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Chambers DA, Goddard KAB. Advancing Implementation Science in Cancer Genomics: Progressing from Discovery to Population Health Benefit. Public Health Genomics 2024; 27:161-167. [PMID: 39374589 DOI: 10.1159/000541577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/17/2024] [Indexed: 10/09/2024] Open
Affiliation(s)
- David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
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Norton BY, Liu J, Lewis SA, Magee H, Kruer TN, Dinh R, Bakhtiari S, Nordlie SH, Shetty S, Heim J, Nishiyama Y, Arango J, Johnson D, Seabrooke L, Shub M, Rosenberg R, Shusterman M, Wisniewski S, Cooper B, Rothwell E, Fahey MC, Shrader MW, Lennon N, Oleszek J, Pierce W, Fleming H, Belthur M, Tinto J, Noritz G, Glader L, Steffan K, Walker W, Grenard D, Aravamuthan B, Bjornson K, Joseph M, Gross P, Kruer MC. Development and validation of a stakeholder-driven, self-contained electronic informed consent platform for trio-based genomic research studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.01.24306461. [PMID: 39040210 PMCID: PMC11261908 DOI: 10.1101/2024.05.01.24306461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Increasingly long and complex informed consents have yielded studies demonstrating comparatively low participant comprehension and satisfaction with traditional face-to-face approaches. In parallel, interest in electronic consents for clinical and research genomics has steadily increased, yet limited data are available for trio-based genomic discovery studies. We describe the design, development, implementation, and validation of an electronic iConsent application for trio-based genomic research deployed to support genomic studies of cerebral palsy. iConsent development incorporated stakeholder perspectives including researchers, patient advocates, institutional review board members, and genomic data-sharing considerations. The iConsent platform integrated principles derived from prior electronic consenting research and elements of multimedia learning theory. Participant comprehension was assessed in an interactive teachback format. The iConsent application achieved nine of ten proposed desiderata for effective patient-focused electronic consenting for genomic research. Overall, participants demonstrated high comprehension and retention of key human subjects' considerations. Enrollees reported high levels of satisfaction with the iConsent, and we found that participant comprehension, iConsent clarity, privacy protections, and study goal explanations were associated with overall satisfaction. Although opportunities exist to optimize iConsent, we show that such an approach is feasible, can satisfy multiple stakeholder requirements, and can realize high participant satisfaction and comprehension while increasing study reach.
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Affiliation(s)
- Bethany Y Norton
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - James Liu
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Sara A Lewis
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Helen Magee
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Tyler N Kruer
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Rachael Dinh
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Somayeh Bakhtiari
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Sandra H. Nordlie
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Sheetal Shetty
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
- Programs in Behavioral Health, Biomedical Informatics, Molecular & Cellular Biology, and Neuroscience, Arizona State University, Tempe, AZ, USA
| | - Jennifer Heim
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Yumi Nishiyama
- Programs in Behavioral Health, Biomedical Informatics, Molecular & Cellular Biology, and Neuroscience, Arizona State University, Tempe, AZ, USA
| | - Jorge Arango
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Darcy Johnson
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Lee Seabrooke
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Mitchell Shub
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Robert Rosenberg
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | | | - Stephen Wisniewski
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Blair Cooper
- Cerebral Palsy Research Network, Greenville, SC, USA
| | - Erin Rothwell
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - M. Wade Shrader
- Department of Orthopaedics, AI DuPont Children’s Hospital, Wilmington, DE, USA
| | - Nancy Lennon
- Department of Orthopaedics, AI DuPont Children’s Hospital, Wilmington, DE, USA
| | - Joyce Oleszek
- Department of Physical Medicine & Rehabilitation, Colorado Children’s Hospital, Aurora, CO, USA
| | - Wendy Pierce
- Department of Physical Medicine & Rehabilitation, Colorado Children’s Hospital, Aurora, CO, USA
| | - Hannah Fleming
- Department of Physical Medicine & Rehabilitation, Colorado Children’s Hospital, Aurora, CO, USA
| | - Mohan Belthur
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Jennifer Tinto
- Division of Complex Care, Department of Pediatrics, Nationwide Children’s, Colombus, OH, USA
| | - Garey Noritz
- Division of Complex Care, Department of Pediatrics, Nationwide Children’s, Colombus, OH, USA
| | - Laurie Glader
- Division of Complex Care, Department of Pediatrics, Nationwide Children’s, Colombus, OH, USA
| | - Kelsey Steffan
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - William Walker
- Department of Pediatrics, Division of Developmental Medicine, Seattle Children’s, Seattle, WA, USA
| | - Deborah Grenard
- Department of Pediatrics, Division of Developmental Medicine, Seattle Children’s, Seattle, WA, USA
| | | | - Kristie Bjornson
- Department of Pediatrics, Division of Developmental Medicine, Seattle Children’s, Seattle, WA, USA
| | - Malin Joseph
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
| | - Paul Gross
- Cerebral Palsy Research Network, Greenville, SC, USA
| | - Michael C Kruer
- Barrow Neurological Institute, Phoenix Children’s, Phoenix, AZ USA
- Departments of Child Health, Cellular & Molecular Medicine, Neurology and Program in Genetics, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
- Programs in Behavioral Health, Biomedical Informatics, Molecular & Cellular Biology, and Neuroscience, Arizona State University, Tempe, AZ, USA
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Kohut K, Morton K, Turner L, Shepherd J, Fenerty V, Woods L, Grimmett C, Eccles DM, Foster C. Patient decision support resources inform decisions about cancer susceptibility genetic testing and risk management: a systematic review of patient impact and experience. FRONTIERS IN HEALTH SERVICES 2023; 3:1092816. [PMID: 37395995 PMCID: PMC10311450 DOI: 10.3389/frhs.2023.1092816] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Abstract
Background Patients with genetic cancer susceptibility are presented with complex management options involving difficult decisions, for example about genetic testing, treatment, screening and risk-reducing surgery/medications. This review sought to explore the experience of patients using decision support resources in this context, and the impact on decision-making outcomes. Methods Systematic review of quantitative, qualitative and mixed-methods studies involving adults with or without cancer who used a decision support resource pre- or post-genetic test for any cancer susceptibility. To gather a broad view of existing resources and gaps for development, digital or paper-based patient resources were included and not limited to decision aids. Narrative synthesis was used to summarise patient impact and experience. Results Thirty-six publications describing 27 resources were included. Heterogeneity of resources and outcome measurements highlighted the multiple modes of resource delivery and personal tailoring acceptable to and valued by patients. Impact on cognitive, emotional, and behavioural outcomes was mixed, but mainly positive. Findings suggested clear potential for quality patient-facing resources to be acceptable and useful. Conclusions Decision support resources about genetic cancer susceptibility are likely useful to support decision-making, but should be co-designed with patients according to evidence-based frameworks. More research is needed to study impact and outcomes, particularly in terms of longer term follow-up to identify whether patients follow through on decisions and whether any increased distress is transient. Innovative, streamlined resources are needed to scale up delivery of genetic cancer susceptibility testing for patients with cancer in mainstream oncology clinics. Tailored patient-facing decision aids should also be made available to patients identified as carriers of a pathogenic gene variant that increases future cancer risks, to complement traditional genetic counselling. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020220460, identifier: CRD42020220460.
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Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kate Morton
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lesley Turner
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Vicky Fenerty
- Engagement Services, University of Southampton Library, University of Southampton, Southampton, United Kingdom
| | - Lois Woods
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Chloe Grimmett
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana M. Eccles
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Wexler A, Choi R, Pearlman A, Rasmussen LM. Navigating biosafety concerns within COVID-19 do-it-yourself (DIY) science: an ethnographic and interview study. BIOSOCIETIES 2023; 19:1-22. [PMID: 37359139 PMCID: PMC10042665 DOI: 10.1057/s41292-023-00301-2] [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: 01/27/2023] [Indexed: 03/30/2023]
Abstract
Non-establishment or do-it-yourself (DIY) science involves individuals who may not have formal training conducting experiments outside of institutional settings. While prior scholarship has examined the motivations and values of those involved in the subset of DIY science known as "DIY biology," little research has addressed how these individuals navigate ethical issues in practice. The present study therefore aimed to understand how DIY biologists identify, approach, and resolve one particular ethical issue-biosafety-in their work. We conducted a digital ethnography of Just One Giant Lab (JOGL), the primary hub for DIY biology during the COVID-19 pandemic, and subsequently conducted interviews with individuals involved with JOGL. We found that JOGL was the first global DIY biology initiative to create a Biosafety Advisory Board and develop formal biosafety guidelines that applied to different groups in multiple locations. There was disagreement, however, regarding whether the Board should have an advisory role or provide mandatory oversight. We found that JOGL practiced ethical gatekeeping of projects that fell outside the limits defined by the Board. Our findings show that the DIY biology community recognized biosafety issues and tried to build infrastructure to facilitate the safe conduct of research. Supplementary Information The online version contains supplementary material available at 10.1057/s41292-023-00301-2.
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Affiliation(s)
- Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Rebekah Choi
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Alex Pearlman
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Lisa M. Rasmussen
- Department of Philosophy, University of North Carolina at Charlotte, Charlotte, USA
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5
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Liles EG, Leo MC, Freed AS, Porter KM, Zepp JM, Kauffman TL, Keast E, McMullen CK, Gruß I, Biesecker BB, Muessig KR, Eubanks DJ, Amendola LM, Dorschner MO, Rolf BA, Jarvik GP, Goddard KAB, Wilfond BS. ORCA, a values-based decision aid for selecting additional findings from genomic sequencing in adults: Efficacy results from a randomized trial. Genet Med 2022; 24:1664-1674. [PMID: 35522237 PMCID: PMC9586129 DOI: 10.1016/j.gim.2022.04.008] [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: 10/05/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Individuals having genomic sequencing can choose to be notified about pathogenic variants in genes unrelated to the testing indication. A decision aid can facilitate weighing one's values before making a choice about these additional results. METHODS We conducted a randomized trial (N = 231) comparing informed values-choice congruence among adults at risk for a hereditary cancer syndrome who viewed either the Optional Results Choice Aid (ORCA) or web-based additional findings information alone. ORCA is values-focused with a low-literacy design. RESULTS Individuals in both arms had informed values-choice congruence (75% and 73% in the decision aid and web-based groups, respectively; odds ratio [OR] = 1.10, 95% CI = 0.58-2.08). Most participants had adequate knowledge (79% and 76% in the decision aid and web-based groups, respectively; OR = 1.20, 95% CI = 0.61-2.34), with no significant difference between groups. Most had information-seeking values (97% and 98% in the decision aid and web-based groups, respectively; OR = 0.59, 95% CI = 0.10-3.61) and chose to receive additional findings. CONCLUSION The ORCA decision aid did not significantly improve informed values-choice congruence over web-based information in this cohort of adults deciding about genomic results. Both web-based approaches may be effective for adults to decide about receiving medically actionable additional results.
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Affiliation(s)
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Amanda S Freed
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR
| | | | - Inga Gruß
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Barbara B Biesecker
- Genetics, Bioinformatics and Translation, RTI International, Washington, D.C
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Michael O Dorschner
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Bradley A Rolf
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA; Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Amendola LM, Shuster E, Leo MC, Dorschner MO, Rolf BA, Shirts BH, Gilmore MJ, Okuyama S, Zepp JM, Kauffman TL, Mittendorf KF, Bellcross C, Jenkins CL, Joseph G, Riddle L, Syngal S, Ukaegbu C, Goddard KAB, Wilfond BS, Jarvik GP. Laboratory-related outcomes from integrating an accessible delivery model for hereditary cancer risk assessment and genetic testing in populations with barriers to access. Genet Med 2022; 24:1196-1205. [PMID: 35305866 DOI: 10.1016/j.gim.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 01/02/2023] Open
Abstract
PURPOSE This study aimed to evaluate the laboratory-related outcomes of participants who were offered genomic testing based on cancer family history risk assessment tools. METHODS Patients from clinics that serve populations with access barriers, who are screened at risk for a hereditary cancer syndrome based on adapted family history collection tools (the Breast Cancer Genetics Referral Screening Tool and PREMM5), were offered exome-based panel testing for cancer risk and medically actionable secondary findings. We used descriptive statistics, electronic health record review, and inferential statistics to explore participant characteristics and results, consultations and actions related to pathogenic/likely pathogenic variants identified, and variables predicting category of findings, respectively. RESULTS Of all the participants, 87% successfully returned a saliva kit. Overall, 5% had a pathogenic/likely pathogenic cancer risk variant and 1% had a secondary finding. Almost all (14/15, 93%) participants completed recommended consultations with nongenetics providers after an average of 17 months. The recommended actions (eg, breast magnetic resonance imaging) were completed by 17 of 25 participants. Participant personal history of cancer and PREMM5 score were each associated with the category of findings (history and colon cancer finding, Fisher's exact P = .02; history and breast cancer finding, Fisher's exact P = .01; PREMM5TM score; and colon cancer finding, Fisher's exact P < .001). CONCLUSION This accessible model of hereditary cancer risk assessment and genetic testing yielded results that were often acted upon by patients and physicians.
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Affiliation(s)
- Laura M Amendola
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Michael O Dorschner
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Department of Laboratory Medicine and Pathology, UW Medicine, University of Washington, Seattle, WA
| | - Bradley A Rolf
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Brian H Shirts
- Department of Laboratory Medicine and Pathology, UW Medicine, University of Washington, Seattle, WA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sonia Okuyama
- Division of Hematology-Oncology, Denver Health and Hospital Authority, Denver, CO
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Cecilia Bellcross
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Charisma L Jenkins
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA
| | - Leslie Riddle
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA
| | - Sapna Syngal
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA; Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA
| | - Chinedu Ukaegbu
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics (TAG), Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA; Division of Bioethics and Paliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Gail P Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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Watson KS, Cohn EG, Fair A, Menon U, Szalacha LA, Carpenter SM, Wilkins CH. Adapting a conceptual framework to engage diverse stakeholders in genomic/precision medicine research. Health Expect 2022; 25:1478-1485. [PMID: 35353945 PMCID: PMC9327871 DOI: 10.1111/hex.13486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/23/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Genomic/precision medicine offers a remarkable opportunity to improve health and address health disparities. Genomic medicine is the study of genes and their interaction with health. Precision medicine is an approach to disease prevention and treatment that considers individual variability in genes, environment and lifestyle. Conclusions from studies lacking diversity may hinder generalizability as genomic variation occurs within and between populations. Historical factors, such as medical mistrust, ethical issues related to decision making, and data sharing pose complex challenges that may further widen inequities in genomic/precision medicine if not appropriately addressed. Although few biomedical studies integrate priorities of community partners into their conceptual framework, effective implementation of genomic/precision medicine research calls for the involvement of diverse stakeholders to expand traditional unidirectional models of engagement in clinical research towards authentic bidirectional collaboration. Methods A multipronged approach was used integrating an evidence‐based literature review and best practices in developing and evaluating the engagement of diverse stakeholders in genomic and precision medicine research. This was combined with expert consensus building to adapt a conceptual model from a community engagement framework to addressing genomics to be scalable to engagement science, which is challenging to genomic/precision medicine research. Results The final enhanced conceptual framework is composed of four overarching dimensions now inclusive of domains in trust, exploitation, discrimination, privacy risk, stigmatization, prior harms/injustices, failure to recognize coexisting governments, intersectionality and research transformation. This conceptual framework proposes effective participant research engagement strategies for upstream relationship building, distinct from downstream recruitment strategies in which the goal is enrolment. Conclusion To further shape the evolution of genomic/precision medicine research, it is important to leverage existing partnerships, engage participants beyond recruitment and embrace diverse perspectives. Patient or Public Contribution In preparation of this manuscript, the perspectives of the community partners on the impact of engaging in genomic/precision medicine research beyond research participation were integrated into this conceptual framework from various guided listening sessions held in diverse communities.
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Affiliation(s)
- Karriem S Watson
- Division of Community Health Sciences, School of Public Health, Mile Square Health Center, University of Illinois, Chicago, Illinois, USA
| | - Elizabeth G Cohn
- Hunter-Bellevue School of Nursing, Hunter College, New York, New York, USA
| | - Alecia Fair
- Department of Medicine, Vanderbilt University Medical Center and the Meharry-Vanderbilt Alliance, Nashville, Tennessee, USA
| | - Usha Menon
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Laura A Szalacha
- Morsani Health College of Medicine and College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Selena M Carpenter
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Consuelo H Wilkins
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Duenas DM, Shipman KJ, Porter KM, Shuster E, Guerra C, Reyes A, Kauffman TL, Hunter JE, Goddard KAB, Wilfond BS, Kraft SA. Motivations and concerns of patients considering participation in an implementation study of a hereditary cancer risk assessment program in diverse primary care settings. Genet Med 2022; 24:610-621. [PMID: 34906471 PMCID: PMC8939763 DOI: 10.1016/j.gim.2021.11.017] [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: 08/25/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Understanding the motivations and concerns of patients from diverse populations regarding participation in implementation research provides the needed evidence about how to design and conduct studies for facilitating access to genetics services. Within a hereditary cancer screening study assessing a multifaceted intervention, we examined primary care patients' motivations and concerns about participation. METHODS We surveyed and interviewed study participants after they enrolled, surveyed those who did not complete enrollment, and used descriptive qualitative and quantitative methods to identify motivations and concerns regarding participation. RESULTS Survey respondents' most common motivations included a desire to learn about their future risk (81%), receiving information that may help family (58%), and a desire to advance research (34%). Interviews revealed 3 additional important factors: affordability of testing, convenience of participation, and clinical relationships supporting research decision-making. Survey data of those who declined enrollment showed that the reasons for declining included concerns about privacy (38%), burdens of the research (19%), and their fear of not being able to cope with the genetic information (19%). CONCLUSION Understanding the facilitating factors and concerns that contribute to decisions about research may reveal ways to improve equity in access to care and research that could lead to greater uptake of genomic medicine across diverse primary care patient populations.
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Affiliation(s)
- Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA.
| | - Kelly J Shipman
- Palliative Care and Resilience Research Program, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA
| | - Elizabeth Shuster
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Claudia Guerra
- Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, CA
| | - Ana Reyes
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Katrina A B Goddard
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA
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Mittendorf KF, Kauffman TL, Amendola LM, Anderson KP, Biesecker BB, Dorschner MO, Duenas DM, Eubanks DJ, Feigelson HS, Gilmore MJ, Hunter JE, Joseph G, Kraft SA, Lee SSJ, Leo MC, Liles EG, Lindberg NM, Muessig KR, Okuyama S, Porter KM, Riddle LS, Rolf BA, Rope AF, Zepp JM, Jarvik GP, Wilfond BS, Goddard KAB. Cancer Health Assessments Reaching Many (CHARM): A clinical trial assessing a multimodal cancer genetics services delivery program and its impact on diverse populations. Contemp Clin Trials 2021; 106:106432. [PMID: 33984519 PMCID: PMC8336568 DOI: 10.1016/j.cct.2021.106432] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022]
Abstract
Advances in the application of genomic technologies in clinical care have the potential to increase existing healthcare disparities. Studies have consistently shown that only a fraction of eligible patients with a family history of cancer receive recommended cancer genetic counseling and subsequent genetic testing. Care delivery models using pre-test and post-test counseling are not scalable, which contributes to barriers in accessing genetics services. These barriers are even more pronounced for patients in historically underserved populations. We have designed a multimodal intervention to improve subsequent cancer surveillance, by improving the identification of patients at risk for familial cancer syndromes, reducing barriers to genetic counseling/testing, and increasing patient understanding of complex genetic results. We are evaluating this intervention in two large, integrated healthcare systems that serve diverse patient populations (NCT03426878). The primary outcome is the number of diagnostic (hereditary cancer syndrome) findings. We are examining the clinical and personal utility of streamlined pathways to genetic testing using electronic medical record data, surveys, and qualitative interviews. We will assess downstream care utilization of individuals receiving usual clinical care vs. genetic testing through the study. We will evaluate the impacts of a literacy-focused genetic counseling approach versus usual care genetic counseling on care utilization and participant understanding, satisfaction, and family communication. By recruiting participants belonging to historically underserved populations, this study is uniquely positioned to evaluate the potential of a novel genetics care delivery program to reduce care disparities.
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Affiliation(s)
- Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA.
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | | | | | - Michael O Dorschner
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Donna J Eubanks
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO 80014, USA
| | - Marian J Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Sandra Soo Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, 630 West 168(th) St, PH15E-1525, New York, NY 10032, USA
| | - Michael C Leo
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Elizabeth G Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Nangel M Lindberg
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Sonia Okuyama
- Denver Health and Hospital Authority, 777 Bannock Denver, CO 80204, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA
| | - Leslie S Riddle
- Department of Humanities and Social Sciences, University of California, San Francisco, 1450 3rd Street, Rm 551 & 556, San Francisco, CA 94143, USA
| | - Bradley A Rolf
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Alan F Rope
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA; Genome Medical, 701 Gateway Blvd, Suite 380, San Francisco, CA 94080, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute and Hospital, 1900 9(th) Ave, M/S JMB-6, Seattle, WA 98101, USA; Department of Pediatrics, Division of Bioethics and Palliative Care, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR 97227, USA
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Bridges C, Duenas DM, Lewis H, Anderson K, Opel DJ, Wilfond BS, Kraft SA. Patient perspectives on how to demonstrate respect: Implications for clinicians and healthcare organizations. PLoS One 2021; 16:e0250999. [PMID: 33914815 PMCID: PMC8084197 DOI: 10.1371/journal.pone.0250999] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Clinicians and healthcare organizations are ethically obligated to treat patients with respect, yet it is not clear what actions best demonstrate respect to patients. This exploratory qualitative study aimed to understand what actions on both an individual and organizational level effectively demonstrate respect for primary care patients. METHODS We conducted semi-structured telephone interviews with primary care patients in an integrated healthcare delivery system in Oregon and an integrated safety net health system in Colorado who were participating in a genomics implementation research study of a hereditary cancer screening program. We systematically coded interview transcripts using a coding framework developed based on iterative review of the interview guide and transcripts. We further analyzed the data coded with sub-codes relating to patients' experiences with respect in healthcare using a descriptive content analysis approach. RESULTS We interviewed 40 English-speaking (n = 30, 75%) and Spanish-speaking (n = 10, 25%) patients. Most interviewees identified as female (n = 35, 88%) and either Hispanic/Latino(a) (n = 17, 43%) or White or European American (n = 15, 38%). Interviewees identified two categories of efforts by individual clinicians that demonstrate respect: engaging with patients and being transparent. They identified five efforts by healthcare organizations: promoting safety and inclusivity, protecting patient privacy, communicating about scheduling, navigating financial barriers to care, and ensuring continuity of care. CONCLUSIONS Our findings suggest that patients' experiences of respect depend on efforts by individual clinicians as well as healthcare organizations. Our findings offer insight into how clinicians can build stronger partnerships with patients and how organizations can seek to promote access to care and patient safety and comfort. They also illustrate areas for future research and quality improvement to more effectively respect patients.
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Affiliation(s)
- Celina Bridges
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Devan M. Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Hannah Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Katherine Anderson
- Denver Health Ambulatory Care Services, Denver, Colorado, United States of America
| | - Douglas J. Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
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Finucane BM, Ledbetter DH, Vorstman JA. Diagnostic genetic testing for neurodevelopmental psychiatric disorders: closing the gap between recommendation and clinical implementation. Curr Opin Genet Dev 2021; 68:1-8. [PMID: 33434711 DOI: 10.1016/j.gde.2020.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
Advances in laboratory testing have significantly increased the detection of rare genetic etiologies of neurodevelopmental psychiatric disorders (NPD), particularly developmental delay/ intellectual disability, autism spectrum disorder, and schizophrenia. Establishing a genetic diagnosis has important medical and personal utility for individuals with these conditions. Diagnostic genetic tests for NPD are clinically available but underutilized outside of medical genetics settings. Without clear multidisciplinary consensus recommendations, active involvement of medical specialists working with NPD patients, and practical education and training, the implementation of genetic testing for NPD will continue to lag behind other areas of medicine. In the long-term, collaborative efforts to address educational, logistical, and workforce obstacles will improve patient care and pave the way for targeted, effective NPD treatments.
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Affiliation(s)
- Brenda M Finucane
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA USA.
| | - David H Ledbetter
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA USA
| | - Jacob As Vorstman
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
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12
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Kraft SA, Rothwell E, Shah SK, Duenas DM, Lewis H, Muessig K, Opel DJ, Goddard KAB, Wilfond BS. Demonstrating 'respect for persons' in clinical research: findings from qualitative interviews with diverse genomics research participants. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106440. [PMID: 33023975 PMCID: PMC8021602 DOI: 10.1136/medethics-2020-106440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/27/2020] [Accepted: 09/05/2020] [Indexed: 05/11/2023]
Abstract
The ethical principle of 'respect for persons' in clinical research has traditionally focused on protecting individuals' autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals' rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English (n=30) or Spanish (n=10) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female (93%), identified as Hispanic/Latino(a) (43%) or non-Hispanic white (38%), reported annual household income under US$60 000 (70%) and did not have a Bachelor's degree (65%); 30% had limited health literacy. We identified four key domains for demonstrating respect: (1) personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; (2) study communication processes, including following up and sharing results with participants; (3) inclusion, particularly ensuring materials are understandable and procedures are accessible; and (4) consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin Rothwell
- Obstetrics and Gynecology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Seema K Shah
- Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Devan M Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Hannah Lewis
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kristin Muessig
- Translational and Applied Genomics, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Katrina A B Goddard
- Translational and Applied Genomics, Kaiser Permanente Center for Health Research Northwest Region, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington, USA
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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