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Uhrig JD, Corbo AM, Brown JA, Baker K, Foster M, Jordan A, Moretti D, Rescate A, Gieck C, Gras-Najjar J, Ortiz A, DeBree S, Lewis MA. Applying Engagement Marketing And Human-Centered Design to Cocreate a Digital Decision Support Tool for Research Participation with LGBTQIA+ Community Members. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024. [PMID: 39207266 DOI: 10.1089/cyber.2023.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
We used engagement marketing and human-centered design principles to cocreate a digital decision support tool for research participation with LGBTQIA+ community members to help them make an informed decision about joining the All of Us Research Program. Building on results from the research phase, we conducted eight problem validation and solutioning workshops with 48 LGBTQIA+ community members. Community members validated barriers to engagement with All of Us and brainstormed 47 potential digital solutions. We developed potential solutions into 27 concepts (descriptive text and visual storyboards) and assessed acceptability, appropriateness, feasibility, and engagement in a set of 10 concept testing workshops with 57 community members. We developed one of the highest rated concepts, the "Decide Later Tool," into a prototype and tested it with 45 LGBTQIA+ community members and 14 community advisory group members to assess acceptability, appropriateness, feasibility, usability, and engagement. Prototype testing participants indicated that the tool provides information to help with decision making, provides a clear value or benefit to them, was designed for someone like them, provides the right amount of information, and is easy to use; they also offered constructive feedback to improve it. Across the design and development phases, community members indicated that the process of engaging them demonstrated integrity, competence, dependability, trust, and collaboration; fostered a sense of connection to All of Us; and will enhance future engagement with All of Us. Our next steps are to develop the prototype into a fully functioning web tool and pilot test it in community and health care settings.
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Affiliation(s)
| | - Allyson M Corbo
- RTI International, Research Triangle Park, North Carolina, USA
| | - Jill A Brown
- RTI International, Research Triangle Park, North Carolina, USA
| | - Katie Baker
- RTI International, Research Triangle Park, North Carolina, USA
| | - Marcel Foster
- RTI International, Research Triangle Park, North Carolina, USA
- Jameel Arts & Health Lab, New York University, New York, New York, USA
| | - Alyssa Jordan
- RTI International, Research Triangle Park, North Carolina, USA
| | - Daniel Moretti
- PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Ana Rescate
- PRIDEnet, Stanford University School of Medicine, Stanford, California, USA
| | - Chelsea Gieck
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Alexa Ortiz
- RTI International, Research Triangle Park, North Carolina, USA
| | - Schuyler DeBree
- RTI International, Research Triangle Park, North Carolina, USA
| | - Megan A Lewis
- RTI International, Research Triangle Park, North Carolina, USA
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Masucci M, Karlsson C, Blomqvist L, Ernberg I. Bridging the Divide: A Review on the Implementation of Personalized Cancer Medicine. J Pers Med 2024; 14:561. [PMID: 38929782 PMCID: PMC11204735 DOI: 10.3390/jpm14060561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/05/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
The shift towards personalized cancer medicine (PCM) represents a significant transformation in cancer care, emphasizing tailored treatments based on the genetic understanding of cancer at the cellular level. This review draws on recent literature to explore key factors influencing PCM implementation, highlighting the role of innovative leadership, interdisciplinary collaboration, and coordinated funding and regulatory strategies. Success in PCM relies on overcoming challenges such as integrating diverse medical disciplines, securing sustainable investment for shared infrastructures, and navigating complex regulatory landscapes. Effective leadership is crucial for fostering a culture of innovation and teamwork, essential for translating complex biological insights into personalized treatment strategies. The transition to PCM necessitates not only organizational adaptation but also the development of new professional roles and training programs, underscoring the need for a multidisciplinary approach and the importance of team science in overcoming the limitations of traditional medical paradigms. The conclusion underscores that PCM's success hinges on creating collaborative environments that support innovation, adaptability, and shared vision among all stakeholders involved in cancer care.
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Affiliation(s)
- Michele Masucci
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18B, 171 65 Solna, Sweden
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solnavägen 9, 171 65 Solna, Sweden
| | - Claes Karlsson
- Department of Oncology-Pathology (Onc-Pat), Karolinska Institutet, Anna Steckséns gata 30A, D2:04, 171 65 Solna, Sweden;
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Anna Steckséns gata 53, 171 65 Solna, Sweden;
| | - Ingemar Ernberg
- Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solnavägen 9, 171 65 Solna, Sweden
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Hammack-Aviran C, Fair AM, Aldrich M, Richmond J, Carpenter SM, Watson KS, Cohn EG, Wilkins CH. Integrating participants as partners in research governance and operations: an approach from the All of Us Research Program Engagement Core. BMJ Open 2023; 13:e068100. [PMID: 38011981 PMCID: PMC10685928 DOI: 10.1136/bmjopen-2022-068100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES During the last two decades, researchers and funders increasingly recognised the value of engaging patients and communities in research. Despite progress, community engagement remains challenging. There are few examples of successful participant engagement in governance of large-scale research programmes. Here we describe efforts to engage participants as partners in new governance roles in the All of Us Research Program, a precision medicine research initiative which intends to enrol at least one million participants. Using intentional, participant-centric engagement strategies, the All of Us Engagement Core recruited and integrated a diverse group of participants into governance roles including Steering and Executive Committees. Evaluation measures included a survey to assess Consortium Members' readiness for participant engagement. RESULTS Over a 3-year period, all items on the survey increased (higher readiness). Of the 291 respondents to the 2021 survey, respondents most frequently agreed that participant perspectives are essential (100%), participants understand enough to contribute meaningfully (94%) and participants should be involved in setting goals (96%). Respondents least frequently agreed that participants should have an equal voice in Working Groups (75%), Steering Committee (69%) and Executive Committee (63%). CONCLUSION In conclusion, participants can be effectively integrated into large-scale research governance, which is associated with increased researcher readiness for engagement.
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Affiliation(s)
- Catherine Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Ethics, Education, Policy, and Society, Research Immersion Program at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alecia Malin Fair
- Department of Medicine; Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melinda Aldrich
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Richmond
- Department of Social Sciences and Health Policy and Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Selena McCoy Carpenter
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karriem S Watson
- All of Us Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth G Cohn
- Zucker School of Medicine, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Consuelo Hopkins Wilkins
- Department of Medicine; Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Fernández-Rhodes L. Beyond borders: A commentary on the benefit of promoting immigrant populations in genome-wide association studies. HGG ADVANCES 2023; 4:100205. [PMID: 37287864 PMCID: PMC10241976 DOI: 10.1016/j.xhgg.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Immigrants are an important part of many high-income nations, in that they contribute to the sociocultural tapestry, economic well-being, and demographic diversity of their receiving countries and communities. Yet, genomic studies to date have generally focused on non-immigrant, European-ancestry populations. Although this approach has proven fruitful in discovering and validating genomic loci, within the context of racially/ethnically diverse countries like the United States-wherein half of immigrants hail from Latin America and another quarter from Asia-this approach is insufficient. There is a persistent diversity gap in genomic research in terms of both current samples and genome-wide association studies, meaning that the field's understanding of genetic architecture and gene-environmental interactions is being hampered. In this commentary, I provide motivating examples of recent research developments related to the following: (1) how the increased ancestral diversity, such as seen among Latin American immigrants, improves power to discover and document genomic loci, (2) informs how environmental factors, such as immigration-related exposures, interact with genotypes to influence phenotypes, and (3) how inclusion can be promoted through community-engaged research programs and policies. I conclude that greater inclusion of immigrants in genomic research can move the field forward toward novel discoveries and interventions to address racial/ethnic health disparities.
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Affiliation(s)
- Lindsay Fernández-Rhodes
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802, USA
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Borthwick J, Evertsz N, Pratt B. How should communities be meaningfully engaged (if at all) when setting priorities for biomedical research? Perspectives from the biomedical research community. BMC Med Ethics 2023; 24:6. [PMID: 36747191 PMCID: PMC9900561 DOI: 10.1186/s12910-022-00879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is now rising consensus that community engagement is ethically and scientifically essential for all types of health research. Yet debate continues about the moral aims, methods and appropriate timing in the research cycle for community engagement to occur, and whether the answer should vary between different types of health research. Co-design and collaborative partnership approaches that involve engagement during priority-setting, for example, are common in many forms of applied health research but are not regular practice in biomedical research. In this study, we empirically examine the normative question: should communities be engaged when setting priorities for biomedical research projects, and, if so, how and for what purpose? METHODS We conducted in-depth interviews with 31 members of the biomedical research community from the UK, Australia, and African countries who had engaged communities in their work. Interview data were thematically analysed. RESULTS Our study shows that biomedical researchers and community engagement experts strongly support engagement in biomedical research priority-setting, except under certain circumstances where it may be harmful to communities. However, they gave two distinct responses on what ethical purpose it should serve-either empowerment or instrumental goals-and their perspectives on how it should achieve those goals also varied. Three engagement approaches were suggested: community-initiated, synergistic, and consultative. Pre-engagement essentials and barriers to meaningful engagement in biomedical research priority-setting are also reported. CONCLUSIONS This study offers initial evidence that meaningful engagement in priority-setting should potentially be defined slightly differently for biomedical research relative to certain types of applied health research and that engagement practice in biomedical research should not be dominated by instrumental goals and approaches, as is presently the case.
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Affiliation(s)
- Josephine Borthwick
- Royal Australian College of General Practitioners, Melbourne, Australia
- Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd., Brisbane, Australia
| | | | - Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd., Brisbane, Australia.
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Fair A, Watson KS, Cohn EG, Carpenter SM, Richardson-Heron D, Wilkins CH. Innovation in Large-Scale Research Programs: Elevating Research Participants to Governance Roles Through the All of Us Research Program Engagement Core. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1794-1798. [PMID: 36449919 PMCID: PMC9698090 DOI: 10.1097/acm.0000000000004950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PROBLEM Despite the successes of community-engaged research in advancing research relevance and health equity for diverse communities, the impact of this research has been limited to local and regional programs. Engaging diverse community voices in large-scale, national research programs represents a paradigm shift in biomedical research. Still, disconnects remain between research decision makers and the communities they serve, impeding richer, bidirectional engagement. APPROACH An engagement core team was established within National Institutes of Health All of Us Research Program (AoURP) in 2018 to synthesize community-engaged research practices and establish infrastructure that operationalizes diverse research participant engagement. The authors integrated research participants as "participant partners" within the AoURP governance, an approach that is embedded into the engagement core's 3 aims: (1) integrate a diverse pool of participants into the program, (2) identify and meaningfully engage a cadre of diverse participants into program governance, and (3) assess the impact of such engagement on research. Participant partners are compensated as consultants at approximately $50/hour. OUTCOMES As of August 2022, more than 515,000 individuals consented to participate in the AoURP, with more than 49% representing racial/ethnic minorities. The authors invited participants to self-nominate if interested in engaging in research working groups, decision making, and governance. Also, consortium partners nominated individuals on AoURP community advisory and/or participant advisory boards to serve as participant ambassadors. Ten individuals were selected as participant partners for the 2022-2025 term. Eight serve on the steering committee; of those, 4 serve on the executive committee; 2 more serve on the advisory panel. An additional 23 serve as participant ambassadors. NEXT STEPS The authors continue to increase the number of research participants serving as engaged partners in the program. Engagement approaches will be systematically evaluated with the goal of adoption by other large-scale research programs.
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Affiliation(s)
- Alecia Fair
- A. Fair is research assistant professor, Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; ORCID: https://orcid.org/0000-0003-0144-1425
| | - Karriem S. Watson
- K.S. Watson was associate executive director at University of Illinois Mile Square Health Center, Chicago, Illinois, at the time of writing and is now chief engagement officer, All of Us Research Program, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-5575-7102
| | - Elizabeth G. Cohn
- E.G. Cohn is the Rudin Professor of Community Health, Hunter-Bellevue School of Nursing, New York, New York; ORCID: https://orcid.org/0000-0002-0923-7827
| | - Selena M. Carpenter
- S.M. Carpenter is senior program manager, Office of Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee; ORCID: https://orcid.org/0000-0002-8837-7990
| | | | - Consuelo H. Wilkins
- C.H. Wilkins is professor of medicine, Division of Geriatric Medicine, and senior vice president and senior associate dean for health equity and inclusive excellence, Vanderbilt University Medical Center, Nashville, Tennessee; ORCID: https://orcid.org/0000-0002-8043-513X
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Cotton RJ, Segal Rick RL, Seamon BA, Sahu A, McLeod MM, Davis RD, Ramey SL, French MA, Roemmich RT, Daley K, Beier M, Penttinen S, Raghavan P, Searson P, Wegener S, Celnik P. Precision Rehabilitation: Optimizing Function, Adding Value to Health Care. Arch Phys Med Rehabil 2022; 103:1883-1884. [PMID: 35690092 PMCID: PMC9979846 DOI: 10.1016/j.apmr.2022.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 01/16/2023]
Affiliation(s)
- R James Cotton
- Department of Physical Medicine and Rehabilitation, Northwestern University; Shirley Ryan AbilityLab, Chicago, Illinois
| | - Richard L Segal Rick
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; National Center of Neuromodulation for Rehabilitation, Medical University of South Carolina, Charleston, South Carolina; NIH/NICHD/NCMRR Medical Rehabilitation Research Resource Network National Coordinating Center, Charleston, South Carolina
| | - Bryant A Seamon
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Amrita Sahu
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Michelle M McLeod
- National Center of Neuromodulation for Rehabilitation (NC NM4R), Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Randal D Davis
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina; National Center of Neuromodulation for Rehabilitation, Medical University of South Carolina, Charleston, South Carolina
| | - Sharon Landesman Ramey
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia; VTC School of Medicine, Roanoke, Virginia
| | - Margaret A French
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Ryan T Roemmich
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Meghan Beier
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Sharon Penttinen
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Peter Searson
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
| | - Pablo Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Center for Movement Studies, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Institute of Nanobiotechnology, Johns Hopkins University, Baltimore, Maryland
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Hammack-Aviran C, Eilmus A, Diehl C, Gottlieb KG, Gonzales G, Davis LK, Clayton EW. LGBTQ+ Perspectives on Conducting Genomic Research on Sexual Orientation and Gender Identity. Behav Genet 2022; 52:246-267. [PMID: 35614288 PMCID: PMC9132750 DOI: 10.1007/s10519-022-10105-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
We conducted in-depth, semi-structured interviews with LGBTQ+-identified individuals (n = 31) to explore the range of LGBTQ+ perspectives on genomic research using either sexual orientation or gender identity (SOGI) data. Most interviewees presumed that research would confirm genetic contributions to sexual orientation and gender identity. Primary hopes for such confirmation included validating LGBTQ+ identities, improved access to and quality of healthcare and other resources, and increased acceptance in familial, socio-cultural, and political environments. Areas of concern included threats of pathologizing and medicalizing LGBTQ+ identities and experiences, undermining reproductive rights, gatekeeping of health or social systems, and malicious testing or misuse of genetic results, particularly for LGBTQ+ youth. Overall, interviewees were divided on the acceptability of genomic research investigating genetic contributions to sexual orientation and gender identity. Participants emphasized researchers' ethical obligations to LGBTQ+ individuals and endorsed engagement with LGBTQ+ communities throughout all aspects of genomic research using SOGI data.
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Affiliation(s)
- Catherine Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA
| | - Ayden Eilmus
- College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA
| | | | - Gilbert Gonzales
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lea K Davis
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN, USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA.
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