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Hansson MG, Lochmüller H, Riess O, Schaefer F, Orth M, Rubinstein Y, Molster C, Dawkins H, Taruscio D, Posada M, Woods S. The risk of re-identification versus the need to identify individuals in rare disease research. Eur J Hum Genet 2016; 24:1553-1558. [PMID: 27222291 PMCID: PMC5110051 DOI: 10.1038/ejhg.2016.52] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 12/25/2022] Open
Abstract
There is a growing concern in the ethics literature and among policy makers that
de-identification or coding of personal data and biospecimens is not sufficient for
protecting research subjects from privacy invasions and possible breaches of
confidentiality due to the possibility of unauthorized re-identification. At the same
time, there is a need in medical science to be able to identify individual patients.
In particular for rare disease research there is a special and well-documented need
for research collaboration so that data and biosamples from multiple independent
studies can be shared across borders. In this article, we identify the needs and
arguments related to de-identification and re-identification of patients and research
subjects and suggest how the different needs may be balanced within a framework of
using unique encrypted identifiers.
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Affiliation(s)
- Mats G Hansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Hanns Lochmüller
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, Rare Disease Center, University of Tübingen, Tübingen, Germany
| | - Franz Schaefer
- Division of Pediatric Nephrology, Heidelberg University Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Michael Orth
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - Yaffa Rubinstein
- Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, Bethesda, MD, USA
| | - Caron Molster
- Office of Population Health Genomics, Public Health and Clinical Services Division, Department of Health Government of Western Australia, Perth, WA, Australia
| | - Hugh Dawkins
- Office of Population Health Genomics, Public Health and Clinical Services Division, Department of Health Government of Western Australia, Perth, WA, Australia.,Centre for Comparative Genomics, Murdoch University, Murdoch, WA, Australia.,Centre for Population Health Research, Curtin University of Technology, Bentley, WA, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | - Domenica Taruscio
- National Center for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Manuel Posada
- Institute of rare Diseases research, ISCIII, SpainRDR and CIBERER, Madrid, Spain
| | - Simon Woods
- Policy Ethics and Life Sciences Research Centre, Newcastle University, Newcastle upon Tyne, UK
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Hall LN, Ficker LJ, Chadiha LA, Green CR, Jackson JS, Lichtenberg PA. Promoting Retention: African American Older Adults in a Research Volunteer Registry. Gerontol Geriatr Med 2016; 2:2333721416677469. [PMID: 28138501 PMCID: PMC5117259 DOI: 10.1177/2333721416677469] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/25/2016] [Accepted: 10/05/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives: The objectives of this study were to evaluate the capability of a research volunteer registry to retain community-dwelling African American older adults, and to explore demographic and health factors associated with retention. Method: A logistic regression model was used to determine the influence of demographics, health factors, and registry logic model activities on retention in a sample of 1,730 older African American adults. Results: Almost 80% of participants active in the volunteer research registry between January 2012 and June 2015 were retained. Employment, being referred to research studies, a higher number of medical conditions, and more follow-up contacts were associated with an increased likelihood of retention. Older age, more months in the registry, and more mobility problems decreased the likelihood of retention. Discussion: These results suggest the Michigan Center for Urban African American Aging Research logic model promotes retention through involving older African American adults in research through study referrals and intensive follow-up. The loss of participants due to age- and mobility-related issues indicate the registry may be losing its most vulnerable participants.
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Halkoaho A, Pietilä AM, Ebbesen M, Karki S, Kangasniemi M. Cultural aspects related to informed consent in health research: A systematic review. Nurs Ethics 2015; 23:698-712. [PMID: 25904548 DOI: 10.1177/0969733015579312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In order to protect the autonomy of human subjects, we need to take their culture into account when we are obtaining informed consent. OBJECTIVE AND RESEARCH DESIGN This study describes the cultural aspects related to informed consent in health research and is based on electronic searches that were conducted using the Scopus, PubMed, CINAHL, and Cochrane databases published between 2000 and 2013. A total of 25 articles were selected. FINDINGS Our findings indicate that cultural perspectives relating to the informed consent process are essential during the whole research process and particularly crucial in the planning phase of a study. Our study indicates that appropriate communication between different stakeholders plays a vital role in cultural understanding. DISCUSSION AND CONCLUSION The researchers' awareness of cultural differences and their ability to work in a culturally sensitive way are key factors in improving study participation and retention in a multicultural context. Taking cultural aspects into account during the whole research process improves the quality of research.
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Affiliation(s)
| | | | - Mette Ebbesen
- iPSYCH & Department of Culture and Society, Aarhus University, Denmark
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Korngut L, MacKean G, Casselman L, Johnston M, Day L, Lam D, Lorenzetti D, Warner J, Jetté N, Pringsheim T. Perspectives on neurological patient registries: a literature review and focus group study. BMC Med Res Methodol 2013; 13:135. [PMID: 24209392 PMCID: PMC4225768 DOI: 10.1186/1471-2288-13-135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 10/30/2013] [Indexed: 11/23/2022] Open
Abstract
Background Patient registries represent a well-established methodology for prospective data collection with a wide array of applications for clinical research and health care administration. An examination and synthesis of registry stakeholder perspectives has not been previously reported in the literature. Methods To inform the development of future neurological registries we examined stakeholder perspectives about such registries through a literature review followed by 3 focus groups comprised of a total of 15 neurological patients and 12 caregivers. Results (1) Literature review: We identified 6,435 abstracts after duplicates were removed. Of these, 410 articles underwent full text review with 24 deemed relevant to perspectives about neurological and non-neurological registries and were included in the final synthesis. From a patient perspective the literature supports altruism, responsible use of data and advancement of research, among others, as motivating factors for participating in a patient registry. Barriers to participation included concerns about privacy and participant burden (i.e. extra clinic visits and associated costs). (2) Focus groups: The focus groups identified factors that would encourage participation such as: having a clear purpose; low participant burden; and being well-managed among others. Conclusions We report the first examination and synthesis of stakeholder perspectives on registries broadly with a specific focus on neurological patient registries. The findings of the broad literature review were congruent with the neurological patient and caregiver focus groups. We report common themes across the literature and the focus groups performed. Stakeholder perspectives need to be considered when designing and operating patient registries. Emphasizing factors that promote participation and mitigating barriers may enhance patient recruitment.
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Affiliation(s)
- Lawrence Korngut
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Clinical Neurosciences, South Health Campus, 4448 Front Street SE, Calgary, Alberta T3M 1M4, Canada.
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Terry AL, Chesworth BM, Bourne RB, Stolee P, Speechley M. Joint replacement recipients' views about health information privacy. Health Expect 2013; 18:1519-29. [PMID: 24112312 DOI: 10.1111/hex.12142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Researchers are concerned about the possibility of restricted access to data as a result of specific consent requirements in privacy legislation, potentially resulting in smaller samples and a lack of representativeness which could bias results. In addition, there is uncertainty about what influences individuals to give consent for the use of their personal health information. OBJECTIVE To measure joint replacement recipients' health information privacy views and to assess potential predictors of these views. DESIGN Cross-sectional survey. SETTING AND PARTICIPANTS Potential joint replacement recipients from two teaching hospitals in London, Ontario, Canada. MAIN VARIABLES Age, gender, education, employment status, anticipated joint replacement, and expectations for surgery. MAIN OUTCOME MEASURES Privacy concerns as measured by the Concern Scale. RESULTS The response rate was 182/253 or 72%. The mean Concern score was 143.9/235.0 for the total sample (range = 82-216). Women had higher levels of privacy concerns than men on slightly over half of the individual questionnaire items. In women, surgical joint, age and employment explained 15% of the variance in concerns about personal health information privacy (P = 0.001). The model explained 6% of the variance in concerns in men (P = 0.138) and was not statistically significant. DISCUSSION AND CONCLUSION This study indicates that demographic characteristics and health-care experiences play a role in the variability of health information privacy concerns. A greater understanding of patients' privacy views about health information could lead to a greater harmonization among privacy rules, research and data access, and the preferences of health-care consumers.
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Affiliation(s)
- Amanda L Terry
- Departments of Family Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, The University of Western Ontario, London, ON, Canada
| | - Bert M Chesworth
- School of Physical Therapy and Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
| | - Robert B Bourne
- Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Stineman MG, Strumpf N, Kurichi JE, Charles J, Grisso JA, Jayadevappa R. Attempts to reach the oldest and frailest: recruitment, adherence, and retention of urban elderly persons to a falls reduction exercise program. THE GERONTOLOGIST 2011; 51 Suppl 1:S59-72. [PMID: 21565820 PMCID: PMC3092973 DOI: 10.1093/geront/gnr012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 02/01/2011] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To assess the recruitment, adherence, and retention of urban elderly, predominantly African Americans to a falls reduction exercise program. DESIGN AND METHODS The randomized controlled trial was designed as an intervention development pilot study. The goal was to develop a culturally sensitive intervention for elderly persons who suffered a fall and visited an emergency department (ED). Participants were taught exercises during 4 on-site group classes and encouraged to continue exercising at home for 12 weeks and attend additional on-site monthly classes. The protocol included a specifically designed intervention for increasing retention through trained community interventionists drawn from the participants' neighborhoods. RESULTS The screening of 1,521 ED records after falling yielded the recruitment of 204 patients aged 65 years and older. Half were randomized into the falls prevention program. Of the 102 people in the intervention group, 92 completed the final 6-month assessment, 68 attended all on-site sessions, but only 1 reported exercising at home all 12 weeks. Those who lived alone were more likely (p = .03) and those with symptoms of depression were less likely (p = .05) to attend all on-site exercise classes. The final recruitment rate was estimated as 31.8%. The final retention rates were 90.2% and 87.3% for the intervention and control groups, respectively. IMPLICATIONS Recruitment of frail elderly African American patients is resource intensive. Adherence to the on-site exercise classes was better than to the home-based component of the program. These findings have implications for the design of future community-based exercise programs and trials.
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Affiliation(s)
- Margaret G Stineman
- Physical Medicine and Rehabilitation and Epidemiology, University of Pennsylvania, 904 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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Du H, Valenzuela V, Diaz P, Cella D, Hahn EA. Factors affecting enrollment in literacy studies for English- and Spanish-speaking cancer patients. Stat Med 2008; 27:4119-31. [DOI: 10.1002/sim.3259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Richesson RL, Lee HS, Cuthbertson D, Lloyd J, Young K, Krischer JP. An automated communication system in a contact registry for persons with rare diseases: scalable tools for identifying and recruiting clinical research participants. Contemp Clin Trials 2008; 30:55-62. [PMID: 18804556 DOI: 10.1016/j.cct.2008.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 08/25/2008] [Accepted: 09/01/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Strategies for study recruitment are useful in clinical research network settings. We describe a registry of individuals who have self-identified with one of a multiplicity of rare diseases, and who express a willingness to be contacted regarding possible enrollment in clinical research studies. We evaluate this registry and supporting tools in terms of registry enrollment and impact on participation rates in advertised clinical research studies. METHODS A web-based automated system generates periodic and customized communications to notify registrants of relevant studies in the NIH Rare Diseases Clinical Research Network (RDCRN). The majority of these communications are sent by email. We compare the characteristics of those enrolled in the registry to the characteristics of participants enrolled in sampled RDCRN studies in order to estimate the impact of the registry on study participation in the network. RESULTS The registry currently contains over 4000 registrants, representing 40 rare diseases. Estimates of study participation range from 6-27% for all enrollees. Study participation rates for some disease areas are over 40% when considering only contact registry enrollees who live within 100 mi of a clinical research study site. CONCLUSIONS Automated notifications can facilitate consistent, customized, and timely communication of relevant protocol information to potential research subjects. Our registry and supporting communication tools demonstrate a significant positive impact on study participation rates in our network. The use of the internet and automated notifications make the system scalable to support many protocols and registrants.
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Affiliation(s)
- R L Richesson
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL 33612, United States.
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10
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Marco CA. Impact of Detailed Informed Consent on Research Subjects’ Participation: A Prospective, Randomized Trial. J Emerg Med 2008; 34:269-75. [DOI: 10.1016/j.jemermed.2007.06.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 12/06/2006] [Accepted: 02/11/2007] [Indexed: 10/22/2022]
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Terry AL, Chesworth BM, Stolee P, Bourne RB, Speechley M. Joint replacement recipients' post-surgery views about health information privacy and registry participation. Health Policy 2007; 85:293-304. [PMID: 17904684 DOI: 10.1016/j.healthpol.2007.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 07/31/2007] [Accepted: 08/19/2007] [Indexed: 10/22/2022]
Abstract
Patient registries have been demonstrated to improve health care, and represent an important source of data to health researchers and policy-makers. Building on our previous research that tested an explanatory model of health information privacy views with pre-operative joint replacement recipients, in the present study we explored privacy views and willingness to participate in registries among post-operative joint replacement recipients. Post-operative patients were asked to complete a self-administered mailed questionnaire. One hundred and fifty-seven of 173 (91%) eligible individuals were enrolled. Bivariate analyses were conducted using t-tests and one-way ANOVAs. Multivariable analyses were conducted using multiple linear regression. Overall, our previous findings that views about health information privacy are more predictive of potential registry participation than patient characteristics or health care experiences continue to hold true post-surgery. Certain health care experiences were found to play a role in health information privacy concerns, including hip versus knee replacement, primary versus revision surgery, and surgical complications. More variance was explained in post-surgery registry participation views than pre-surgery. In addition, gender differences in R(2) values were smaller post-surgery. However, some aspects of the final models, such as gender as an effect modifier continued in the post-surgery study. Researchers and policy-makers should consider the impact of encounters with the health care system when seeking to understand patients' privacy concerns and willingness to participate in registries.
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Affiliation(s)
- Amanda L Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
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Nosowsky R, Giordano TJ. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rule: implications for clinical research. Annu Rev Med 2006; 57:575-90. [PMID: 16409167 DOI: 10.1146/annurev.med.57.121304.131257] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the short time since it became effective for health care organizations, a privacy regulation issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has had a significant adverse impact on the conduct of clinical research in the United States, without a substantial corresponding increase in privacy protection for research participants. Some of the problems associated with HIPAA have been resolved through revisions since the regulation's initial promulgation in December 2000, and other problems can be addressed by better educating health care providers and researchers about its requirements and available alternatives for compliance; however, considerable structural challenges remain. These constitute substantial barriers to research and resulting medical advances. Additional revisions to HIPAA based on the principles and trade-offs reflected in the Common Rule-which responsibly balances an individual's interest in privacy protection with the public interest in gaining knowledge through biomedical research-can go a long way to remedying remaining flaws in the system.
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Affiliation(s)
- Rachel Nosowsky
- Office of the Vice President and General Counsel, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Schwartz MF, Brecher AR, Whyte J, Klein MG. A patient registry for cognitive rehabilitation research: a strategy for balancing patients' privacy rights with researchers' need for access. Arch Phys Med Rehabil 2005; 86:1807-14. [PMID: 16181947 DOI: 10.1016/j.apmr.2005.03.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe a consent-based Patient Research Registry designed to improve the quality and efficiency of cognitive rehabilitation research by balancing patients' privacy rights with researchers' need for access to research participants. DESIGN Description of a protocol for a Patient Research Registry. SETTING Three rehabilitation hospitals. PARTICIPANTS Inpatients with stroke or traumatic brain injury (TBI) at the 3 participating hospitals. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Percentages of eligible patients with stroke or TBI who consented to be enrolled in the Registry, were subsequently contacted about a study, and ultimately participated in a study. A survey examined satisfaction with the Registry among researchers who used it for recruitment. RESULTS After 36 months of operation, 58% of patients approached have consented to be in the Registry (N=1256). Eighty-seven percent of those later identified as potential subjects for research studies expressed interest, and 63% eventually participated. Researchers reported satisfaction with the recruitment opportunities afforded by the Registry. CONCLUSIONS The Registry succeeded in identifying eligible patients interested in participating in research studies, while safeguarding their privacy rights. We identify its strengths and limitations and characterize the type of facility that would most profit from adopting this recruitment model.
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Affiliation(s)
- Myrna F Schwartz
- Moss Rehabilitation Research Institute, Philadelphia, PA; Thomas Jefferson University, Philadelphia, PA 19141, USA.
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