1
|
Bühler N, Frahsa A, Jaramillo NG, Bourqui RM, Nusslé SG, Zuppinger C, Bochud M, von Goetz N. Willingness to participate in a personalized health cohort - insights from the swiss health study pilot phase. BMC Public Health 2024; 24:2140. [PMID: 39112992 PMCID: PMC11305038 DOI: 10.1186/s12889-024-19650-z] [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: 02/08/2024] [Accepted: 07/30/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND This paper explores the feasibility of establishing a large-scale population-based cohort and biobank in Switzerland by assessing potential participants' needs, expectations, and concerns about such an infrastructure providing information on health, lifestyle, and exposure trajectories, the development of disease, and risk factors over time. METHODS We utilized a scenario-based questionnaire in the Swiss Health Study pilot phase (2020-2021), involving 1349 adults aged 20-69 from the cantons Vaud and Bern. We conducted descriptive statistics supported by R and qualitative content analysis of n = 374 open responses related to attitudes towards research. RESULTS We highlight the benefits and challenges of the scenario-based approach, discuss the sample represented in the pilot phase, and present implications for building a full cohort. We also report on participants' attitudes towards and previous experience with health research. We analyze references regarding informed consent and feedback, attitudes towards the Swiss Health Study, and recommendations on improving its scope, design, and instruments. Results indicate a high interest (90%) in participating in a national health study, with 85% of a random population sample willing to join a long-term cohort. Only 43% were familiar with biobanks, and 44% preferred general consent. Trust was high for Swiss-based public research but lower for researchers from other countries or private sector. Over 95% expressed willingness to complete online questionnaires, undergo physical examination, and donate biosamples. Almost all participants wanted to know the outcomes of the medical tests (99.5%) and the exposure to environmental stressors (95%) from their study center visit. Preferred tools for monitoring sleep, physical activity, and diet were known smartphone apps with automatic data management. CONCLUSION Overall, the study reveals a positive attitude towards personalized health research, with a strong willingness to share data and samples. Key insights focus the meaning of informed consent for participation, the relevance of sampling and representativeness, as well as the significance and challenges of personalized feedback, especially regarding environmental health concerns. Findings emphasize participants' supportive yet reflexive stances, underscoring the importance of aligning research values with individual values in personalized health research. These insights contribute valuable considerations for refining the scope, design, and instruments of future cohort studies.
Collapse
Affiliation(s)
- Nolwenn Bühler
- Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland.
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | | | | | - Semira Gonseth Nusslé
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Claire Zuppinger
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Murielle Bochud
- Center for Primary Care and Public Health, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Natalie von Goetz
- Federal Office of Public Health, Schwarzenburgstr. 157, Bern, 3003, Switzerland
| |
Collapse
|
2
|
Lee SSJ, Walker A, Callier SL, Fletcher FE, Galarneau C, Garrison N, James JE, McLeod-Sordjan R, Ogbogu U, Sederstrom N, Smith PT, Braddock CH, Mitchell C. Racial Equity, Diversity and Inclusion in Bioethics: Recommendations from the Association of Bioethics Program Directors Presidential Task Force. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-12. [PMID: 39102590 DOI: 10.1080/15265161.2024.2371116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Recent calls to address racism in bioethics reflect a sense of urgency to mitigate the lethal effects of a lack of action. While the field was catalyzed largely in response to pivotal events deeply rooted in racism and other structures of oppression embedded in research and health care, it has failed to center racial justice in its scholarship, pedagogy, advocacy, and practice, and neglected to integrate anti-racism as a central consideration. Academic bioethics programs play a key role in determining the field's norms and practices, including methodologies, funding priorities, and professional networks that bear on equity, inclusion, and epistemic justice. This article describes recommendations from the Racial Equity, Diversity, and Inclusion (REDI) Task Force commissioned by the Association of Bioethics Program Directors to prioritize and strengthen anti-racist practices in bioethics programmatic endeavors and to evaluate and develop specific goals to advance REDI.
Collapse
Affiliation(s)
| | | | - Shawneequa L Callier
- The George Washington University and Center for Research on Genomics and Global Health, National Human Genome Research Institute, NIH
| | | | | | | | - Jennifer E James
- Institute for Health and Aging, University of California, San Francisco
| | | | | | | | | | | | | |
Collapse
|
3
|
McMahon CE, Foti N, Jeske M, Britton WR, Fullerton SM, Shim JK, Lee SSJ. Interrogating the Value of Return of Results for Diverse Populations: Perspectives from Precision Medicine Researchers. AJOB Empir Bioeth 2024; 15:108-119. [PMID: 37962912 PMCID: PMC11090989 DOI: 10.1080/23294515.2023.2279965] [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: 11/15/2023]
Abstract
BACKGROUND Over the last decade, the return of results (ROR) in precision medicine research (PMR) has become increasingly routine. Calls for individual rights to research results have extended the "duty to report" from clinically useful genetic information to traits and ancestry results. ROR has thus been reframed as inherently beneficial to research participants, without a needed focus on who benefits and how. This paper addresses this gap, particularly in the context of PMR aimed at increasing participant diversity, by providing investigator and researcher perspectives on and questions about the assumed value of ROR in PMR. METHODS Semi-structured interviews with a purposive sample of investigators and researchers across federally funded PMR studies in three national consortia, as well as observations of study activities, focused on how PM researchers conceptualize diversity and implement inclusive practices across research stages, including navigating ROR. RESULTS Interviewees (1) validated the value of ROR as a benefit of PMR, while others (2) questioned the benefit of clinically actionable results to individuals in the absence of sufficient resources for translating findings into health care for diverse and disadvantaged populations; (3) expressed uncertainties in applying the presumed value of ROR as a benefit for non-clinical results; and (4) and debated when the promise of the value of ROR may undermine trust in PMR, and divert efforts to return value beyond ROR. CONCLUSIONS Conceptualizations of diversity and inclusion among PM researchers and investigators raise unique ethical questions where unexamined assumptions of the value of ROR inform study recruitment efforts to enroll minoritized and under-represented populations. A lack of consideration for resources and infrastructure necessary to translate ROR into actionable information may hinder trustworthy community-research relationships. Thus, we argue for a more intentional interrogation of ROR practices as an offer of benefit and for whom.
Collapse
Affiliation(s)
- Caitlin E. McMahon
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, United States of America
| | - Nicole Foti
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, United States of America
| | - Melanie Jeske
- Institute on the Formation of Knowledge, University of Chicago, Chicago, Illinois, United States of America
| | - William R. Britton
- Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, United States of America
| | - Stephanie M. Fullerton
- Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Janet K. Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, United States of America
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY, United States of America
| |
Collapse
|
4
|
Bühler N, Frahsa A, Morand Bourqui R, Von Götz N, Bochud M, Panese F. Between data providers and concerned citizens: Exploring participation in precision public health in Switzerland. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2024; 33:105-120. [PMID: 37458286 PMCID: PMC10756011 DOI: 10.1177/09636625231183265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
This empirical article explores the dynamics of exchange and reciprocity between cohorters, that is, study organizers, and cohortees, that is, study participants. Drawing on literature on bioeconomy and valuation, we analyze cohortees' expectations in return for the "clinical labor" they perform in the pilot phase of a Swiss precision public health study. Based on an ethnography of this cohort and data from seven focus groups with cohortees (n = 37), we identified four positions: (1) the good citizen participant, (2) the critical participant, (3) the concerned participant, and (4) the self-oriented participant. These reveal that cohortees' participation, still framed in altruistic terms, nevertheless engages expectations about reciprocal obligations of the state and science in terms of public health, confirming the deep entanglement of gift-based, financial, and moral economies of participation. The different values emerging from these expectations-robust scientific evidence about environmental exposure and a socially oriented public health-provide rich indications about stake making which might matter for the future of precision public health.
Collapse
Affiliation(s)
| | | | | | | | - Murielle Bochud
- Unisanté, University Center for Primary Care and Public Health, Switzerland
| | | |
Collapse
|
5
|
Knox JBL, Svendsen MN. The fertility of moral ambiguity in precision medicine. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:465-476. [PMID: 37280471 PMCID: PMC10243698 DOI: 10.1007/s11019-023-10160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
Although precision medicine cuts across a large spectrum of professions, interdisciplinary and cross-sectorial moral deliberation has yet to be widely enacted, let alone formalized in this field. In a recent research project on precision medicine, we designed a dialogical forum (i.e. 'the Ethics Laboratory') giving interdisciplinary and cross-sectorial stakeholders an opportunity to discuss their moral conundrums in concert. We organized and carried out four Ethics Laboratories. In this article, we use Simone de Beauvoir's concept of moral ambiguity as a lens to frame the participants' experience with fluid moral boundaries. By framing our approach through this concept we are able to elucidate irremediable moral issues that are collectively underexplored in the practice of precision medicine. Moral ambiguity accentuates an open and free space where different types of perspectives converge and can inform each other. Based on our study, we identified two dilemmas, or thematic interfaces, in the interdisciplinary moral deliberations which unfolded in the Ethics Laboratories: (1) the dilemma between the individual and the collective good; and (2) the dilemma between care and choice. Through our investigation of these dilemmas, we show how Beauvoir's concept of moral ambiquity not only serves as a fertile catalyst for greater moral awareness but, furthermore, how the concept can become an indispensable part of the practices of and the discourse about precision medicine.
Collapse
Affiliation(s)
- Jeanette Bresson Ladegaard Knox
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building, 1014 Copenhagen, Denmark
- University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mette Nordahl Svendsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building, 1014 Copenhagen, Denmark
| |
Collapse
|
6
|
Green S, Prainsack B, Sabatello M. Precision medicine and the problem of structural injustice. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:433-450. [PMID: 37231234 PMCID: PMC10212228 DOI: 10.1007/s11019-023-10158-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the perspective needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on-and simultaneously affects-access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects.
Collapse
Affiliation(s)
- Sara Green
- Section for History and Philosophy of Science, Department of Science Education, University of Copenhagen, Niels Bohr Building (NBB), Universitetsparken 5, 2100 Copenhagen Ø, Denmark
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copengagen, Denmark
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Universitätsstraße 7, 1010 Vienna, Austria
- School of Social and Political Sciences, Faculty of Arts and Social Sciences, University of Sydney, Camperdown, NSW 2006 Australia
| | - Maya Sabatello
- Center for Precision Medicine and Genomics, Department of Medicine, Columbia University, New York, USA
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, USA
| |
Collapse
|
7
|
Halley MC, Olson NW. Blurred Boundaries: Toward an Expanded Ethics of Research and Clinical Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:5-9. [PMID: 38410998 DOI: 10.1080/15265161.2023.2224148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
|
8
|
Vasquez EE, Foti N, McMahon CE, Jeske M, Bentz M, Fullerton S, Shim JK, Lee SSJ. Rethinking Benefit and Responsibility in the Context of Diversity: Perspectives from the Front Lines of Precision Medicine Research. Public Health Genomics 2023; 26:103-112. [PMID: 37442104 PMCID: PMC10614449 DOI: 10.1159/000531656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Federal agencies have instituted guidelines to prioritize the enrollment and retention of diverse participants in precision medicine research (PMR). Prior studies examining participation of minoritized communities have shown that potential benefits represent a key determinant. Human subject research guidance, however, conceptualizes potential benefits narrowly, emphasizing generalized advances in medical knowledge. Further, few studies have provided qualitative data that critically examine how the concept of "benefit" is interpreted or challenged in the context of research practice. This paper examines the experiences of PMR investigators and frontline research staff to understand how standard approaches to benefit are received, contested, and negotiated "on the ground." METHODS Findings are drawn from a qualitative project conducted across five US-based, federally funded PMR studies. Data collection included 125 in-depth interviews with a purposive sample of investigators, research staff, community advisory board members, and NIH program officers associated with these PMR studies. RESULTS Researchers report that the standard approach to benefit - which relies on the premise of altruism and the promise of incrementally advancing scientific knowledge - is frequently contested. Researchers experience moral distress over the unmet clinical, psychosocial, and material needs within the communities they are engaging. Many believe the broader research enterprise has a responsibility to better address these needs. CONCLUSION Researchers frequently take issue with and sometimes negotiate what is owed to participants and to their communities in exchange for the data they provide. These experiences of moral distress and these improvisations warrant systematic redress, not by individual researchers but by the broader research ethics infrastructure.
Collapse
Affiliation(s)
- Emily E Vasquez
- Department of Sociology, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Nicole Foti
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Caitlin E McMahon
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Melanie Jeske
- Institute on the Formation of Knowledge, University of Chicago, Chicago, Illinois, USA
| | - Michael Bentz
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | - Stephanie Fullerton
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Janet K Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| |
Collapse
|
9
|
Dolan DD, Cho MK, Lee SSJ. Innovating for a Just and Equitable Future in Genomic and Precision Medicine Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:1-4. [PMID: 37353052 PMCID: PMC10339710 DOI: 10.1080/15265161.2023.2215201] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Affiliation(s)
- Deanne Dunbar Dolan
- Center for ELSI Resources and Analysis (CERA), Stanford University School of Medicine, Stanford, CA, USA
| | - Mildred K. Cho
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities & Ethics, Columbia University, New York, NY, USA
| |
Collapse
|
10
|
Kraft SA, Rohrig A, Williams A, Shah SK. Better recognition for research participants: what society should learn from covid-19. BMJ 2023; 380:e071178. [PMID: 36649969 PMCID: PMC11200266 DOI: 10.1136/bmj-2022-071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Bioethics and Palliative Care, University of Washington School of Medicine, Seattle, Washington, USA
| | - Abie Rohrig
- Department of Philosophy, Swarthmore College, Swarthmore, Pennsylvania, USA
- Research Ethics Team, 1Day Sooner, Delaware, USA
| | - Anthony Williams
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA States
| | - Seema K Shah
- Lurie Children's Hospital, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
11
|
Skovgaard L, Grundtvig A. Who tweets what about personalised medicine? Promises and concerns from Twitter discussions in Denmark. Digit Health 2023; 9:20552076231169832. [PMID: 37113257 PMCID: PMC10126701 DOI: 10.1177/20552076231169832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/29/2023] [Indexed: 04/29/2023] Open
Abstract
Digital health data are seen as valuable resources for the development of better and more efficient treatments, for instance through personalised medicine. However, health data are information about individuals who hold opinions and can challenge how data about them are used. Therefore it is important to understand public discussions around reuse of digital health data. Social media have been heralded as enabling new forms of public engagement and as a place to study social issues. In this paper, we study a public debate on Twitter about personalised medicine. We explore who participates in discussions about personalised medicine on Twitter and what they tweet about. Based on user-generated biographies we categorise users as having a 'Professional interest in personalised medicine' or as 'Private' users. We describe how users within the field tweet about the promises of personalised medicine, while users unaffiliated with the field tweet about the concrete realisation of these ambitions in the form of a new infrastructure and express concerns about the conditions for the implementation. Our study serves to remind people interested in public opinion that Twitter is a platform used for multiple purposes by different actors and not simply a bottom-up democratic forum. This study contributes with insights relevant to policymakers wishing to expand infrastructures for reuse of health data. First, by providing insights into what is discussed about health data reuse. Second, by exploring how Twitter can be used as a platform to study public discussions about reuse of health data.
Collapse
Affiliation(s)
- Lea Skovgaard
- Department of Public Health, University of
Copenhagen, Copenhagen K, Denmark
- Lea Skovgaard, Department of Public Health,
University of Copenhagen, Øster Farigmagsgade 5, Copenhagen K 1014, Denmark.
| | - Anders Grundtvig
- Department of Public Health, University of
Copenhagen, Copenhagen K, Denmark
| |
Collapse
|
12
|
Tang A, Woldemariam S, Roger J, Sirota M. Translational Bioinformatics to Enable Precision Medicine for All: Elevating Equity across Molecular, Clinical, and Digital Realms. Yearb Med Inform 2022; 31:106-115. [PMID: 36463867 PMCID: PMC9719766 DOI: 10.1055/s-0042-1742513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVES Over the past few years, challenges from the pandemic have led to an explosion of data sharing and algorithmic development efforts in the areas of molecular measurements, clinical data, and digital health. We aim to characterize and describe recent advanced computational approaches in translational bioinformatics across these domains in the context of issues or progress related to equity and inclusion. METHODS We conducted a literature assessment of the trends and approaches in translational bioinformatics in the past few years. RESULTS We present a review of recent computational approaches across molecular, clinical, and digital realms. We discuss applications of phenotyping, disease subtype characterization, predictive modeling, biomarker discovery, and treatment selection. We consider these methods and applications through the lens of equity and inclusion in biomedicine. CONCLUSION Equity and inclusion should be incorporated at every step of translational bioinformatics projects, including project design, data collection, model creation, and clinical implementation. These considerations, coupled with the exciting breakthroughs in big data and machine learning, are pivotal to reach the goals of precision medicine for all.
Collapse
Affiliation(s)
- Alice Tang
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Graduate Program in Bioengineering, UCSF, San Francisco, CA, USA
- School of Medicine, UCSF, San Francisco, CA, USA
| | - Sarah Woldemariam
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- School of Medicine, UCSF, San Francisco, CA, USA
| | - Jacquelyn Roger
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Graduate Program in Biological and Medical Informatics, UCSF, San Francisco, CA, USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
- Department of Pediatrics, UCSF, San Francisco, CA, USA
| |
Collapse
|
13
|
Spector-Bagdady K, Kent M, Krenz CD, Brummel C, Swiecicki PL, Brenner JC, Shuman AG. Patient and Provider Perspectives on Enrollment in Precision Oncology Research: Qualitative Ethical Analysis. JMIR Cancer 2022; 8:e35033. [PMID: 35503525 PMCID: PMC9115650 DOI: 10.2196/35033] [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: 11/23/2021] [Revised: 03/14/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The genomic frontier continues to revolutionize the practice of oncology. Advances in cancer biology from tumorigenesis to treatment resistance are driven by the molecular underpinnings of malignancy. The framing of precision oncology as both a clinical and research tool is constantly evolving and directly influences conversations between oncologists and their patients. Prior research has shown that patient-participants often have unmet or unrealistic expectations regarding the clinical utility of oncology research and genomic sequencing. This indicates the need for more in-depth investigation of how and why patients choose to participate in such research. Objective This study presents a qualitative ethical analysis to better understand patient and provider perspectives on enrollment in precision oncology research. Methods Paired semistructured interviews were conducted with patient-participants enrolled in a prospective head and neck precision oncology research platform, along with their oncology providers, at a National Cancer Institute–designated academic cancer center. Results There were three major themes that emerged from the analysis. (1) There are distinct and unique challenges with informed consent to precision medicine, chiefly involving the ability of both patient-participants and providers to effectively understand the science underlying the research. (2) The unique benefits of precision medicine enrollment are of paramount importance to patients considering enrollment. (3) Patient-participants have little concern for the risks of research enrollment, particularly in the context of a low-burden protocol. Conclusions Patient-participants and their providers offer complementary and nuanced perspectives on their motivation to engage in precision oncology research. This reflects both the inherent promise and enthusiasm within the field, as well as the limitations and challenges of ensuring that both patient-participants and clinicians understand the complexities of the science involved.
Collapse
Affiliation(s)
- Kayte Spector-Bagdady
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.,Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Madison Kent
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.,Michigan Otolaryngology and Translational Oncology Laboratory, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Chris D Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Collin Brummel
- Michigan Otolaryngology and Translational Oncology Laboratory, University of Michigan Medical School, Ann Arbor, MI, United States.,Division of Hematology-Oncology, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Paul L Swiecicki
- Michigan Otolaryngology and Translational Oncology Laboratory, University of Michigan Medical School, Ann Arbor, MI, United States.,Division of Hematology-Oncology, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - J Chad Brenner
- Michigan Otolaryngology and Translational Oncology Laboratory, University of Michigan Medical School, Ann Arbor, MI, United States.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Andrew G Shuman
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.,Michigan Otolaryngology and Translational Oncology Laboratory, University of Michigan Medical School, Ann Arbor, MI, United States.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| |
Collapse
|
14
|
Return of genomic results does not motivate intent to participate in research for all: Perspectives across 22 countries. Genet Med 2022; 24:1120-1129. [PMID: 35125311 DOI: 10.1016/j.gim.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this study was to determine how attitudes toward the return of genomic research results vary internationally. METHODS We analyzed the "Your DNA, Your Say" online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle-, and high-income countries, and these were gathered in 15 languages. We analyzed how participants responded when asked whether return of results (RoR) would motivate their decision to donate DNA or health data. We examined variation across the study countries and compared the responses of participants from other countries with those from the United States, which has been the subject of the majority of research on return of genomic results to date. RESULTS There was substantial variation in the extent to which respondents reported being influenced by RoR. However, only respondents from Russia were more influenced than those from the United States, and respondents from 20 countries had lower odds of being partially or wholly influenced than those from the United States. CONCLUSION There is substantial international variation in the extent to which the RoR may motivate people's intent to donate DNA or health data. The United States may not be a clear indicator of global attitudes. Participants' preferences for return of genomic results globally should be considered.
Collapse
|
15
|
Erdmann A, Rehmann-Sutter C, Bozzaro C. Clinicians’ and Researchers’ Views on Precision Medicine in Chronic Inflammation: Practices, Benefits and Challenges. J Pers Med 2022; 12:jpm12040574. [PMID: 35455690 PMCID: PMC9031131 DOI: 10.3390/jpm12040574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Due to the high burden of diseases with chronic inflammation as an underlying condition, great expectations are placed in the development of precision medicine (PM). Our research explores the benefits and possible risks of this development from the perspective of clinicians and researchers in the field. We have asked these professionals about the current state of their research and their expectations, concerns, values and attitudes regarding PM. (2) Methods: Following a grounded theory approach, we conducted qualitative interviews with 17 clinicians and researchers. For respondent validation, we discussed the findings with the participants in a validation workshop. (3) Results: Professionals expect multiple benefits from PM in chronic inflammation. They provided their concepts of professionals’ and patients’ work in the development of PM in chronic inflammatory diseases. Ethical, process-related and economic challenges were raised regarding the lack of integration of data from minority groups, the risk of data misuse and discrimination, the potential risk of no therapy being available for small strata, the lack of professional support and political measures in developing a healthy lifestyle, the problem of difficult access to the inflammation clinic for some populations and the difficulty of financing PM for all. (4) Conclusions: In the further research, development and implementation of PM, these ethical challenges need to be adequately addressed.
Collapse
Affiliation(s)
- Anke Erdmann
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University, 24105 Kiel, Germany;
- Correspondence: ; Tel.: +49-431-500-30332
| | - Christoph Rehmann-Sutter
- Institute for History of Medicine and Science Studies, University of Lübeck, 23552 Lübeck, Germany;
| | - Claudia Bozzaro
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University, 24105 Kiel, Germany;
| |
Collapse
|
16
|
Silva CP, de la Fuente Castro C, González Zarzar T, Raghavan M, Tonko-Huenucoy A, Martínez FI, Montalva N. The Articulation of Genomics, Mestizaje, and Indigenous Identities in Chile: A Case Study of the Social Implications of Genomic Research in Light of Current Research Practices. Front Genet 2022; 13:817318. [PMID: 35309125 PMCID: PMC8927767 DOI: 10.3389/fgene.2022.817318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Constanza P. Silva
- Criminal Justice Research Center, The Pennsylvania State University, University Park, PA, United States
- Comunidad Autónoma Diaguita Mapochogasta, Santiago, Chile
- *Correspondence: Constanza P. Silva, ; Constanza de la Fuente Castro, ; Tomás González Zarzar,
| | - Constanza de la Fuente Castro
- Department of Human Genetics, University of Chicago, Chicago, IL, United States
- *Correspondence: Constanza P. Silva, ; Constanza de la Fuente Castro, ; Tomás González Zarzar,
| | - Tomás González Zarzar
- Department of Veterinary and Biomedical Sciences, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, United States
- The Huck Institutes of the Life Science, The Pennsylvania State University, University Park, PA, United States
- *Correspondence: Constanza P. Silva, ; Constanza de la Fuente Castro, ; Tomás González Zarzar,
| | - Maanasa Raghavan
- Department of Human Genetics, University of Chicago, Chicago, IL, United States
| | | | - Felipe I. Martínez
- School of Anthropology, Faculty of Social Sciences, Pontificia Universidad Católica, Santiago, Chile
- Center for Intercultural and Indigenous Research (CIIR), Santiago, Chile
| | - Nicolás Montalva
- Society and Health Research Center, Universidad Mayor, Santiago, Chile
- School of Public Health, Universidad Mayor, Santiago, Chile
| |
Collapse
|
17
|
Erdmann A, Rehmann-Sutter C, Bozzaro C. Patients' and professionals' views related to ethical issues in precision medicine: a mixed research synthesis. BMC Med Ethics 2021; 22:116. [PMID: 34465328 PMCID: PMC8406914 DOI: 10.1186/s12910-021-00682-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Precision medicine development is driven by the possibilities of next generation sequencing, information technology and artificial intelligence and thus, raises a number of ethical questions. Empirical studies have investigated such issues from the perspectives of health care professionals, researchers and patients. We synthesize the results from these studies in this review. METHODS We used a systematic strategy to search, screen and assess the literature for eligibility related to our research question. The initial search for empirical studies in five data bases provided 665 different records and we selected 92 of these publications for inclusion in this review. Data were extracted in a spreadsheet and categorized into different topics representing the views on ethical issues in precision medicine. RESULTS Many patients and professionals expect high benefits from precision medicine and have a positive attitude towards it. However, patients and professionals also perceive some risks. Commonly perceived risks include: lack of evidence for accuracy of tests and efficacy of treatments; limited knowledge of patients, which makes informed consent more difficult; possible unavailability of access to precision medicine for underprivileged people and ethnic minorities; misuse of data by insurance companies and employers, potential of racial stigmatization due to genetic information; unwanted communication of incidental findings; changes in doctor-patient-relationship through focusing on data; and the problem that patients could feel under pressure to optimize their health. CONCLUSIONS National legislation and guidelines already minimize many risks associated with precision medicine. However, from our perspective some problems require more attention. Should hopes for precision medicine's benefits be fulfilled, then the ethical principle of justice would require an unlimited access to precision medicine for all people. The potential for autonomous patients' decisions must be greatly enhanced by improvements in patient education. Harm from test results must be avoided in any case by the highest possible data security level and communication guidelines. Changes in the doctor-patient relationship and the impact of precision medicine on the quality of life should be further investigated. Additionally, the cost-effectiveness of precision medicine should be further examined, in order to avoid malinvestment.
Collapse
Affiliation(s)
- Anke Erdmann
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University (CAU), Kiel, Germany.
| | | | - Claudia Bozzaro
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University (CAU), Kiel, Germany
| |
Collapse
|
18
|
Abstract
The collection and use of human genetic data raise important ethical questions about how to balance individual autonomy and privacy with the potential for public good. The proliferation of local, national, and international efforts to collect genetic data and create linkages to support large-scale initiatives in precision medicine and the learning health system creates new demands for broad data sharing that involve managing competing interests and careful consideration of what constitutes appropriate ethical trade-offs. This review describes these emerging ethical issues with a focus on approaches to consent and issues related to justice in the shifting genomic research ecosystem.
Collapse
Affiliation(s)
- Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY 10032, USA;
| |
Collapse
|
19
|
Ochieng CA, Minion JT, Turner A, Blell M, Murtagh MJ. What does engagement mean to participants in longitudinal cohort studies? A qualitative study. BMC Med Ethics 2021; 22:77. [PMID: 34167521 PMCID: PMC8223352 DOI: 10.1186/s12910-021-00648-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Engagement is important within cohort studies for a number of reasons. It is argued that engaging participants within the studies they are involved in may promote their recruitment and retention within the studies. Participant input can also improve study designs, make them more acceptable for uptake by participants and aid in contextualising research communication to participants. Ultimately it is also argued that engagement needs to provide an avenue for participants to feedback to the cohort study and that this is an ethical imperative. This study sought to explore the participants' experiences and thoughts of their engagement with their birth cohort study. METHODS Participants were recruited from the Children of the 90s (CO90s) study. Qualitative semi-structured interviews were conducted with 42 participants. The interviews were transcribed verbatim, and uploaded onto Nvivo software. They were then analysed via thematic analysis with a constant comparison technique. RESULTS Participants' experiences of their engagement with CO90s were broadly based on three aspects: communication they received from CO90s, experiences of ethical conduct from CO90s and receiving rewards from CO90s. The communication received from CO90s, ranged from newsletters explaining study findings and future studies, to more personal forms like annual greeting cards posted to each participant. Ethical conduct from CO90s mainly involved participants understanding that CO90s would keep their information confidential, that it was only involved in 'good' ethical research and their expectation that CO90s would always prioritise participant welfare. Some of the gifts participants said they received at CO90s included toys, shopping vouchers, results from clinical tests, and time off from school to attend data collection (Focus) days. Participants also described a temporality in their engagement with CO90s and the subsequent trust they had developed for the cohort study. CONCLUSION The experiences of engagement described by participants were theorized as being based on reciprocity which was sometimes overt and other times more nuanced. We further provide empirical evidence of participants' expectation for a reciprocal interaction with their cohort study while highlighting the trust that such an interaction fosters. Our study therefore provides key insights for other cohort studies on what participants value in their interactions with their cohort studies.
Collapse
Affiliation(s)
- Cynthia A. Ochieng
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Joel T. Minion
- Qualitative Research Lead, Health Technology Assessment Unit, Department of Community Health Sciences, O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6 Canada
| | - Andrew Turner
- Population Health Sciences, University of Bristol, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
| | - Mwenza Blell
- School of Geography, Politics and Sociology, Newcastle University, 18-20 Windsor Terrace, Newcastle upon Tyne, NE2 4HE UK
| | - Madeleine J. Murtagh
- School of Social and Political Sciences, University of Glasgow, Adam Smith Building, Bute Gardens, Glasgow, G12 8RT UK
| |
Collapse
|
20
|
|
21
|
Barazzetti G, Bosisio F. A Value-Oriented Framework for Precision Medicine. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:88-90. [PMID: 33825639 DOI: 10.1080/15265161.2021.1891338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
22
|
Desmond H. Precision Medicine, Data, and the Anthropology of Social Status. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:80-83. [PMID: 33825631 DOI: 10.1080/15265161.2021.1891345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Hugh Desmond
- IHPST, CNRS/Université Paris I-Sorbonne
- University of Antwerp
| |
Collapse
|
23
|
Blumling AA, Childers-Buschle KE, Lynch JA, Myers MF, McGowan ML. The Underdeveloped "Gift": Ethics in Implementing Precision Medicine Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:67-69. [PMID: 33825648 PMCID: PMC8170672 DOI: 10.1080/15265161.2021.1891352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
| | | | | | - Melanie F. Myers
- Cincinnati Children’s Hospital Medical Center
- University of Cincinnati
| | | |
Collapse
|
24
|
Lanphier E. Aporia of the Gift: Precision Medicine's Obligations Without Expectations. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:83-85. [PMID: 33825633 DOI: 10.1080/15265161.2021.1891344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Elizabeth Lanphier
- Cincinnati Children's Hospital Medical Center
- University of Cincinnati College of Medicine
| |
Collapse
|
25
|
Tsosie KS, Yracheta JM, Kolopenuk JA, Geary J. We Have "Gifted" Enough: Indigenous Genomic Data Sovereignty in Precision Medicine. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:72-75. [PMID: 33825628 DOI: 10.1080/15265161.2021.1891347] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | | | | | - Janis Geary
- University of Alberta
- Arizona State University
| |
Collapse
|
26
|
Lee BM, Kraft SA. Fostering Relationships in Pediatric Oncology Research: A Relational Ethics Approach to Clinically Integrated Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:85-88. [PMID: 33825652 DOI: 10.1080/15265161.2021.1891350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Brittany M Lee
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and University of Washington School of Medicine
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and University of Washington School of Medicine
| |
Collapse
|
27
|
Barton A, Cumyn A, Dault R, Ethier JF. Gift, Reciprocity and Learning Health Systems. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:91-93. [PMID: 33825634 DOI: 10.1080/15265161.2021.1891341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Adrien Barton
- GRIIS and CIRIUS, Université de Sherbrooke, Canada
- IRIT, CNRS, France
| | | | | | | |
Collapse
|
28
|
Neuhaus CP, Crane JT. Experiences at a Federally Qualified Health Center Support Expanded Conception of the Gifts of Precision Medicine. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:70-72. [PMID: 33825629 PMCID: PMC9721388 DOI: 10.1080/15265161.2021.1891348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
29
|
Lee SSJ. Response to Open Peer Commentaries: Distinguishing the "Gift" from "Donation" as a Path toward Reciprocity and Relational Ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:W1-W3. [PMID: 33856287 PMCID: PMC8634772 DOI: 10.1080/15265161.2021.1905102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
|
30
|
Lensink MA, Jongsma KR, Boers SN, van Delden JJM, Bredenoord AL. Responsible Research with Human Tissues: The Need for Reciprocity Toward Both Collectives and Individuals. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:75-78. [PMID: 33825632 DOI: 10.1080/15265161.2021.1891346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | | | - Sarah N Boers
- Julius Center, University Medical Center
- Utrecht General Practice Training Institute, University Medical Center Utrecht
| | | | | |
Collapse
|
31
|
Zlotnik Shaul R, Shaul D, Anderson J, McCradden M. The Gift in Precision Medicine: Unwrapping the Significance of Reciprocity and Generosity. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:78-80. [PMID: 33825625 DOI: 10.1080/15265161.2021.1891349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Randi Zlotnik Shaul
- Hospital for Sick Children
- University of Toronto
- Joint Centre for Bioethics, University of Toronto
| | | | - James Anderson
- Hospital for Sick Children
- University of Toronto
- Joint Centre for Bioethics, University of Toronto
| | - Melissa McCradden
- Hospital for Sick Children
- University of Toronto
- Joint Centre for Bioethics, University of Toronto
| |
Collapse
|