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Sahan K, Wijesurendra R, Preiss D, Mafham M, Sheehan M. Towards an understanding of the ethics of electronic consent in clinical trials. Trials 2024; 25:545. [PMID: 39152507 PMCID: PMC11329992 DOI: 10.1186/s13063-024-08330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 07/08/2024] [Indexed: 08/19/2024] Open
Abstract
There are good practical reasons to use electronic consent (e-consent) in randomised trials, especially when conducting large-scale clinical trials to answer population-level health research questions. However, determining ethical reasons for e-consent is not so clear and depends on a proper understanding of what e-consent means when used in clinical trials and its ethical significance. Here we focus on four features of ethical significance which give rise to a range of ethical considerations relating to e-consent and merit further focused ethics research.
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Affiliation(s)
- Katherine Sahan
- Ethox Centre, Oxford Population Health, University of Oxford, Big Data Institute, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Rohan Wijesurendra
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - David Preiss
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Marion Mafham
- Clinical Trial Service Unit, Oxford Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Mark Sheehan
- Ethox Centre, Oxford Population Health, University of Oxford, Big Data Institute, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK.
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2
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Zenker S, Strech D, Jahns R, Müller G, Prasser F, Schickhardt C, Schmidt G, Semler SC, Winkler E, Drepper J. [Nationally standardized broad consent in practice: initial experiences, current developments, and critical assessment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:637-647. [PMID: 38639817 PMCID: PMC11166792 DOI: 10.1007/s00103-024-03878-6] [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: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The digitalization in the healthcare sector promises a secondary use of patient data in the sense of a learning healthcare system. For this, the Medical Informatics Initiative's (MII) Consent Working Group has created an ethical and legal basis with standardized consent documents. This paper describes the systematically monitored introduction of these documents at the MII sites. METHODS The monitoring of the introduction included regular online surveys, an in-depth analysis of the introduction processes at selected sites, and an assessment of the documents in use. In addition, inquiries and feedback from a large number of stakeholders were evaluated. RESULTS The online surveys showed that 27 of the 32 sites have gradually introduced the consent documents productively, with a current total of 173,289 consents. The analysis of the implementation procedures revealed heterogeneous organizational conditions at the sites. The requirements of various stakeholders were met by developing and providing supplementary versions of the consent documents and additional information materials. DISCUSSION The introduction of the MII consent documents at the university hospitals creates a uniform legal basis for the secondary use of patient data. However, the comprehensive implementation within the sites remains challenging. Therefore, minimum requirements for patient information and supplementary recommendations for best practice must be developed. The further development of the national legal framework for research will not render the participation and transparency mechanisms developed here obsolete.
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Affiliation(s)
- Sven Zenker
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek), Kaufmännische Direktion, Universitätsklinikum Bonn, Bonn, Deutschland.
- AG Angewandte Medizininformatik (AMI), Institut für Medizinische Biometrie, Informatik und Epidemiologie (IMBIE), Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland.
- AG Angewandte Mathematische Physiologie (AMP), Klinik & Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek) Kaufmännische Direktion, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Daniel Strech
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Roland Jahns
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw), Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Müller
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Fabian Prasser
- Center for Health Data Science, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Schickhardt
- Sektion Translationale Medizinethik, KKE Angewandte Tumor-Immunität, Nationales Centrum für Tumorerkrankungen (NCT), Deutsches Krebsforschungszentrum (DKFZ) Heidelberg und Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Georg Schmidt
- Klinik und Poliklinik für Innere Medizin I. Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Sebastian C Semler
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
| | - Eva Winkler
- Sektion Translationale Medizinethik, Abteilung Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Universität Heidelberg, Heidelberg, Deutschland
| | - Johannes Drepper
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
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Haas MA, Madelli EO, Brown R, Prictor M, Boughtwood T. Evaluation of CTRL: a web application for dynamic consent and engagement with individuals involved in a cardiovascular genetic disorders cohort. Eur J Hum Genet 2024; 32:61-68. [PMID: 37709947 PMCID: PMC10772119 DOI: 10.1038/s41431-023-01454-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
There has been keen interest in whether dynamic consent should be used in health research but few real-world studies have evaluated its use. Australian Genomics piloted and evaluated CTRL ('control'), a digital consent tool incorporating granular, dynamic decision-making and communication for genomic research. Individuals from a Cardiovascular Genetic Disorders Flagship were invited in person (prospective cohort) or by email (retrospective cohort) to register for CTRL after initial study recruitment. Demographics, consent choices, experience surveys and website analytics were analysed using descriptive statistics. Ninety-one individuals registered to CTRL (15.5% of the prospective cohort and 11.8% of the retrospective cohort). Significantly more males than females registered when invited retrospectively, but there was no difference in age, gender, or education level between those who did and did not use CTRL. Variation in individual consent choices about secondary data use and return of results supports the desirability of providing granular consent options. Robust conclusions were not drawn from satisfaction, trust, decision regret and knowledge outcome measures: differences between CTRL and non-CTRL cohorts did not emerge. Analytics indicate CTRL is acceptable, although underutilised. This is one of the first studies evaluating uptake and decision making using online consent tools and will inform refinement of future designs.
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Affiliation(s)
- Matilda A Haas
- Australian Genomics, Parkville, VIC, 3052, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
| | - Evanthia O Madelli
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Rosie Brown
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Tiffany Boughtwood
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
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Mascalzoni D, Melotti R, Pattaro C, Pramstaller PP, Gögele M, De Grandi A, Biasiotto R. Ten years of dynamic consent in the CHRIS study: informed consent as a dynamic process. Eur J Hum Genet 2022; 30:1391-1397. [PMID: 36064788 PMCID: PMC9441838 DOI: 10.1038/s41431-022-01160-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/13/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
The Cooperative Health Research in South Tyrol (CHRIS) is a longitudinal study in Northern Italy, using dynamic consent since its inception in 2011. The CHRIS study collects health data and biosamples for research, and foresees regular follow-ups over time. We describe the experience with the CHRIS study dynamic consent, providing an overview of its conceptualization and implementation, and of the participant-centered strategies used to assess and improve the process, directly linked to participation and communication. In order to comply with high ethical standards and to allow broadness in the areas of research, CHRIS dynamic consent was conceived as an interactive process: based on a strong governance and an ongoing tailored communication with participants, it aims to promote autonomy and to develop a trust-based engaged relationship with participants, also relevant for retention. Built within an online platform, the consent allows granular choices, which can be changed over time. In a process of co-production, participants views have been investigated and kept into account in policy development. Participants showed a high degree of participation, thus enabling the consolidation of the CHRIS resources. Even though a low change rate was reported in the baseline, participants valued the possibility of changing their informed consent choices. Communication (language-tailored, ongoing, multimedia) was important for participants, and for participation and retention. In our experience, dynamic consent was proven to be a flexible consent model, which allowed to meet ethical and legal standards for participation in research, and to accommodate participants' and researchers' needs.
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Affiliation(s)
- Deborah Mascalzoni
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy ,grid.8993.b0000 0004 1936 9457Center for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Roberto Melotti
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Cristian Pattaro
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Peter Paul Pramstaller
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Martin Gögele
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Alessandro De Grandi
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Roberta Biasiotto
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy. .,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Milne R, Sheehan M, Barnes B, Kapper J, Lea N, N'Dow J, Singh G, Martín-Uranga A, Hughes N. A concentric circles view of health data relations facilitates understanding of sociotechnical challenges for learning health systems and the role of federated data networks. Front Big Data 2022; 5:945739. [PMID: 36238653 PMCID: PMC9552575 DOI: 10.3389/fdata.2022.945739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
The ability to use clinical and research data at scale is central to hopes for data-driven medicine. However, in using such data researchers often encounter hurdles–both technical, such as differing data security requirements, and social, such as the terms of informed consent, legal requirements and patient and public trust. Federated or distributed data networks have been proposed and adopted in response to these hurdles. However, to date there has been little consideration of how FDNs respond to both technical and social constraints on data use. In this Perspective we propose an approach to thinking about data in terms that make it easier to navigate the health data space and understand the value of differing approaches to data collection, storage and sharing. We set out a socio-technical model of data systems that we call the “Concentric Circles View” (CCV) of data-relationships. The aim is to enable a consistent understanding of the fit between the local relationships within which data are produced and the extended socio-technical systems that enable their use. The paper suggests this model can help understand and tackle challenges associated with the use of real-world data in the health setting. We use the model to understand not only how but why federated networks may be well placed to address emerging issues and adapt to the evolving needs of health research for patient benefit. We conclude that the CCV provides a useful model with broader application in mapping, understanding, and tackling the major challenges associated with using real world data in the health setting.
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Affiliation(s)
- Richard Milne
- Wellcome Connecting Science, Cambridge, United Kingdom
- Kavli Centre for Ethics, Science and the Public, Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Mark Sheehan
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Oxford National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Brendan Barnes
- European Federation of Pharmaceutical Industries and Associations, Brussels, Belgium
| | - Janek Kapper
- Estonian Chamber of Disabled People/European Patients Forum, The Estonian Inflammatory Bowel Disease Society, Tallinn, Estonia
| | - Nathan Lea
- Institute for Innovation Through Health Data (i-HD), Gent, Belgium
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | | | | | - Nigel Hughes
- Janssen Research and Development, Beerse, Belgium
- *Correspondence: Nigel Hughes
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6
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Lensink MA, Jongsma KR, Boers SN, Bredenoord AL. Better governance starts with better words: why responsible human tissue research demands a change of language. BMC Med Ethics 2022; 23:90. [PMID: 36050689 PMCID: PMC9438266 DOI: 10.1186/s12910-022-00823-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
The rise of precision medicine has led to an unprecedented focus on human biological material in biomedical research. In addition, rapid advances in stem cell technology, regenerative medicine and synthetic biology are leading to more complex human tissue structures and new applications with tremendous potential for medicine. While promising, these developments also raise several ethical and practical challenges which have been the subject of extensive academic debate. These debates have led to increasing calls for longitudinal governance arrangements between tissue providers and biobanks that go beyond the initial moment of obtaining consent, such as closer involvement of tissue providers in what happens to their tissue, and more active participatory approaches to the governance of biobanks. However, in spite of these calls, such measures are being adopted slowly in practice, and there remains a strong tendency to focus on the consent procedure as the tool for addressing the ethical challenges of contemporary biobanking. In this paper, we argue that one of the barriers to this transition is the dominant language pervading the field of human tissue research, in which the provision of tissue is phrased as a 'donation' or 'gift', and tissue providers are referred to as 'donors'. Because of the performative qualities of language, the effect of using 'donation' and 'donor' shapes a professional culture in which biobank participants are perceived as passive providers of tissue free from further considerations or entitlements. This hampers the kind of participatory approaches to governance that are deemed necessary to adequately address the ethical challenges currently faced in human tissue research. Rather than reinforcing this idea through language, we need to pave the way for the kind of participatory approaches to governance that are being extensively argued for by starting with the appropriate terminology.
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Affiliation(s)
- Michael A Lensink
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Karin R Jongsma
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Sarah N Boers
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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7
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McKay F, Williams BJ, Prestwich G, Bansal D, Hallowell N, Treanor D. The ethical challenges of artificial intelligence-driven digital pathology. J Pathol Clin Res 2022; 8:209-216. [PMID: 35174655 PMCID: PMC8977272 DOI: 10.1002/cjp2.263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 12/28/2022]
Abstract
Digital pathology - the digitalisation of clinical histopathology services through the scanning and storage of pathology slides - has opened up new possibilities for health care in recent years, particularly in the opportunities it brings for artificial intelligence (AI)-driven research. Recognising, however, that there is little scholarly debate on the ethics of digital pathology when used for AI research, this paper summarises what it sees as four key ethical issues to consider when deploying AI infrastructures in pathology, namely, privacy, choice, equity, and trust. The themes are inspired from the authors' experience grappling with the challenge of deploying an ethical digital pathology infrastructure to support AI research as part of the National Pathology Imaging Cooperative (NPIC), a collaborative of universities, hospital trusts, and industry partners largely located across the North of England. Though focusing on the UK case, internationally, few pathology departments have gone fully digital, and so the themes developed here offer a heuristic for ethical reflection for other departments currently making a similar transition or planning to do so in the future. We conclude by promoting the need for robust public governance mechanisms in AI-driven digital pathology.
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Affiliation(s)
- Francis McKay
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Bethany J Williams
- Department of HistopathologyLeeds Teaching Hospitals NHS TrustLeedsUK
- Department of PathologyUniversity of LeedsLeedsUK
| | - Graham Prestwich
- Patient and Public Engagement LeadYorkshire and Humber Academic Health Science NetworkWakefieldUK
| | - Daljeet Bansal
- Department of HistopathologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Nina Hallowell
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Darren Treanor
- Department of HistopathologyLeeds Teaching Hospitals NHS TrustLeedsUK
- Department of PathologyUniversity of LeedsLeedsUK
- Department of Clinical PathologyLinköping UniversityLinköpingSweden
- Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
- Center for Medical Image Science and Visualization (CMIV)Linköping UniversityLinköpingSweden
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8
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Purvis RS, Ayers BL, Bogulski CA, Kaminicki KF, Haggard-Duff LK, Riklon LA, Iban A, Mejbon-Samuel R, Lakmis R, Riklon S, Thompson JW, McElfish PA. Multicomponent Informed Consent with Marshallese Participants. J Empir Res Hum Res Ethics 2021; 16:144-153. [PMID: 33780279 PMCID: PMC8238841 DOI: 10.1177/15562646211005651] [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: 11/16/2022]
Abstract
Pacific Islanders are the second fastest-growing population in the United States; however, Pacific Islanders, and Marshallese specifically, are underrepresented in health research. A community-based participatory research (CBPR) approach was used to engage Marshallese stakeholders and build an academic-community research collaborative to conduct health disparities research. Our CBPR partnership pilot tested a multicomponent consent process that provides participants the option to control the use of their data. Consent forms used concise plain language to describe study information, including participant requirements, risks, and personal health information protections, and were available in both English and Marshallese. This study demonstrates that when provided a multicomponent consent, the vast majority of consenting study participants (89.6%) agreed to all additional options, and only five (10.4%) provided consent for some but not all options. Our description of the development and implementation of a multicomponent consent using a CBPR approach adds a specific example of community engagement and may be informative for other indigenous populations.
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Affiliation(s)
- Rachel S. Purvis
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Britni L. Ayers
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Cari A. Bogulski
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Kyle F. Kaminicki
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | | | - Lynda A. Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | - Anita Iban
- Faith in Action Research and Resource Alliance (FARRA), Springdale (USA)
| | | | | | - Sheldon Riklon
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
| | | | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville (USA)
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9
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Ferretti A, Ienca M, Sheehan M, Blasimme A, Dove ES, Farsides B, Friesen P, Kahn J, Karlen W, Kleist P, Liao SM, Nebeker C, Samuel G, Shabani M, Rivas Velarde M, Vayena E. Ethics review of big data research: What should stay and what should be reformed? BMC Med Ethics 2021; 22:51. [PMID: 33931049 PMCID: PMC8085804 DOI: 10.1186/s12910-021-00616-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/15/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Ethics review is the process of assessing the ethics of research involving humans. The Ethics Review Committee (ERC) is the key oversight mechanism designated to ensure ethics review. Whether or not this governance mechanism is still fit for purpose in the data-driven research context remains a debated issue among research ethics experts. MAIN TEXT In this article, we seek to address this issue in a twofold manner. First, we review the strengths and weaknesses of ERCs in ensuring ethical oversight. Second, we map these strengths and weaknesses onto specific challenges raised by big data research. We distinguish two categories of potential weakness. The first category concerns persistent weaknesses, i.e., those which are not specific to big data research, but may be exacerbated by it. The second category concerns novel weaknesses, i.e., those which are created by and inherent to big data projects. Within this second category, we further distinguish between purview weaknesses related to the ERC's scope (e.g., how big data projects may evade ERC review) and functional weaknesses, related to the ERC's way of operating. Based on this analysis, we propose reforms aimed at improving the oversight capacity of ERCs in the era of big data science. CONCLUSIONS We believe the oversight mechanism could benefit from these reforms because they will help to overcome data-intensive research challenges and consequently benefit research at large.
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Affiliation(s)
- Agata Ferretti
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Hottingerstrasse 10 (HOA), 8092, Zürich, Switzerland.
| | - Marcello Ienca
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Hottingerstrasse 10 (HOA), 8092, Zürich, Switzerland
| | - Mark Sheehan
- The Ethox Centre, Department of Population Health, University of Oxford, Oxford, UK
| | - Alessandro Blasimme
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Hottingerstrasse 10 (HOA), 8092, Zürich, Switzerland
| | - Edward S Dove
- School of Law, University of Edinburgh, Edinburgh, UK
| | | | - Phoebe Friesen
- Biomedical Ethics Unit, Department of Social Studies of Medicine, McGill University, Montreal, Canada
| | - Jeff Kahn
- Johns Hopkins Berman Institute of Bioethics, Baltimore, USA
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Peter Kleist
- Cantonal Ethics Committee Zürich, Zürich, Switzerland
| | - S Matthew Liao
- Center for Bioethics, Department of Philosophy, New York University, New York, USA
| | - Camille Nebeker
- Research Center for Optimal Digital Ethics in Health (ReCODE Health), Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, USA
| | - Gabrielle Samuel
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Mahsa Shabani
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Minerva Rivas Velarde
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Effy Vayena
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Hottingerstrasse 10 (HOA), 8092, Zürich, Switzerland
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10
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Feiler T, Schlote Y, Schunkert H. [Banks, archives or libraries? Models for the ethical foundation of biobanks]. Dtsch Med Wochenschr 2021; 146:623-626. [PMID: 33906242 DOI: 10.1055/a-1294-1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
At present, when it comes to research with biomedical data, research interests and data protection seem to be irreconcilable. Such differences are best mediated by an institution. The presuppositions of biobanking can be productively questioned with respect to public libraries. These represent a successful combination of knowledge and power, security and freedom.
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Affiliation(s)
- Therese Feiler
- Institut für Technik, Theologie und Naturwissenschaften, Evangelisch-Theologische Fakultät, Ludwig-Maximilians-Universität München
| | - Yannick Schlote
- Institut für Technik, Theologie und Naturwissenschaften, Evangelisch-Theologische Fakultät, Ludwig-Maximilians-Universität München
| | - Heribert Schunkert
- Institut für Technik, Theologie und Naturwissenschaften, Evangelisch-Theologische Fakultät, Ludwig-Maximilians-Universität München
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11
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Teare HJA, Prictor M, Kaye J. Reflections on dynamic consent in biomedical research: the story so far. Eur J Hum Genet 2021; 29:649-656. [PMID: 33249421 PMCID: PMC7695991 DOI: 10.1038/s41431-020-00771-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022] Open
Abstract
Dynamic consent (DC) was originally developed in response to challenges to the informed consent process presented by participants agreeing to 'future research' in biobanking. In the past 12 years, it has been trialled in a number of different projects, and examined as a new approach for consent and to support patient engagement over time. There have been significant societal shifts during this time, namely in our reliance on digital tools and the use of social media, as well as a greater appreciation of the integral role of patients in biomedical research. This paper reflects on the development of DC to understand its importance in an age where digital health is becoming the norm and patients require greater oversight and control of how their data may be used in a range of settings. As well as looking back, it looks forwards to consider how DC could be further utilised to enhance the patient experience and address some of the inequalities caused by the digital divide in society.
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Affiliation(s)
- Harriet J A Teare
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK.
| | - Megan Prictor
- Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK
- Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
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12
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McKeown A, Mourby M, Harrison P, Walker S, Sheehan M, Singh I. Ethical Issues in Consent for the Reuse of Data in Health Data Platforms. SCIENCE AND ENGINEERING ETHICS 2021; 27:9. [PMID: 33538942 PMCID: PMC7862505 DOI: 10.1007/s11948-021-00282-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 12/21/2020] [Indexed: 05/08/2023]
Abstract
Data platforms represent a new paradigm for carrying out health research. In the platform model, datasets are pooled for remote access and analysis, so novel insights for developing better stratified and/or personalised medicine approaches can be derived from their integration. If the integration of diverse datasets enables development of more accurate risk indicators, prognostic factors, or better treatments and interventions, this obviates the need for the sharing and reuse of data; and a platform-based approach is an appropriate model for facilitating this. Platform-based approaches thus require new thinking about consent. Here we defend an approach to meeting this challenge within the data platform model, grounded in: the notion of 'reasonable expectations' for the reuse of data; Waldron's account of 'integrity' as a heuristic for managing disagreement about the ethical permissibility of the approach; and the element of the social contract that emphasises the importance of public engagement in embedding new norms of research consistent with changing technological realities. While a social contract approach may sound appealing, however, it is incoherent in the context at hand. We defend a way forward guided by that part of the social contract which requires public approval for the proposal and argue that we have moral reasons to endorse a wider presumption of data reuse. However, we show that the relationship in question is not recognisably contractual and that the social contract approach is therefore misleading in this context. We conclude stating four requirements on which the legitimacy of our proposal rests.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry, Wellcome Centre for Ethics and Humanities, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
| | - Miranda Mourby
- Centre for Health, Law and Emerging Technologies (HeLEX), University of Oxford, Oxford, UK
| | - Paul Harrison
- Department of Psyhiatry, Oxford Health NHS Foundation Trust, University of Oxford, Oxford, UK
| | - Sophie Walker
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mark Sheehan
- Ethox, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Ilina Singh
- Department of Psychiatry, Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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13
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Haas MA, Teare H, Prictor M, Ceregra G, Vidgen ME, Bunker D, Kaye J, Boughtwood T. 'CTRL': an online, Dynamic Consent and participant engagement platform working towards solving the complexities of consent in genomic research. Eur J Hum Genet 2021; 29:687-698. [PMID: 33408362 PMCID: PMC8115139 DOI: 10.1038/s41431-020-00782-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
The complexities of the informed consent process for participating in research in genomic medicine are well-documented. Inspired by the potential for Dynamic Consent to increase participant choice and autonomy in decision-making, as well as the opportunities for ongoing participant engagement it affords, we wanted to trial Dynamic Consent and to do so developed our own web-based application (web app) called CTRL (control). This paper documents the design and development of CTRL, for use in the Australian Genomics study: a health services research project building evidence to inform the integration of genomic medicine into mainstream healthcare. Australian Genomics brought together a multi-disciplinary team to develop CTRL. The design and development process considered user experience; security and privacy; the application of international standards in data sharing; IT, operational and ethical issues. The CTRL tool is now being offered to participants in the study, who can use CTRL to keep personal and contact details up to date; make consent choices (including indicate preferences for return of results and future research use of biological samples, genomic and health data); follow their progress through the study; complete surveys, contact the researchers and access study news and information. While there are remaining challenges to implementing Dynamic Consent in genomic research, this study demonstrates the feasibility of building such a tool, and its ongoing use will provide evidence about the value of Dynamic Consent in large-scale genomic research programs.
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Affiliation(s)
- Matilda A Haas
- Australian Genomics Health Alliance, Parkville, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Harriet Teare
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK
| | - Megan Prictor
- Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | | | - Miranda E Vidgen
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - David Bunker
- Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK.,Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | - Tiffany Boughtwood
- Australian Genomics Health Alliance, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
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14
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Heslop PA, Davies K, Sayer A, Witham M. Making consent for electronic health and social care data research fit for purpose in the 21st century. BMJ Health Care Inform 2020; 27:bmjhci-2020-100128. [PMID: 32616478 PMCID: PMC7333808 DOI: 10.1136/bmjhci-2020-100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Philip Anthony Heslop
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom .,NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Karen Davies
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom
| | - Avan Sayer
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom.,NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Miles Witham
- AGE Research Group, Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing & Vitality, Newcastle University, Newcastle University, United Kingdom.,NIHR Newcastle Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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