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Starke G, Akmazoglu TB, Colucci A, Vermehren M, van Beinum A, Buthut M, Soekadar SR, Bublitz C, Chandler JA, Ienca M. Qualitative studies involving users of clinical neurotechnology: a scoping review. BMC Med Ethics 2024; 25:89. [PMID: 39138452 PMCID: PMC11323440 DOI: 10.1186/s12910-024-01087-z] [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: 01/23/2023] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The rise of a new generation of intelligent neuroprostheses, brain-computer interfaces (BCI) and adaptive closed-loop brain stimulation devices hastens the clinical deployment of neurotechnologies to treat neurological and neuropsychiatric disorders. However, it remains unclear how these nascent technologies may impact the subjective experience of their users. To inform this debate, it is crucial to have a solid understanding how more established current technologies already affect their users. In recent years, researchers have used qualitative research methods to explore the subjective experience of individuals who become users of clinical neurotechnology. Yet, a synthesis of these more recent findings focusing on qualitative methods is still lacking. METHODS To address this gap in the literature, we systematically searched five databases for original research articles that investigated subjective experiences of persons using or receiving neuroprosthetics, BCIs or neuromodulation with qualitative interviews and raised normative questions. RESULTS 36 research articles were included and analysed using qualitative content analysis. Our findings synthesise the current scientific literature and reveal a pronounced focus on usability and other technical aspects of user experience. In parallel, they highlight a relative neglect of considerations regarding agency, self-perception, personal identity and subjective experience. CONCLUSIONS Our synthesis of the existing qualitative literature on clinical neurotechnology highlights the need to expand the current methodological focus as to investigate also non-technical aspects of user experience. Given the critical role considerations of agency, self-perception and personal identity play in assessing the ethical and legal significance of these technologies, our findings reveal a critical gap in the existing literature. This review provides a comprehensive synthesis of the current qualitative research landscape on neurotechnology and the limitations thereof. These findings can inform researchers on how to study the subjective experience of neurotechnology users more holistically and build patient-centred neurotechnology.
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Grants
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- HYBRIDMIND (SNSF 32NE30_199436; BMBF, 01GP2121A and -B), ERA-NET NEURON
- NGBMI (759370) European Research Council (ERC)
- NGBMI (759370) European Research Council (ERC)
- NGBMI (759370) European Research Council (ERC)
- NGBMI (759370) European Research Council (ERC)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- SSMART (01DR21025A), NEO (13GW0483C), QHMI (03ZU1110DD), QSHIFT (01UX2211) and NeuroQ (13N16486) Federal Ministry of Research and Education (BMBF)
- A-2019-558 Einstein Foundation Berlin
- A-2019-558 Einstein Foundation Berlin
- A-2019-558 Einstein Foundation Berlin
- A-2019-558 Einstein Foundation Berlin
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Affiliation(s)
- Georg Starke
- Faculty of Medicine, Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany.
- College of Humanities, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
| | | | - Annalisa Colucci
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mareike Vermehren
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Amanda van Beinum
- Centre for Health Law Policy and Ethics, University of Ottawa, Ottawa, ON, Canada
| | - Maria Buthut
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jennifer A Chandler
- Bertram Loeb Research Chair, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Marcello Ienca
- Faculty of Medicine, Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany
- College of Humanities, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Levy L, Ebadi H, Smith AP, Taiclet L, Pouratian N, Feinsinger A. Disentangling Function from Benefit: Participant Perspectives from an Early Feasibility Trial for a Novel Visual Cortical Prosthesis. AJOB Neurosci 2024; 15:158-176. [PMID: 37812142 PMCID: PMC11001790 DOI: 10.1080/21507740.2023.2257152] [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: 10/10/2023]
Abstract
Visual cortical prostheses (VCPs) have the potential to provide artificial vision for visually impaired persons. However, the nature and utility of this form of vision is not yet fully understood. Participants in the early feasibility trial for the Orion VCP were interviewed to gain insight into their experiences using artificial vision, their motivations for participation, as well as their expectations and assessments of risks and benefits. Analyzed using principles of grounded theory and an interpretive description approach, these interviews yielded six themes, including: the irreducibility of benefit to device functionality, mixed expectations for short-term device functionality and long-term technological advancement of visual prostheses, and a broad range of risks, concerns, and fears related to trial participation. We argue that these narratives motivate a nuanced set of ethical considerations related to the complex relationship between functionality and benefit, the intersection of user experience with disability justice, and the import of expectations and indirect risks on consent.
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Affiliation(s)
- Lilyana Levy
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Hamasa Ebadi
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ally Peabody Smith
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Lauren Taiclet
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Gowda V, Dinesh S, Sharma S. Manipulative neuroparasites: uncovering the intricacies of neurological host control. Arch Microbiol 2023; 205:314. [PMID: 37603130 DOI: 10.1007/s00203-023-03637-2] [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: 04/27/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
Manipulative neuroparasites are a fascinating group of organisms that possess the ability to hijack the nervous systems of their hosts, manipulating their behavior in order to enhance their own survival and reproductive success. This review provides an overview of the different strategies employed by manipulative neuroparasites, ranging from viruses to parasitic worms and fungi. By examining specific examples, such as Toxoplasma gondii, Leucochloridium paradoxum, and Ophiocordyceps unilateralis, we highlight the complex mechanisms employed by these parasites to manipulate their hosts' behavior. We explore the mechanisms through which these parasites alter the neural processes and behavior of their hosts, including the modulation of neurotransmitters, hormonal pathways, and neural circuits. This review focuses less on the diseases that neuroparasites induce and more on the process of their neurological manipulation. We also investigate the fundamental mechanisms of host manipulation in the developing field of neuroparasitology, which blends neuroscience and parasitology. Finally, understanding the complex interaction between manipulative neuroparasites and their hosts may help us to better understand the fundamentals of behavior, neurology, and host-parasite relationships.
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Affiliation(s)
- Vishvas Gowda
- Department of Bioinformatics, BioNome, Bangalore, 560043, India
| | - Susha Dinesh
- Department of Bioinformatics, BioNome, Bangalore, 560043, India
| | - Sameer Sharma
- Department of Bioinformatics, BioNome, Bangalore, 560043, India.
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Hood B, Plummer R, Hogarth L, Brown G, Porteous H, Armstrong A, Grice C, Barron C. Impact of an educational intervention for advanced cancer patients referred for early phase clinical trials. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:748-753. [PMID: 37596084 DOI: 10.12968/bjon.2023.32.15.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
A 2017 service evaluation identified a lack of information and knowledge among patients who were referred on to early phase oncology clinical trials (Hood, 2020). An educational booklet was developed to improve patients' knowledge and experience. To build upon this work, a patient co-designed website was developed. This study examined the impact, if any, of a patient co-designed educational intervention within the clinical pathway for patients who are referred for an early phase oncology clinical trial at an experimental cancer medicine centre (ECMC). AIMS 1. To understand the experiences of patients who have been referred to an ECMC for an early phase clinical trial pre- and post-intervention. 2. To investigate if the intervention reduced anxiety levels in newly referred patients. METHOD A convergent mixed-methods design was used in this study, to collect quantitative and qualitative data in parallel. OUTCOMES This study examined the experiences of advanced cancer patients who attended their initial research outpatient appointment to discuss the possibility of taking part in an early phase clinical trial and the impact of an educational resource.
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Affiliation(s)
- Ben Hood
- Nurse Consultant, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - Ruth Plummer
- Professor, Newcastle University, Newcastle upon Tyne
| | - Linda Hogarth
- Project Manager, Newcastle University, Newcastle upon Tyne
| | - Gary Brown
- Specialist Psychological Therapist, Northumbria Healthcare NHS Trust, Ashington
| | - Helen Porteous
- Clinical Trial Coordinator, Newcastle University, Newcastle upon Tyne
| | | | - Carole Grice
- Research Administrator, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne
| | - Chris Barron
- Clinical Trials Unit Manager, Newcastle University, Newcastle upon Tyne
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Peabody Smith A, Pouratian N, Feinsinger A. Two Practices to Improve Informed Consent for Intraoperative Brain Research. Neurosurgery 2023; 92:e97-e101. [PMID: 36700725 PMCID: PMC10158867 DOI: 10.1227/neu.0000000000002336] [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: 08/13/2022] [Accepted: 11/01/2022] [Indexed: 01/27/2023] Open
Abstract
As the clinical applications of neurologically implanted devices increase, so do opportunities for intracranial investigations in human patients. In some of these studies, patients participate in research during their awake brain surgery, performing additional tasks without the prospect of personal therapeutic benefit. These intraoperative studies raise persistent ethical challenges because they are conducted during a clinical intervention, in a clinical space, and often by the treating clinician. Whether intraoperative research necessitates innovative informed consent methods has become a pressing conversation. Familiar worries about inadequate participant understanding and undue influence dominate these discussions, as do calls for increasing information retention (e.g., using methods such as "teach-back") and minimizing enrollment pressures (e.g., preventing surgeons from consenting their own patients). However, efforts have yet to inspire widespread consent practices that mirror the scope of ethical concern. Focusing on awake, intraoperative intracranial research, we identify 2 underappreciated problems in approaches to informed consent. The first is epistemic: Many practices do not fully consider when and under which conditions participants are adequately informed. The second is relational: Many practices do not fully consider the effects of trust between patient-participants and surgeon-researchers. In exploring these concerns, we also raise questions about whether additional steps beyond preoperative consent may improve the process because decisions at this time are decoupled from both the experiences and vulnerability of awake brain surgery. Motivated by these considerations, we propose 2 practices: first, requiring a third-party patient advocate in initial consent and second, requiring verbal intraoperative reconsent before initiating research.
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Affiliation(s)
- Ally Peabody Smith
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ashley Feinsinger
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Smith AP, Taiclet L, Ebadi H, Levy L, Weber M, Caruso EM, Pouratian N, Feinsinger A. "They were already inside my head to begin with": Trust, Translational Misconception, and Intraoperative Brain Research. AJOB Empir Bioeth 2023; 14:111-124. [PMID: 36137012 PMCID: PMC10030379 DOI: 10.1080/23294515.2022.2123869] [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: 10/14/2022]
Abstract
Background: Patients undergoing invasive neurosurgical procedures offer researchers unique opportunities to study the brain. Deep brain stimulation patients, for example, may participate in research during the surgical implantation of the stimulator device. Although this research raises many ethical concerns, little attention has been paid to basic studies, which offer no therapeutic benefits, and the value of patient-participant perspectives.Methods: Semi-structured interviews were conducted with fourteen individuals across two studies who participated in basic intraoperative research during their deep brain stimulator surgery. Interviews explored interpretations of risks and benefits, enrollment motivations, and experiences of participating in awake brain research. Reflexive thematic analysis was conducted.Results: Seven themes were identified from participant narratives, including robust attitudes of trust, high valuations of basic science research, impacts of the surgical context, and mixed experiences of participation.Conclusion: We argue that these narratives raise the potential for a translational misconception and motivate intraoperative re-consent procedures.
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Affiliation(s)
- Ally Peabody Smith
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Lauren Taiclet
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Hamasa Ebadi
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, United States
| | - Liliana Levy
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
| | - Megan Weber
- Anderson School of Management, University of California, Los Angeles, United States
| | - Eugene M. Caruso
- Anderson School of Management, University of California, Los Angeles, United States
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, United States
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, United States
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Kalokairinou L, Choi R, Nagappan A, Wexler A. Opportunity Cost or Opportunity Lost: An Empirical Assessment of Ethical Concerns and Attitudes of EEG Neurofeedback Users. NEUROETHICS-NETH 2022; 15:28. [PMID: 36249541 PMCID: PMC9555209 DOI: 10.1007/s12152-022-09506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
Background Electroencephalography (EEG) neurofeedback is a type of biofeedback that purportedly teaches users how to control their brainwaves. Although neurofeedback is currently offered by thousands of providers worldwide, its provision is contested, as its effectiveness beyond a placebo effect is unproven. While scholars have voiced numerous ethical concerns about neurofeedback-regarding opportunity cost, physical and psychological harms, financial cost, and informed consent-to date these concerns have remained theoretical. This pilot study aimed to provide insights on whether these issues were supported by empirical data from the experiences of neurofeedback users. Methods Semi-structured telephone interviews were conducted with individuals who had used EEG neurofeedback for themselves and/or for a child. Results The majority of respondents (N = 36) were female (75%), white (92%), and of higher socioeconomic status relative to the U.S. population. Among adult users (n = 33), most (78.8%) resorted to neurofeedback after having tried other therapies and were satisfied with treatment (81.8%). The majority paid for neurofeedback out-of-pocket (72.7%) and considered it to be good value for money (84.8%). More than half (57.6%) considered neurofeedback to be a scientifically well-established therapy. However, of those, 78.9%were using neurofeedback for indications not adequately supported by scientific evidence. Conclusion Concerns regarding opportunity cost, physical and psychological harms, and financial cost are not substantiated by our findings. Our results partially support concerns regarding insufficient understanding of limitations. This study underlines the disconnect between some of the theoretical concerns raised by scholars regarding the use of non-validated therapies and the lived experiences of users.
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Affiliation(s)
- Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebekah Choi
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashwini Nagappan
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Engagement, Exploitation, and Human Intracranial Electrophysiology Research. NEUROETHICS-NETH 2022; 15. [DOI: 10.1007/s12152-022-09502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schönau A, Goering S, Versalovic E, Montes N, Brown T, Dasgupta I, Klein E. Asking questions that matter – Question prompt lists as tools for improving the consent process for neurotechnology clinical trials. Front Hum Neurosci 2022; 16:983226. [PMID: 35966997 PMCID: PMC9372354 DOI: 10.3389/fnhum.2022.983226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
Implantable neurotechnology devices such as Brain Computer Interfaces (BCIs) and Deep Brain Stimulators (DBS) are an increasing part of treating or exploring potential treatments for neurological and psychiatric disorders. While only a few devices are approved, many promising prospects for future devices are under investigation. The decision to participate in a clinical trial can be challenging, given a variety of risks to be taken into consideration. During the consent process, prospective participants might lack the language to consider those risks, feel unprepared, or simply not know what questions to ask. One tool to help empower participants to play a more active role during the consent process is a Question Prompt List (QPL). QPLs are communication tools that can prompt participants and patients to articulate potential concerns. They offer a structured list of disease, treatment, or research intervention-specific questions that research participants can use as support for question asking. While QPLs have been studied as tools for improving the consent process during cancer treatment, in this paper, we suggest they would be helpful in neurotechnology research, and offer an example of a QPL as a template for an informed consent tool in neurotechnology device trials.
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Affiliation(s)
- Andreas Schönau
- Department of Philosophy, University of Washington, Seattle, WA, United States
- *Correspondence: Andreas Schönau,
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Erika Versalovic
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Natalia Montes
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Tim Brown
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | | | - Eran Klein
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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