takimoto Y, Nakazawa E, Hayashi Y, Tsuchiya A, Fujita M, Akabayashi A. Discovery and informing research participants of incidental findings detected in brain magnetic resonance imaging studies: Review and multi-institutional study. Brain Behav 2017; 7:e00676. [PMID: 28523219 PMCID: PMC5434182 DOI: 10.1002/brb3.676] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/01/2017] [Accepted: 02/10/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Brain imaging studies using magnetic resonance imaging (MRI) sometimes reveal incidental findings (IFs) that might be relevant to some of the health issues in research participants. Although professional communities have discussed how to manage these IFs, there is no global consensus on the concrete handling procedures including how to inform participants of IFs. METHODS First, this study reviewed previous studies for the number of IFs discovered in brain imaging studies using MEDLINE. Second, a multi-institutional study determined the number of IF discoveries and evaluated the method of informing participants at multiple institutions, which participated in a national brain science project in Japan. RESULTS Both the review and multi-institutional study showed that IFs with a high urgency level were discovered in 0-2.0% of participants, including healthy volunteers, and that the rate of IF discovery in general was higher in studies conducted in elderly population. Moreover, multi-institutional study suggested the criteria used to judge whether or not to inform participants of IFs may differ by institution. CONCLUSIONS Our results suggest that in order to ensure informing the participants of high urgency IFs, physicians who are capable of interpreting brain images clinically should review all brain images, and the establishment of a support system is required for brain imaging studies at nonmedical institutions. Since the method of informing participants of IFs might affect their understanding and acceptance of IFs, which are related to managing risks of false "clean bill of health" or psychological impacts of informing IFs, further research focusing on communication of IFs is needed.
Collapse
Affiliation(s)
- Kyoko Takashima
- Department of Public Policy Institute of Medical Science the University of Tokyo Tokyo Japan
| | - Yoshiyuki Takimoto
- Department of Biomedical Ethics Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Eisuke Nakazawa
- Department of Biomedical Ethics Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Yoshinori Hayashi
- Department of Philosophy College of Letters Ritsumeikan University Kyoto Japan
| | - Atsushi Tsuchiya
- Graduate School of Integrated Arts and Sciences Tokushima University Tokushima Japan
| | - Misao Fujita
- Uehiro Research Division for iPS Cell Ethics Center for iPS Cell Research and Application (CiRA) Kyoto University Kyoto Japan
| | - Akira Akabayashi
- Department of Biomedical Ethics Graduate School of Medicine the University of Tokyo Tokyo Japan
| |
Collapse
|
7
|
Hofmann B. Incidental findings of uncertain significance: To know or not to know--that is not the question. BMC Med Ethics 2016; 17:13. [PMID: 26873084 PMCID: PMC4752786 DOI: 10.1186/s12910-016-0096-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although the "right not to know" is well established in international regulations, it has been heavily debated. Ubiquitous results from extended exome and genome analysis have challenged the right not to know. American College of Medical Genetics and Genomics (ACMG) Recommendations urge to inform about incidental findings that pretend to be accurate and actionable. However, ample clinical cases raise the question whether these criteria are met. Many incidental findings are of uncertain significance (IFUS). The eager to feedback information appears to enter the field of IFUS and thereby threaten the right not to know. This makes it imperative to investigate the arguments for and against a right not to know for IFUS. DISCUSSION This article investigates how the various arguments for and against a right not to know hold for IFUS. The main investigated arguments are: hypothetical utilitarianism, the right-based argument, the feasibility argument, the value of knowledge argument, the argument from lost significance, the empirical argument, the duty to disclose argument, the avoiding harm argument; the argument from principle, from autonomy, from privacy, as well as the argument from the right to an open future. The analysis shows that both sides in the debate have exaggerated the importance of incidental findings. Opponents of a right not to know have exaggerated the importance of IFUS, while proponents have exaggerated the need to be protected from something that is not knowledge. Hence, to know or not to know is not the question. The question is whether we should be able to stay ignorant of incidental findings of uncertain significance, if we want to. The answer is yes: As long as the information is not accurate and/or actionable: ignorance is bliss. When answering questions that are not asked, we need to think twice.
Collapse
Affiliation(s)
- Bjørn Hofmann
- Norwegian University of Science and Technology, Gjøvik, Norway. .,Centre for Medical Ethics, University of Oslo, PO Box 1130, Blindern, N-0318, Oslo, Norway.
| |
Collapse
|
8
|
van den Veyver IB, Eng CM. Genome-Wide Sequencing for Prenatal Detection of Fetal Single-Gene Disorders. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a023077. [PMID: 26253094 DOI: 10.1101/cshperspect.a023077] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
New sequencing methods capable of rapidly analyzing the genome at increasing resolution have transformed diagnosis of single-gene or oligogenic genetic disorders in pediatric and adult medicine. Targeted tests, consisting of disease-focused multigene panels and diagnostic exome sequencing to interrogate the sequence of the coding regions of nearly all genes, are now clinically offered when there is suspicion for an undiagnosed genetic disorder or cancer in children and adults. Implementation of diagnostic exome and genome sequencing tests on invasively and noninvasively obtained fetal DNA samples for prenatal genetic diagnosis is also being explored. We predict that they will become more widely integrated into prenatal care in the near future. Providers must prepare for the practical, ethical, and societal dilemmas that accompany the capacity to generate and analyze large amounts of genetic information about the fetus during pregnancy.
Collapse
Affiliation(s)
- Ignatia B van den Veyver
- Department of Obstetrics and Gynecology, Baylor College of Medicine, The Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, Texas 77030 Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030
| | - Christine M Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030
| |
Collapse
|
9
|
Bjugn R. Research findings with clinical implications. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:755-8. [PMID: 25947596 DOI: 10.4045/tidsskr.14.0861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Medical and health research may yield findings that are of direct clinical significance for project participants. The Council of Europe has stated that information on such findings shall be offered to participants, and that applications to research ethics committees shall include plans for managing such findings. The purpose of the study was to investigate how the management of such findings had been described in research projects that had been granted prior approval by a regional committee for medical and health research ethics (REK). MATERIAL AND METHOD Research projects that were associated with Oslo University Hospital and had a start-up date in 2011 were identified in the database of the regional ethics committee. Copies of the application form submitted to the committee, project protocols, participant information/consent forms and letters of approval were reviewed with regard to information on the management of findings with possible clinical implications. RESULTS Of the 87 projects found in the database, 70 were included in the study. Of these, 57 studies involved direct interaction with humans, whereof 45 with intended use of biological material. In 21 studies, the management of findings with possible clinical implications was described in one or more documents. In all of these projects, the applicant him-/herself had referred to this topic in the initial application. INTERPRETATION The absence of written information on the management of research findings with possible clinical implications is not in conformity with the recommendations issued by the Council of Europe. By introducing a separate item for this in the form to be submitted to the regional ethics committee for application of prior approval, this issue could be made subject to better assessment.
Collapse
Affiliation(s)
- Roger Bjugn
- Avdeling for forskningsadministrasjon og biobank Oslo universitetssykehus * Nåværende adresse: Avdeling for patologi Oslo universitetssykehus
| |
Collapse
|
10
|
ANDERSON JAMESA, EIJKHOLT MARLEEN, ILLES JUDY. Neuroethical issues in clinical neuroscience research. HANDBOOK OF CLINICAL NEUROLOGY 2013; 118:335-43. [PMID: 24182390 PMCID: PMC10460147 DOI: 10.1016/b978-0-444-53501-6.00028-7] [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] [Indexed: 08/08/2023]
Abstract
In this chapter, we use the special features of neuroimaging to illustrate research ethics issues for the clinical neurologic sciences, and focus on one particularly compelling case: studies involving first-episode schizophrenic treatment-naïve individuals (FESTNIs) (Eijkholt et al., 2012). FESTNIs are scanned prior to the administration of medication in order to control for the confounding effects of treatment. By concentrating on this program of research, we capture the distinctive ethical challenges associated with neuroimaging research overall, and foreground the issues particular to neuroimaging research involving FESTNIs that have yet to receive sufficient attention in the literature. We highlight assessment of risks and burdens, including risks associated with treatment delays and incidental findings; assessment of benefit, including direct benefit, social value, and scientific quality; subject selection; justice questions related to responsiveness and poststudy access; and, finally, issues related to consent and capacity.
Collapse
Affiliation(s)
| | - MARLEEN EIJKHOLT
- National Core for Neuroethics, Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - JUDY ILLES
- National Core for Neuroethics, Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|