1
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de Groot NF. A contextual integrity approach to genomic information: what bioethics can learn from big data ethics. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:367-379. [PMID: 38865053 PMCID: PMC11310229 DOI: 10.1007/s11019-024-10211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
Genomic data is generated, processed and analysed at an increasingly rapid pace. This data is not limited to the medical context, but plays an important role in other contexts in society, such as commercial DNA testing, the forensic setting, archaeological research, and genetic surveillance. Genomic information also crosses the borders of these domains, e.g. forensic use of medical genetic information, insurance use of medical genomic information, or research use of commercial genomic data. This paper (1) argues that an informed consent approach for genomic information has limitations in many societal contexts, and (2) seeks to broaden the bioethical debate on genomic information by suggesting an approach that is applicable across multiple societal contexts. I argue that the contextual integrity framework, a theory rooted in information technology and big data ethics, is an effective tool to explore ethical challenges that arise from genomic information within a variety of different contexts. Rather than focusing on individual control over information, the contextual integrity approach holds that information should be shared and protected according to the norms that govern certain distinct social contexts. Several advantages of this contextual integrity approach will be discussed. The paper concludes that the contextual integrity framework helps to articulate and address a broad spectrum of ethical, social, and political factors in a variety of different societal contexts, while giving consideration to the interests of individuals, groups, and society at large.
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Affiliation(s)
- Nina F de Groot
- Department of Philosophy, Faculty of Humanities, VU University Amsterdam, Amsterdam, the Netherlands.
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2
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Song R. Waiving the consent requirement to mitigate bias in observational precision medicine research. Int J Equity Health 2024; 23:142. [PMID: 39026212 PMCID: PMC11256561 DOI: 10.1186/s12939-024-02221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
Consent bias is a type of selection bias in biomedical research where those consenting to the research differ systematically from those not consenting. It is particularly relevant in precision medicine research because the complexity of these studies prevents certain subgroups from understanding, trusting, and consenting to the research. Because consent bias distorts research findings and causes inequitable distribution of research benefits, scholars propose two types of schemes to reduce consent bias: reforming existing consent models and removing the consent requirement altogether. This study explores the possibility of waiving consent in observational studies using existing data, because they involve fewer risks to participants than clinical trials if privacy safeguards are strengthened. It suggests that data protection mechanisms such as security enhancement and data protection impact assessment should be conducted to protect data privacy of participants in observational studies without consent.
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Affiliation(s)
- Ruifeng Song
- Faculty of Law, The University of Hong Kong, Pokfulam, Hong Kong, China.
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3
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Gibbon VE, Thompson JC, Alves S. Informed proxy consent for ancient DNA research. Commun Biol 2024; 7:815. [PMID: 38965340 PMCID: PMC11224335 DOI: 10.1038/s42003-024-06413-0] [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: 03/27/2023] [Accepted: 06/05/2024] [Indexed: 07/06/2024] Open
Abstract
Embracing the underlying principles and processes of informed proxy consent or relational autonomy consent in human ancient DNA research can transform research.
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Affiliation(s)
- Victoria E Gibbon
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, University of Cape Town, Observatory 7935, Cape Town, South Africa.
| | - Jessica C Thompson
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT, 06511, USA
- Yale Peabody Museum, Yale University, 170 Whitney Avenue, New Haven, CT, 06511, USA
| | - Sianne Alves
- Office for Inclusivity & Change, Office of the Deputy Vice Chancellor for Transformation: University of Cape Town, Ivan Toms Building, 28 Rhodes Avenue Mowbray, Cape Town, South Africa
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4
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Martyn M, Forbes E, Lee L, Kanga-Parabia A, Weerasuriya R, Lynch E, Gleeson P, Gaff C. Secondary use of genomic data: patients' decisions at point of testing and perspectives to inform international data sharing. Eur J Hum Genet 2024; 32:717-724. [PMID: 38528053 PMCID: PMC11153578 DOI: 10.1038/s41431-023-01531-5] [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: 04/27/2023] [Revised: 09/14/2023] [Accepted: 12/19/2023] [Indexed: 03/27/2024] Open
Abstract
International sharing of genomic data files arising from clinical testing of patients is essential to further improve genomic medicine. Whilst the general public are reluctant to donate DNA for research, the choices patients actually make about sharing their clinical genomic data for future re-use (research or clinical) are unknown. We ascertained the data-sharing choices of 1515 patients having genomic testing for inherited conditions or cancer treatment from clinical consent forms. To understand the experiences and preferences of these patients, surveys were administered after test consent (RR 73%). Almost all patients (98%) consented to share their data. Survey respondents' decision recall was high (90%), but poorer if English was an additional language (p < 0.001). Parents deciding on behalf of children were over-represented amongst data-sharing decliners (p = 0.047) and decliners were more likely to believe that stored data could be easily reidentified (p < 0.001). A quarter of respondents did not know if reidentification would be easy and 44% of them were concerned about this possibility. Of those willing to share data overseas (60%), 23% indicated the recipient researcher's country would affect their decision. Most respondents (89%) desired some ongoing control over research use of their data. Four preliminary data-sharing profiles emerged; their further development could inform tailored patient resources. Our results highlight considerations for establishment of systems to make clinical genomic data files available for reanalysis locally and across borders. Patients' willingness to share their data - and value of the resulting research - should encourage clinical laboratories to consider sharing data systematically for secondary uses.
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Affiliation(s)
- Melissa Martyn
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Emily Forbes
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
| | - Ling Lee
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Anaita Kanga-Parabia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, 3052, Australia
| | - Rona Weerasuriya
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
| | - Elly Lynch
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, 3052, Australia
| | - Penny Gleeson
- Deakin Law school, Deakin University, Burwood, VIC, 3125, Australia
| | - Clara Gaff
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- Melbourne Genomics Health Alliance, Parkville, VIC, 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia.
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5
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Savage SK, LoTempio J, Smith ED, Andrew EH, Mas G, Kahn-Kirby AH, Délot E, Cohen AJ, Pitsava G, Nussbaum R, Fusaro VA, Berger S, Vilain E. Using a chat-based informed consent tool in large-scale genomic research. J Am Med Inform Assoc 2024; 31:472-478. [PMID: 37665746 PMCID: PMC10797258 DOI: 10.1093/jamia/ocad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/03/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE We implemented a chatbot consent tool to shift the time burden from study staff in support of a national genomics research study. MATERIALS AND METHODS We created an Institutional Review Board-approved script for automated chat-based consent. We compared data from prospective participants who used the tool or had traditional consent conversations with study staff. RESULTS Chat-based consent, completed on a user's schedule, was shorter than the traditional conversation. This did not lead to a significant change in affirmative consents. Within affirmative consents and declines, more prospective participants completed the chat-based process. A quiz to assess chat-based consent user understanding had a high pass rate with no reported negative experiences. CONCLUSION Our report shows that a structured script can convey important information while realizing the benefits of automation and burden shifting. Analysis suggests that it may be advantageous to use chatbots to scale this rate-limiting step in large research projects.
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Affiliation(s)
| | - Jonathan LoTempio
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
| | - Erica D Smith
- Invitae Corporation, San Francisco, CA, United States
| | - E Hallie Andrew
- Division of Genetics and Metabolism, Children's National Rare Disease Institute, Washington, DC, United States
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, DC, United States
| | - Gloria Mas
- Invitae Corporation, San Francisco, CA, United States
| | - Amanda H Kahn-Kirby
- Invitae Corporation, San Francisco, CA, United States
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
| | - Emmanuèle Délot
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, DC, United States
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, United States
| | - Andrea J Cohen
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, DC, United States
| | - Georgia Pitsava
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, DC, United States
| | | | - Vincent A Fusaro
- Invitae Corporation, San Francisco, CA, United States
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
| | - Seth Berger
- Division of Genetics and Metabolism, Children's National Rare Disease Institute, Washington, DC, United States
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, DC, United States
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, United States
| | - Eric Vilain
- Institute for Clinical and Translational Science, University of California, Irvine, CA, United States
- Center for Genetic Medicine Research, Children's National Research Institute, Washington, DC, United States
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, United States
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6
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Oliva A, Kaphle A, Reguant R, Sng LMF, Twine NA, Malakar Y, Wickramarachchi A, Keller M, Ranbaduge T, Chan EKF, Breen J, Buckberry S, Guennewig B, Haas M, Brown A, Cowley MJ, Thorne N, Jain Y, Bauer DC. Future-proofing genomic data and consent management: a comprehensive review of technology innovations. Gigascience 2024; 13:giae021. [PMID: 38837943 PMCID: PMC11152178 DOI: 10.1093/gigascience/giae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/15/2024] [Accepted: 04/09/2024] [Indexed: 06/07/2024] Open
Abstract
Genomic information is increasingly used to inform medical treatments and manage future disease risks. However, any personal and societal gains must be carefully balanced against the risk to individuals contributing their genomic data. Expanding our understanding of actionable genomic insights requires researchers to access large global datasets to capture the complexity of genomic contribution to diseases. Similarly, clinicians need efficient access to a patient's genome as well as population-representative historical records for evidence-based decisions. Both researchers and clinicians hence rely on participants to consent to the use of their genomic data, which in turn requires trust in the professional and ethical handling of this information. Here, we review existing and emerging solutions for secure and effective genomic information management, including storage, encryption, consent, and authorization that are needed to build participant trust. We discuss recent innovations in cloud computing, quantum-computing-proof encryption, and self-sovereign identity. These innovations can augment key developments from within the genomics community, notably GA4GH Passports and the Crypt4GH file container standard. We also explore how decentralized storage as well as the digital consenting process can offer culturally acceptable processes to encourage data contributions from ethnic minorities. We conclude that the individual and their right for self-determination needs to be put at the center of any genomics framework, because only on an individual level can the received benefits be accurately balanced against the risk of exposing private information.
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Affiliation(s)
- Adrien Oliva
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Anubhav Kaphle
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Roc Reguant
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Letitia M F Sng
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Natalie A Twine
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Yuwan Malakar
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, 41 Boggo Rd, Dutton Park QLD 4102, Australia
| | - Anuradha Wickramarachchi
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
| | - Marcel Keller
- Data61, Commonwealth Scientific and Industrial Research Organisation, Level 5/13 Garden St, Eveleigh NSW 2015, Australia
| | - Thilina Ranbaduge
- Data61, Commonwealth Scientific and Industrial Research Organisation, Building 101, Clunies Ross St, Black Mountain, Canberra, ACT 2601, Australia
| | - Eva K F Chan
- NSW Health Pathology, Sydney, 1 Reserve Road, St Leonards NSW 2065, Australia
| | - James Breen
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Sam Buckberry
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Boris Guennewig
- Sydney Medical School, Brain and Mind Centre, The University of Sydney, Sydney, 94 Mallett St, Camperdown NSW 2050, Australia
| | - Matilda Haas
- Australian Genomics, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria 3052, Australia
| | - Alex Brown
- Telethon Kids Institute, Perth, WA 6009, Australia
- National Centre for Indigenous Genomics, The John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Mark J Cowley
- Children’s Cancer Institute, Lowy Cancer Research Centre, Level 4, Lowy Cancer Research Centre Corner Botany & High Streets UNSW Kensington Campus UNSW Sydney, Kensington NSW 2052, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW Sydney, Kensington NSW 2052, Australia
| | - Natalie Thorne
- University of Melbourne, Melbourne, Parkville VIC 3052, Australia
- Melbourne Genomics Health Alliance, Melbourne 1G, Walter and Eliza Hall Institute/1G Royal Parade, Parkville VIC 3052, Australia
- Walter and Eliza Hall Institute, Melbourne, 1G, Walter and Eliza Hall Institute/1G Royal Parade, Parkville VIC 3052, Australia
| | - Yatish Jain
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 3/160 Hawkesbury Rd, Westmead NSW 2145, Australia
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Applied BioSciences 205B Culloden Rd Macquarie University, NSW 2109, Australia
| | - Denis C Bauer
- Applied BioSciences, Faculty of Science and Engineering, Macquarie University, Applied BioSciences 205B Culloden Rd Macquarie University, NSW 2109, Australia
- Department of Biomedical Sciences, MQ Health General Practice - Macquarie University, Suite 305, Level 3/2 Technology Pl, Macquarie Park NSW 2109, Australia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Gate 13, Kintore Avenue University of Adelaide, Adelaide SA 5000, Australia
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7
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Roberts W, McKee S, Miranda R, Barnett N. Navigating ethical challenges in psychological research involving digital remote technologies and people who use alcohol or drugs. AMERICAN PSYCHOLOGIST 2024; 79:24-38. [PMID: 38236213 PMCID: PMC10798215 DOI: 10.1037/amp0001193] [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: 01/19/2024]
Abstract
Digital and remote technologies (DRT) are increasingly being used in scientific investigations to objectively measure human behavior during day-to-day activities. Using these devices, psychologists and other behavioral scientists can investigate health risk behaviors, such as drug and alcohol use, by closely examining the causes and consequences of monitored behaviors as they occur naturalistically. There are, however, complex ethical issues that emerge when using DRT methodologies in research with people who use substances. These issues must be identified and addressed so DRT devices can be incorporated into psychological research with this population in a manner that comports the ethical standards of the American Psychological Association. In this article, we discuss the ethical ramifications of using DRT in behavioral studies with people who use substances. Drawing on allied fields with similar ethical issues, we make recommendations to researchers who wish to incorporate DRT into their own research. Major topics include (a) threats to and methods for protecting participant and nonparticipant privacy, (b) shortcomings of traditional informed consent in DRT research, (c) researcher liabilities introduced by real-time continuous data collection, (d) threats to distributive justice arising from computational tools often used to manage and analyze DRT data, and (e) ethical implications of the "digital divide." We conclude with a more optimistic discussion of how DRT may provide safer alternatives to gold standard paradigms in substance use research, allowing researchers to test hypotheses that were previously prohibited on ethical grounds. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale University School of Medicine
| | - Sherry McKee
- Department of Psychiatry, Yale University School of Medicine
| | - Robert Miranda
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health
| | - Nancy Barnett
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
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8
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Lorenzo D, Esquerda M, Bofarull M, Cusi V, Roig H, Bertran J, Carrera J, Torralba F, Cambra FJ, Vila M, Garriga M, Palau F. The reuse of genetic information in research and informed consent. Eur J Hum Genet 2023; 31:1393-1397. [PMID: 37699995 PMCID: PMC10689789 DOI: 10.1038/s41431-023-01457-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/28/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Important advances in genetics research have been made in recent years. Such advances have facilitated the availability of huge amounts of genetic information that could potentially be reused beyond the original purpose for which such information was obtained. Any such reuse must meet certain ethical criteria to ensure that the dignity, integrity, and autonomy of the individual from whom that information was obtained are protected. The aim of this paper is to reflect on these criteria through a critical analysis of the literature. To guarantee these values, ethical criteria need to be established in several respects. For instance, the question must be posed whether the information requires special attention and protection (so-called genetic exceptionalism). Another aspect to bear in mind is the most appropriate type of consent to be given by the person involved, on the one hand favouring research and the reuse of genetic information while on the other protecting the autonomy of that person. Finally, there is a need to determine what protection such reuse should have in order to avoid detrimental consequences and protect the rights of the individual. The main conclusions are that genetic information requires special care and protection (genetic exceptionalism) and that broad consent is the most practical and trustworthy type of consent for the reuse of genetic information.
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Affiliation(s)
- David Lorenzo
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
- EUI San Joan de Deu, Barcelona, Spain
| | - Montse Esquerda
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain.
- Sant Joan de Deu Terres de Lleida, Lleida, Spain.
| | | | - Victoria Cusi
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Helena Roig
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Joan Bertran
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Joan Carrera
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francesc Torralba
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francisco José Cambra
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
- Hospital Universitari Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Martí Vila
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Martina Garriga
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francesc Palau
- Department of Genetic Medicine and Pediatric Institut of Rare Diseases, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Enfermedades Raras, ISCIII, Madrid, Spain
- Division of Pediatrics, University of Barcelona School of Medicine and Health Sciences, Barcelona, Spain
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9
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Chapman CR, Quinn GP, Natri HM, Berrios C, Dwyer P, Owens K, Heraty S, Caplan AL. Consideration and Disclosure of Group Risks in Genomics and Other Data-Centric Research: Does the Common Rule Need Revision? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023:1-14. [PMID: 38010648 PMCID: PMC11167719 DOI: 10.1080/15265161.2023.2276161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Harms and risks to groups and third-parties can be significant in the context of research, particularly in data-centric studies involving genomic, artificial intelligence, and/or machine learning technologies. This article explores whether and how United States federal regulations should be adapted to better align with current ethical thinking and protect group interests. Three aspects of the Common Rule deserve attention and reconsideration with respect to group interests: institutional review board (IRB) assessment of the risks/benefits of research; disclosure requirements in the informed consent process; and criteria for waivers of informed consent. In accordance with respect for persons and communities, investigators and IRBs should systematically consider potential group harm when designing and reviewing protocols, respectively. Research participants should be informed about any potential group harm in the consent process. We call for additional public discussion, empirical research, and normative analysis on these issues to determine the right regulatory and policy path forward.
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Affiliation(s)
| | | | | | - Courtney Berrios
- Children's Mercy Kansas City
- University of Missouri-Kansas City School of Medicine
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10
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Perni S, Jimenez R, Jagsi R. Optimizing Informed Consent in Cancer Clinical Trials. Semin Radiat Oncol 2023; 33:349-357. [PMID: 37684064 DOI: 10.1016/j.semradonc.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
The concept of informed consent has evolved considerably over the course of the 20th century, leading to its establishment as a foundational ethical principle for the conduct of biomedical research in the United States. Even though it is now a highly regulated part of cancer research, the process of obtaining informed consent is often impeded by systemic, clinician, and patient factors that require both small- and large-scale intervention. New challenges and considerations continue to emerge due to innovations in clinical trial design, increases in utilization of genomic sequencing, and advances in genomic editing and artificial intelligence. We present a review of the history, policy, pragmatic challenges, and evolving role of the central ethical tenet of informed consent in clinical trials.
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Affiliation(s)
- Subha Perni
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Reshma Jagsi
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA.
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11
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Gooden A, Thaldar D. Toward an open access genomics database of South Africans: ethical considerations. Front Genet 2023; 14:1166029. [PMID: 37260770 PMCID: PMC10228717 DOI: 10.3389/fgene.2023.1166029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
Genomics research holds the potential to improve healthcare. Yet, a very low percentage of the genomic data used in genomics research internationally relates to persons of African origin. Establishing a large-scale, open access genomics database of South Africans may contribute to solving this problem. However, this raises various ethics concerns, including privacy expectations and informed consent. The concept of open consent offers a potential solution to these concerns by (a) being explicit about the research participant's data being in the public domain and the associated privacy risks, and (b) setting a higher-than-usual benchmark for informed consent by making use of the objective assessment of prospective research participants' understanding. Furthermore, in the South African context-where local culture is infused with Ubuntu and its relational view of personhood-community engagement is vital for establishing and maintaining an open access genomics database of South Africans. The South African National Health Research Ethics Council is called upon to provide guidelines for genomics researchers-based on open consent and community engagement-on how to plan and implement open access genomics projects.
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Affiliation(s)
- Amy Gooden
- School of Law, University of KwaZulu-Natal, Durban, South Africa
| | - Donrich Thaldar
- School of Law, University of KwaZulu-Natal, Durban, South Africa
- Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, Harvard Law School, Cambridge, MA, United States
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12
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Vaz M, Warrier P, Wai-Loon Ho C, Bull S. Respecting values and perspectives in biobanking and genetic research governance: Outcomes of a qualitative study in Bengaluru, India. Wellcome Open Res 2023; 7:78. [PMID: 37485294 PMCID: PMC10357076 DOI: 10.12688/wellcomeopenres.17628.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 07/25/2023] Open
Abstract
Background: The promise of biobanking and genetic research (BGR) in the context of translational research towards improving public health and personalised medicine has been recognised in India. Worldwide experience has shown that incorporating stakeholders' expectations and values into the governance of BGR is essential to address ethical aspects of BGR. This paper draws on engagement with various stakeholders in the South Indian city of Bengaluru to understand how incorporating people's values and beliefs can inform policy making decisions and strengthen BGR governance within India. Methods: We adopted a qualitative research approach and conducted six focus group discussions with civil society members and seven in-depth interviews with key informants in BGR, identified through a targeted web search and snowballing methods, until data saturation was reached. Data were thematically analysed to identify emergent patterns. Results: Specific themes relating to the ethics and governance of BGR emerged. Fears and uncertainty about future sample and data use, possibilities of discrimination and exploitation in the use of findings and the lack of comprehensive data protection policies in India along with expectations of enhanced contributor agency, control in future use of samples and data, benefit sharing, enhanced utility of samples, sustained BGR and public good, reflected tensions between different stakeholders' values and beliefs. Fair governance processes through an independent governance committee for biobanks and a system of ongoing engagement with stakeholders emerged as best practice towards building trust and respecting diversity of views and values. Conclusions: Ensuring public trust in BGR requires listening to stakeholders' voices, being open to counter narratives, and a commitment to long term engagement embedded in principles of participatory democracy. This is central to a 'people-centred governance framework' involving a negotiated middle ground and an equilibrium of governance which promotes social justice by being inclusive, transparent, equitable, and trustworthy.
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Affiliation(s)
- Manjulika Vaz
- Health and Humanities, St John's Research Institute, St John's Medical College, Bangalore, Karnataka, 560 034, India
| | - Prasanna Warrier
- Health and Humanities, St John's Research Institute, St John's Medical College, Bangalore, Karnataka, 560 034, India
| | - Calvin Wai-Loon Ho
- Department of Law and Centre for Medical Ethics and Law, The University of Hong Kong, Hong Kong SAR, China
| | - Susan Bull
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford, OX3 7LF, UK
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, 1142, New Zealand
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Smith ED, Savage SK, Andrew EH, Martin GM, Kahn-Kirby AH, LoTempio J, Délot E, Cohen AJ, Pitsava G, Berger S, Fusaro VA, Vilain E. "Development and Implementation of Novel Chatbot-based Genomic Research Consent". BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.23.525221. [PMID: 36747692 PMCID: PMC9900780 DOI: 10.1101/2023.01.23.525221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective To conduct a retrospective analysis comparing traditional human-based consenting to an automated chat-based consenting process. Materials and Methods We developed a new chat-based consent using our IRB-approved consent forms. We leveraged a previously developed platform (GiaⓇ, or "Genetic Information Assistant") to deliver the chat content to candidate participants. The content included information about the study, educational information, and a quiz to assess understanding. We analyzed 144 families referred to our study during a 6-month time period. A total of 37 families completed consent using the traditional process, while 35 families completed consent using Gia. Results Engagement rates were similar between both consenting methods. The median length of the consent conversation was shorter for Gia users compared to traditional (44 vs. 76 minutes). Additionally, the total time from referral to consent completion was faster with Gia (5 vs. 16 days). Within Gia, understanding was assessed with a 10-question quiz that most participants (96%) passed. Feedback about the chat consent indicated that 86% of participants had a positive experience. Discussion Using Gia resulted in time savings for both the participant and study staff. The chatbot enables studies to reach more potential candidates. We identified five key features related to human-centered design for developing a consent chat. Conclusion This analysis suggests that it is feasible to use an automated chatbot to scale obtaining informed consent for a genomics research study. We further identify a number of advantages when using a chatbot.
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Affiliation(s)
| | | | - E. Hallie Andrew
- Children’s National Rare Disease Institute, Division of Genetics and Metabolism, Washington, DC, USA
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
| | | | | | - Jonathan LoTempio
- Institute for Clinical and Translational Science, University of California, Irvine, CA, USA
| | - Emmanuèle Délot
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA
| | - Andrea J. Cohen
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
| | - Georgia Pitsava
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
| | - Seth Berger
- Children’s National Rare Disease Institute, Division of Genetics and Metabolism, Washington, DC, USA
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA
| | | | - Eric Vilain
- Center for Genetic Medicine Research, Children’s National Research Institute, Washington, DC, USA
- Institute for Clinical and Translational Science, University of California, Irvine, CA, USA
- Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA
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14
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Ochieng J, Kwagala B, Barugahare J, Möller M, Moodley K. Feedback of individual genetic and genomics research results: A qualitative study involving grassroots communities in Uganda. PLoS One 2022; 17:e0267375. [PMID: 36399445 PMCID: PMC9674126 DOI: 10.1371/journal.pone.0267375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genetics and genomics research (GGR) is associated with several challenges including, but not limited to, methods and implications of sharing research findings with participants and their family members, issues of confidentiality, and ownership of data obtained from samples. Additionally, GGR holds significant potential risk for social and psychological harms. Considerable research has been conducted globally, and has advanced the debate on return of genetic and genomics testing results. However, such investigations are limited in the African setting, including Uganda where research ethics guidance on return of results is deficient or suboptimal at best. The objective of this study was to assess perceptions of grassroots communities on if and how feedback of individual genetics and genomics testing results should occur in Uganda with a view to improving ethics guidance. METHODS This was a cross-sectional study that employed a qualitative exploratory approach. Five deliberative focus group discussions (FGDs) were conducted with 42 participants from grassroots communities representing three major ethnic groupings. These were rural settings and the majority of participants were subsistence farmers with limited or no exposure to GGR. Data were analysed through thematic analysis, with both deductive and inductive approaches applied to interrogate predetermined themes and to identify any emerging themes. NVivo software (QSR international 2020) was used to support data analysis and illustrative quotes were extracted. RESULTS All the respondents were willing to participate in GGR and receive feedback of results conditional upon a health benefit. The main motivation was diagnostic and therapeutic benefits as well as facilitating future health planning. Thematic analysis identified four themes and several sub-themes including 1) the need-to-know health status 2) paternity information as a benefit and risk; 3) ethical considerations for feedback of findings and 4) extending feedback of genetics findings to family and community. CONCLUSION Participation in hypothetical GGR as well as feedback of results is acceptable to individuals in grassroots communities. However, the strong therapeutic and/or diagnostic misconception linked to GGR is concerning given that hopes for therapeutic and/or diagnostic benefit are unfounded. Viewing GGR as an opportunity to confirm or dispute paternity was another interesting perception. These findings carry profound implications for consent processes, genetic counselling and research ethics guidance. Privacy and confidentiality, benefits, risks as well as implications for sharing need to be considered for such feedback of results to be conducted appropriately.
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Affiliation(s)
- Joseph Ochieng
- Makerere University School of Biomedical Sciences, Kampala, Uganda
- Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Betty Kwagala
- Makerere University School of Statistics and Planning, Kampala, Uganda
| | | | - Marlo Möller
- Division of Molecular Biology and Human Genetics, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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16
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Nelson SC, Gogarten SM, Fullerton SM, Isasi CR, Mitchell BD, North KE, Rich SS, Taylor MRG, Zöllner S, Sofer T. Social and scientific motivations to move beyond groups in allele frequencies: The TOPMed experience. Am J Hum Genet 2022; 109:1582-1590. [PMID: 36055210 PMCID: PMC9502047 DOI: 10.1016/j.ajhg.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
For the genomics community, allele frequencies within defined groups (or "strata") are useful across multiple research and clinical contexts. Benefits include allowing researchers to identify populations for replication or "look up" studies, enabling researchers to compare population-specific frequencies to validate findings, and facilitating assessment of variant pathogenicity in clinical contexts. However, there are potential concerns with stratified allele frequencies. These include potential re-identification (determining whether or not an individual participated in a given research study based on allele frequencies and individual-level genetic data), harm from associating stigmatizing variants with specific groups, potential reification of race as a biological rather than a socio-political category, and whether presenting stratified frequencies-and the downstream applications that this presentation enables-is consistent with participants' informed consents. The NHLBI Trans-Omics for Precision Medicine (TOPMed) program considered the scientific and social implications of different approaches for adding stratified frequencies to the TOPMed BRAVO (Browse All Variants Online) variant server. We recommend a novel approach of presenting ancestry-specific allele frequencies using a statistical method based upon local genetic ancestry inference. Notably, this approach does not require grouping individuals by either predominant global ancestry or race/ethnicity and, therefore, mitigates re-identification and other concerns as the mixture distribution of ancestral allele frequencies varies across the genome. Here we describe our considerations and approach, which can assist other genomics research programs facing similar issues of how to define and present stratified frequencies in publicly available variant databases.
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Affiliation(s)
- Sarah C Nelson
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA.
| | | | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Braxton D Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kari E North
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Matthew R G Taylor
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sebastian Zöllner
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Tamar Sofer
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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Loosman I, Nickel PJ. Towards a Design Toolkit of Informed Consent Models Across Fields: A Systematic Review. SCIENCE AND ENGINEERING ETHICS 2022; 28:42. [PMID: 36042065 PMCID: PMC9427926 DOI: 10.1007/s11948-022-00398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
In the 60+ years that the modern concept of informed consent has been around, researchers in various fields of practice, especially medical ethics, have developed new models to overcome theoretical and practical problems. While (systematic) literature reviews of such models exist within given fields (e.g., genetic screening), this article breaks ground by analyzing academic literature on consent models across fields. Three electronic research databases (Scopus, Google Scholar, and Web of Science) were searched for publications mentioning informed consent models. The titles, abstracts, and if applicable, full publications were screened and coded. The resulting data on fields, models, and themes were then analyzed. We scanned 300 sources from three databases to find 207 uniquely named consent models, and created a network visualization displaying which models occur primarily in one field, and which models overlap between fields. This analysis identifies trends in the consent debate in different fields, as well as common goals of consent models. The most frequently occurring consent models are identified and defined. The analysis contributes toward a cross-disciplinary "consent design toolkit" and highlights that there are more interrelationships between models and fields than are acknowledged in the literature. Where some models are designed to solve distinctively field-specific issues and are specific to biomedical ethics, some may be adaptable and applicable for other fields including engineering and design.
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Affiliation(s)
- Iris Loosman
- Department of Philosophy and Ethics, School of Innovation Sciences, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - Philip J Nickel
- Department of Philosophy and Ethics, School of Innovation Sciences, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands
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18
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Artificial Intelligence-Based Medical Data Mining. J Pers Med 2022; 12:jpm12091359. [PMID: 36143144 PMCID: PMC9501106 DOI: 10.3390/jpm12091359] [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] [Received: 07/05/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Understanding published unstructured textual data using traditional text mining approaches and tools is becoming a challenging issue due to the rapid increase in electronic open-source publications. The application of data mining techniques in the medical sciences is an emerging trend; however, traditional text-mining approaches are insufficient to cope with the current upsurge in the volume of published data. Therefore, artificial intelligence-based text mining tools are being developed and used to process large volumes of data and to explore the hidden features and correlations in the data. This review provides a clear-cut and insightful understanding of how artificial intelligence-based data-mining technology is being used to analyze medical data. We also describe a standard process of data mining based on CRISP-DM (Cross-Industry Standard Process for Data Mining) and the most common tools/libraries available for each step of medical data mining.
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19
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Beskow LM, Wolf LE. "Choice of law" in precision medicine research. Am J Hum Genet 2022; 109:1347-1352. [PMID: 35931047 PMCID: PMC9388386 DOI: 10.1016/j.ajhg.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
Large-scale precision medicine research requires massive amounts of data representing people from all walks of life; thus, in the US, it is often multistate research. Significant legal and ethical quandaries arise as a result of the patchwork of laws states have enacted that may apply to research, are not preempted by federal law, and may impose requirements or provide participant rights and protections that differ from other states. Determining which state's laws apply, and under what circumstances, is not solved by the transition to a single-IRB model and researchers cannot simply choose one state's laws to apply uniformly. At a minimum, the current process of meeting each state's requirements could be made more reliable and efficient. To fundamentally change this status quo, however, requires action at multiple levels. Federally, well-known gaps in the Genetic Information Nondiscrimination Act should be closed, and a coherent system of compensation for research injury-including non-physical injuries-should be developed. States should clarify which of their laws are intended to apply to research and work collaboratively to harmonize them. At the level of individual research projects, numerous policies and procedures could be standardized through authoritative guidelines. Examples include clarifying the scope of broad consent, understanding and upholding Certificates of Confidentiality, offering individual research results responsibly, and consistently disseminating aggregate results to participants and the public. Overall, development of a choice of law framework specific to the research context could significantly promote clarity and consistency.
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Affiliation(s)
- Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 400, Nashville, TN 37203, USA.
| | - Leslie E Wolf
- Center for Law, Health and Society, Georgia State University College of Law, Atlanta, GA 30303, USA
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20
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Laurijssen SJ, van der Graaf R, van Dijk WB, Schuit E, Groenwold RH, Grobbee DE, de Vries MC. When is it impractical to ask informed consent? A systematic review. Clin Trials 2022; 19:545-560. [PMID: 35775421 PMCID: PMC9523816 DOI: 10.1177/17407745221103567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Informed consent is one of the cornerstones of biomedical research with human subjects. Research ethics committees may allow for a modification or a waiver of consent when the research has social value, involves minimal risk, and if consent is impractical to obtain. While the conditions of social value and minimal risk have received ample attention in research ethics literature, the impractical condition remains unclear. There seem to be different interpretations of the meaning of impractical within academic literature. To address this lack of clarity, we performed a systematic review on the interpretation of impractical. METHODS First, we examined international research ethics guidelines on their usage and interpretation of impractical. Next, we used international ethical guidelines to identify synonyms of the term "impractical." Accordingly, PubMed, Embase, and Web of Science were searched for articles that included "informed consent" and "impractical" or one of its synonyms. RESULTS We found that there were only a few international ethics guidelines that described what could be considered impractical. Out of 2329 identified academic articles, 42 were included. Impractical was used to describe four different conditions: (1) obtaining informed consent becomes too demanding for researchers, (2) obtaining informed consent leads to invalid study outcomes, (3) obtaining informed consent harms the participant, and (4) obtaining informed consent is meaningless for the participant. CONCLUSION There are conditions that render conventional informed consent truly impractical, such as untraceable participants or harm for participants. At the same time, researchers have a moral responsibility to design an infrastructure in which consent can be obtained, even if they face hardship in obtaining consent. In addition, researchers should seek to minimize harm inflicted upon participants when harm may occur as a result of the consent procedure. Invalidity of research due to consent issues should not be regarded as impractical but as a condition that limits the social value of research. Further research is essential for when a waiver of informed consent based on impractical is also reasonable.
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Affiliation(s)
- Sara Jm Laurijssen
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Rieke van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wouter B van Dijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rolf Hh Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
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21
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Wiertz S, Boldt J. Evaluating models of consent in changing health research environments. MEDICINE, HEALTH CARE AND PHILOSOPHY 2022; 25:269-280. [PMID: 35286521 PMCID: PMC9135890 DOI: 10.1007/s11019-022-10074-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Abstract
While Specific Informed Consent has been the established standard for obtaining consent for medical research for many years, it does not appear suitable for large-scale biobank and health data research. Thus, alternative forms of consent have been suggested, based on a variety of ethical background assumptions. This article identifies five main ethical perspectives at stake. Even though Tiered Consent, Dynamic Consent and Meta Consent are designed to the demands of the self-determination perspective as well as the perspective of research as a public good, they are still also criticized from both perspectives. In addition, criticisms based on concerns of justice, participation and democratic deliberation, and relational concerns have been levelled at each of the models. As all of these perspectives have valid points to make, the task at hand lies in balancing these ethical perspectives. What constitutes an adequate balancing depends on contextual factors. These factors include digital infrastructure and digital literacy, data safety regulation, good scientific and clinical practice, transparent debates on ethically relevant features of research, social inequalities, anti-discrimination laws and practices, trust in health care institutions and recognition of patient preferences, and consensus on unethical research. We argue that the role of context in determining acceptable models of consent puts the ethical importance of models of consent into perspective. Since altering contextual factors can help to live up to the ethical concerns at stake in debates about models of consent, opting for such a shift of focus comes without ethical loss.
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Affiliation(s)
- Svenja Wiertz
- Department of Medical Ethics and the History of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
| | - Joachim Boldt
- Department of Medical Ethics and the History of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
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22
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Luthuli M, Ngwenya N, Gumede D, Gunda R, Gareta D, Koole O, Siedner MJ, Wong EB, Seeley J. Participant recall and understandings of information on biobanking and future genomic research: experiences from a multi-disease community-based health screening and biobank platform in rural South Africa. BMC Med Ethics 2022; 23:43. [PMID: 35436913 PMCID: PMC9014601 DOI: 10.1186/s12910-022-00782-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background Limited research has been conducted on explanations and understandings of biobanking for future genomic research in African contexts with low literacy and limited healthcare access. We report on the findings of a sub-study on participant understanding embedded in a multi-disease community health screening and biobank platform study known as ‘Vukuzazi’ in rural KwaZulu-Natal, South Africa. Methods Semi-structured interviews were conducted with research participants who had been invited to take part in the Vukuzazi study, including both participants and non-participants, and research staff that worked on the study. The interviews were transcribed, and themes were identified from the interview transcripts, manually coded, and thematically analysed. Results Thirty-nine individuals were interviewed. We found that the research team explained biobanking and future genomic research by describing how hereditary characteristics create similarities among individuals. However, recollection and understanding of this explanation seven months after participation was variable. The large volume of information about the Vukuzazi study objectives and procedures presented a challenge to participant recall. By the time of interviews, some participants recalled rudimentary facts about the genetic aspects of the study, but many expressed little to no interest in genetics and biobanking. Conclusion Participant’s understanding of information related to genetics and biobanking provided during the consent process is affected by the volume of information as well as participant’s interest (or lack thereof) in the subject matter being discussed. We recommend that future studies undertaking biobanking and genomic research treat explanations of this kind of research to participants as an on-going process of communication between researchers, participants and the community and that explanatory imagery and video graphic storytelling should be incorporated into theses explanations as these have previously been found to facilitate understanding among those with low literacy levels. Studies should also avoid having broader research objectives as this can divert participant’s interest and therefore understanding of why their samples are being collected. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00782-z.
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Affiliation(s)
- Manono Luthuli
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
| | - Nothando Ngwenya
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infection and Immunity, University College London, London, UK.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Dumsani Gumede
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Resign Gunda
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infection and Immunity, University College London, London, UK.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Emily B Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,Global Health and Development Department, London School of Hygiene and Tropical Medicine, London, UK
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Robertson AJ, Tan NB, Spurdle AB, Metke-Jimenez A, Sullivan C, Waddell N. Re-analysis of genomic data: An overview of the mechanisms and complexities of clinical adoption. Genet Med 2022; 24:798-810. [PMID: 35065883 DOI: 10.1016/j.gim.2021.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/20/2022] Open
Abstract
Re-analyzing genomic information from a patient suspected of having an underlying genetic condition can improve the diagnostic yield of sequencing tests, potentially providing significant benefits to the patient and to the health care system. Although a significant number of studies have shown the clinical potential of re-analysis, less work has been performed to characterize the mechanisms responsible for driving the increases in diagnostic yield. Complexities surrounding re-analysis have also emerged. The terminology itself represents a challenge because "re-analysis" can refer to a range of different concepts. Other challenges include the increased workload that re-analysis demands of curators, adequate reimbursement pathways for clinical and diagnostic services, and the development of systems to handle large volumes of data. Re-analysis also raises ethical implications for patients and families, most notably when re-classification of a variant alters diagnosis, treatment, and prognosis. This review highlights the possibilities and complexities associated with the re-analysis of existing clinical genomic data. We propose a terminology that builds on the foundation presented in a recent statement from the American College of Medical Genetics and Genomics and describes each re-analysis process. We identify mechanisms for increasing diagnostic yield and provide perspectives on the range of challenges that must be addressed by health care systems and individual patients.
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Affiliation(s)
- Alan J Robertson
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Queensland, Australia; The Genomic Institute, Department of Health, Queensland Government, Brisbane, Queensland, Australia
| | - Natalie B Tan
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda B Spurdle
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Clair Sullivan
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Metro North Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Queensland, Australia
| | - Nicola Waddell
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
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Vaz M, Warrier P, Wai-Loon Ho C, Bull S. Respecting values and perspectives in biobanking and genetic research governance: Outcomes of a qualitative study in Bengaluru, India. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17628.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The promise of biobanking and genetic research (BGR) in the context of translational research towards improving public health and personalised medicine has been recognised in India. Worldwide experience has shown that incorporating stakeholders’ expectations and values into the governance of BGR is essential to address ethical aspects of BGR. This paper draws on engagement with various stakeholders in the South Indian city of Bengaluru to understand how incorporating people’s values and beliefs can inform policy making decisions and strengthen BGR governance within India. Methods: We adopted a qualitative research approach and conducted six focus group discussions with civil society members and seven in-depth interviews with key informants in BGR, identified through a targeted web search and snowballing methods, until data saturation was reached. Data were thematically analysed to identify emergent patterns. Results: Specific themes relating to the ethics and governance of BGR emerged. Fears and uncertainty about future sample and data use, possibilities of discrimination and exploitation in the use of findings and the lack of comprehensive data protection policies in India along with expectations of enhanced contributor agency, control in future use of samples and data, benefit sharing, enhanced utility of samples, sustained BGR and public good, reflected tensions between different stakeholders’ values and beliefs. Fair governance processes through an independent governance committee for biobanks and a system of ongoing engagement with stakeholders emerged as best practice towards building trust and respecting diversity of views and values. Conclusions: Ensuring public trust in BGR requires listening to stakeholders’ voices, being open to counter narratives, and a commitment to long term engagement embedded in principles of participatory democracy. This is central to a ‘people-centred governance framework’ involving a negotiated middle ground and an equilibrium of governance which promotes social justice by being inclusive, transparent, equitable, and trustworthy.
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Fedeli P, Scendoni R, Cingolani M, Corrales Compagnucci M, Cirocchi R, Cannovo N. Informed Consent and Protection of Personal Data in Genetic Research on COVID-19. Healthcare (Basel) 2022; 10:healthcare10020349. [PMID: 35206963 PMCID: PMC8871888 DOI: 10.3390/healthcare10020349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
The particular characteristics of COVID-19 demand the careful biomedical study of samples from patients who have shown different symptomatology, in order to understand the genetic foundations of its phenotypic expression. Research on genetic material from COVID-19 patients is indispensable for understanding the biological bases for its varied clinical manifestations. The issue of “informed consent” constitutes the crux of the problem in regulating research biobanks, because it concerns the relationship between the person and the parts separated from the body. There are several consensus models that can be adopted, varying from quite restricted models of specific informed consent to forms that allow very broad authorization (open consent). Our current understanding of COVID-19 is incomplete. Thus, we cannot plan, with precision, the research to be conducted on biological samples that have been, or will be, collected from patients infected by the novel coronavirus. Therefore, we suggest utilizing the “participation pact” between researchers and donors, based on a new form of participation in research, which offers a choice based on the principles of solidarity and reciprocity, which represent the communication of “values”. In the last part of this paper, the general data protection regulation concerning the matter is discussed. The treatment of personal data must be performed with explicit goals, and donors must be provided with a clear, transparent explanation of the methods, goals and time of storage. The data must not be provided to unauthorized subjects. In conclusion, open informed consent forms will be necessary for research on individual patients and on populations.
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Affiliation(s)
| | - Roberto Scendoni
- Department of Law, University of Macerata, 62100 Macerata, Italy;
| | - Mariano Cingolani
- Department of Law, University of Macerata, 62100 Macerata, Italy;
- Correspondence:
| | - Marcelo Corrales Compagnucci
- Centre for Advanced Studies on Biomedical Innovation Law (CeBIL), Faculty of Law, University of Copenhagen, Karen Blixens Plads 16, DK-2300 Copenhagen, Denmark;
| | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, 06132 Perugia, Italy;
| | - Nunzia Cannovo
- Ethic Committee, University of Naples, 80138 Napoli, Italy;
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Kilkku N, Halkoaho A. Informed consent, genomic research and mental health: A integrative review. Nurs Ethics 2022; 29:973-987. [PMID: 35119339 PMCID: PMC9289972 DOI: 10.1177/09697330211066573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research on genomics has increased while the biobank activities are becoming more common in different countries. In the mental health field, the questions concerning the potential participants' vulnerability as well as capacity to give the informed consent can cause reluctancy in recruiting persons with mental health problems, although the knowledge and understanding of mental health problems has remarkable changed, and practice is guided with inclusive approaches, such as recovery approach. AIM The aim of this study was to describe the current knowledge of informed consent practices in the context of genomic research on mental health from the nurses' viewpoint. METHODS An integrative review was conducted with search from seven international databases. Data consist 14 publications which were analyzed with thematic analysis. ETHICAL CONSIDERATIONS Ethical requirements were respected in every phase of the research process. FINDINGS Most of the papers were published in USA and between 2000-2010. Eight reports were categorized as discussion papers, four qualitative studies and one quantitative study. The thematic analysis provided information on five themes: complexity with the capacity to consent, mixed emotions towards participation, factors influencing the decision to participate, nurses' informed consent process competence and variations between consent procedures. DISCUSSION In the informed consent practices, there are various aspects which may affect both the willingness to participate in the study and the informed consent process itself. Implications for practice, education, research, and policies are discussed. CONCLUSION There is a need for more updated international research on the topic in the context of different international and national guidelines, legislation, and directives. This study provided a viewpoint to the more collaborative research activities with people with lived experiences also in this field of research following the ideas of recovery approach.
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Affiliation(s)
- Nina Kilkku
- School of Social Services and Health Care, 20615Tampere University of Applied Sciences, Tampere, Finland
| | - Arja Halkoaho
- School of Health, 52917Tampere University of Applied Sciences, Tampere, Finland Corresponding author
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27
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Allen KA, McInerney-Leo AM, Gamble N, Wurf G, Boyle C. The ethical protection of genetic information: procedure analysis for psychologists. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1985376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kelly-Ann Allen
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, Australia
- The Centre for Wellbeing Science, The Melbourne Graduate School of Education, The University of Melbourne, Parkville, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Australia
| | - Nicholas Gamble
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, Australia
| | - Gerald Wurf
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, Australia
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28
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Rowan W, O'Connor Y, Lynch L, Heavin C. Comprehension, Perception, and Projection. J ORGAN END USER COM 2021. [DOI: 10.4018/joeuc.286766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health social networks (HSNs) allow individuals with health information needs to connect and discuss health-related issues online. Political-technology intertwinement (e.g. GDPR and Digital Technology) highlights that users need to be aware, understand, and willing to provide electronic consent (eConsent) when sharing personal information online. The objective of this study is to explore the ‘As-Is’ factors which impact individuals’ decisional autonomy when consenting to the privacy policy (PP) and Terms and Conditions (T&Cs) on a HSN. We use a Situational Awareness (SA) lens to examine decision autonomy when providing eConsent. A mixed-methods approach reveals that technical and privacy comprehension, user perceptions, and projection of future consequences impact participants’ decision autonomy in providing eConsent. Without dealing with the privacy paradox at the outset, decision awareness and latterly decision satisfaction is negatively impacted. Movement away from clickwrap online consent to customised two-way engagement is the way forward for the design of eConsent.
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Munung NS, de Vries J, Pratt B. Genomics governance: advancing justice, fairness and equity through the lens of the African communitarian ethic of Ubuntu. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:377-388. [PMID: 33797712 PMCID: PMC8349790 DOI: 10.1007/s11019-021-10012-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 05/18/2023]
Abstract
There is growing interest for a communitarian approach to the governance of genomics, and for such governance to be grounded in principles of justice, equity and solidarity. However, there is a near absence of conceptual studies on how communitarian-based principles, or values, may inform, support or guide the governance of genomics research. Given that solidarity is a key principle in Ubuntu, an African communitarian ethic and theory of justice, there is emerging interest about the extent to which Ubuntu could offer guidance for the governance of genomics research in Africa. To this effect, we undertook a conceptual analysis of Ubuntu with the goal of identifying principles that could inform equity-oriented governance of genomics research. Solidarity, reciprocity, open sharing, accountability, mutual trust, deliberative decision-making and inclusivity were identified as core principles that speak directly to the different macro-level ethical issues in genomics research in Africa such as: the exploitation of study populations and African researchers, equitable access and use of genomics data, benefit sharing, the possibility of genomics to widen global health inequities and the fair distribution of resources such as intellectual property and patents. We use the identified the principles to develop ethical guidance for genomics governance in Africa.
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Affiliation(s)
- Nchangwi Syntia Munung
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Abstract
The collection and use of human genetic data raise important ethical questions about how to balance individual autonomy and privacy with the potential for public good. The proliferation of local, national, and international efforts to collect genetic data and create linkages to support large-scale initiatives in precision medicine and the learning health system creates new demands for broad data sharing that involve managing competing interests and careful consideration of what constitutes appropriate ethical trade-offs. This review describes these emerging ethical issues with a focus on approaches to consent and issues related to justice in the shifting genomic research ecosystem.
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Affiliation(s)
- Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, NY 10032, USA;
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31
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Greenwood J, Crowden A. Thinking about the idea of consent in data science genomics: How 'informed' is it? Nurs Philos 2021; 22:e12347. [PMID: 33979474 DOI: 10.1111/nup.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
In this paper we argue that 'informed' consent in Big Data genomic biobanking is frequently less than optimally informative. This is due to the particular features of genomic biobanking research which render it ethically problematic. We discuss these features together with details of consent models aimed to address them. Using insights from consent theory, we provide a detailed analysis of the essential components of informed consent which includes recommendations to improve consent performance. In addition, and using insights from philosophy of mind and language and psycholinguistics we support our analyses by identifying the nature and function of concepts (ideas) operational in human cognition and language together with an implicit coding/decoding model of human communication. We identify this model as the source of patients/participants poor understanding. We suggest an alternative, explicit model of human communication, namely, that of relevance-theoretic inference which obviates the limitations of the code model. We suggest practical strategies to assist health service professionals to ensure that the specific information they provide concerning the proposed treatment or research is used to inform participants' decision to consent. We do not prescribe a standard, formal approach to decision-making where boxes are ticked; rather, we aim to focus attention towards the sorts of considerations and questions that might usefully be borne in mind in any consent situation. We hope that our theorising will be of real practical benefit to nurses and midwives working on the clinical and research front-line of genomic science.
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Affiliation(s)
- Jennifer Greenwood
- School of Historical and Philosophical Inquiry, University of Queensland, St Lucia, QLD, Australia
| | - Andrew Crowden
- School of Historical and Philosophical Inquiry, University of Queensland, St Lucia, QLD, Australia
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32
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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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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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Chartier KG, Martinez P, Cummings C, Riley BP, Karriker-Jaffe KJ. Recruiting for diversity: a pilot test of recruitment strategies for a national alcohol survey with mail-in genetic data collection. J Community Genet 2021; 12:459-468. [PMID: 33398649 DOI: 10.1007/s12687-020-00502-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022] Open
Abstract
We assessed the feasibility and acceptability of collecting a saliva sample for DNA through the mail from a national sample of drinkers and examined whether targeted messaging would increase the response rates of Black/African American and Hispanic/Latino participants. We invited respondents from two prior national population surveys to participate in a brief telephone survey regarding recent alcohol use and to mail in a self-administered saliva sample. Blacks/African Americans, Hispanics/Latinos, and Whites had similar rates of consenting to participate. A higher proportion of respondents with a college education and a family history of alcohol problems consented. The differences in participation between respondents receiving targeted and general messaging were not statistically significant. This study provides preliminary evidence for the feasibility of recruiting diverse participants into a genetic study of alcohol use disorder.
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Affiliation(s)
- Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
| | | | - Cory Cummings
- School of Social Work, Monmouth University, West Long Branch, NJ, USA
| | - Brien P Riley
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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35
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Blasimme A, Brall C, Vayena E. Reporting Genetic Findings to Individual Research Participants: Guidelines From the Swiss Personalized Health Network. Front Genet 2020; 11:585820. [PMID: 33362850 PMCID: PMC7759560 DOI: 10.3389/fgene.2020.585820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022] Open
Abstract
In 2017 the Swiss federal government established the Swiss Personalized Health Network (SPHN), a nationally coordinated data infrastructure for genetic research. The SPHN advisory group on Ethical, Legal, and Social Implications (ELSI) was tasked with the creation of a recommendation to ensure ethically responsible reporting of genetic research findings to research participants in SPHN-funded studies. Following consultations with expert stakeholders, including geneticists, pediatricians, sociologists, university hospitals directors, patient representatives, consumer protection associations, and insurers, the ELSI advisory group issued its recommendation on "Reporting actionable genetic findings to research participants" in May 2020. In this paper we outline the development of this recommendation and the provisions it contains. In particular, we discuss some of its key features, namely: (1) that participation in SPHN-funded studies as a research subject is conditional to accepting that medically relevant genetic research findings will be reported; (2) that a Multidisciplinary Expert Panel (MEP) should be created to support researchers' decision-making processes about reporting individual genetic research findings; (3) that such Multidisciplinary Expert Panel will make case-by-case decisions about whether to allow reporting of genetic findings, instead of relying on a pre-defined list of medically relevant variants; (4) that research participants shall be informed of the need to disclose genetic mutations when applying for private insurance, which may influence individual decisions about participation in research. By providing an account of the procedural background and considerations leading to the SPHN recommendation on "Reporting actionable genetic findings to research participants," we seek to promote a better understanding of the proposed guidance, as well as to contribute to the global dialog on the reporting of genetic research findings.
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Affiliation(s)
- Alessandro Blasimme
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Caroline Brall
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
- Ethical, Legal, and Social Implications (ELSI) Advisory Group, Swiss Personalized Health Network (SPHN), Bern, Switzerland
| | - Effy Vayena
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
- Ethical, Legal, and Social Implications (ELSI) Advisory Group, Swiss Personalized Health Network (SPHN), Bern, Switzerland
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36
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Doerr M, Moore S, Barone V, Sutherland S, Bot BM, Suver C, Wilbanks J. Assessment of the All of Us research program's informed consent process. AJOB Empir Bioeth 2020; 12:72-83. [PMID: 33275082 DOI: 10.1080/23294515.2020.1847214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Informed consent is the gateway to research participation. We report on the results of the formative evaluation that follows the electronic informed consent process for the All of Us Research Program. Of the nearly 250,000 participants included in this analysis, more than 95% could correctly answer questions distinguishing the program from medical care, the voluntary nature of participation, and the right to withdraw; comparatively, participants were less sure of privacy risk of the program. We also report on a small mixed-methods study of the experience of persons of very low health literacy with All of Us informed consent materials. Of note, many of the words commonly employed in the consent process were unfamiliar to or differently defined by informants. In combination, these analyses may inform participant-centered development and highlight areas for refinement of informed consent materials for the All of Us Research Program and similar studies.
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Affiliation(s)
| | | | | | - Scott Sutherland
- Broad Institute, Cambridge, Massachusetts.,Vibrent Health, Fairfax, Virginia
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37
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Davies E, Craufurd D, MacLeod R. "It's being part of the big picture, even though you're a tiny jigsaw piece"-motivations and expectations of individuals participating in the Enroll-HD observational study. J Community Genet 2020; 11:421-432. [PMID: 32157658 PMCID: PMC7475145 DOI: 10.1007/s12687-020-00459-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/21/2020] [Indexed: 01/28/2023] Open
Abstract
Predictive test guidelines for Huntington's disease (HD) recommend individuals are offered opportunities to participate in research regardless of test outcome. Consistent with most HD centres of excellence, the Manchester Centre for Genomic Medicine (MCGM) invites eligible individuals to participate in the observational study, Enroll-HD. Limited research has been conducted to date on the views of research participants and the possible impact of participation. The aim of this qualitative study was to explore the experiences of ten individuals taking part in the Enroll-HD study following pre-symptomatic testing for HD. Half of the individuals had tested positive for the HD mutation and the other half had tested negative. Participants were generally motivated to take part in the study by both personal and altruistic reasons. Overall, they were very positive about participation in Enroll-HD. Valuable aspects included good relationships with the research/clinical team, increased understanding of the condition, an enhanced self-image and a shared experience with affected parents. Issues for improvement to encourage participation included access to study site and more regular communication about study progress. Participants, while generally optimistic about research progress, were realistic about challenges.
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Affiliation(s)
- E Davies
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.
- Department of Clinical Genetics, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
| | - D Craufurd
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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38
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Nansumba H, Ssewanyana I, Tai M, Wassenaar D. Role of a regulatory and governance framework in human biological materials and data sharing in National Biobanks: Case studies from Biobank Integrating Platform, Taiwan and the National Biorepository, Uganda. Wellcome Open Res 2020; 4:171. [PMID: 32954012 DOI: 10.12688/wellcomeopenres.15442.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 01/13/2023] Open
Abstract
Background: In the last decade, Low- and Middle-Income Countries (LMICs) have set up Biobanks to collect human biological materials and associated data for genomic research and public health purposes. Biobanking gives rise to ethical challenges, such as informed consent, benefit sharing, confidentiality, ownership, commercialization and public participation which are harder to navigate in LMIC settings due to disparities in research infrastructure and capacity. This paper summarizes presentations on Biobank related case studies from two countries, with a focus on challenges in the regulatory and governance framework and suggestions on how to mitigate them. Methods: Two case studies of Biobanks from LMICs have been used . The case studies were presented at the 2018 Global Forum on Bioethics in Research (GFBR) meeting on the "Ethics of data sharing and Biobanking in health research". Results: The case studies show that an integrated, well-regulated platform for human biological materials and data ensures good quality of human biological materials, saves resources and promotes mutual collaboration of work among researchers. National regulatory bodies are required to generate Biobanking guidelines and policies to facilitate guidance to the rapidly changing landscape of science. Discussion: In general, LMICs have weaker research regulatory infrastructure and governance mechanisms for Biobanks than high-income countries. This has increased the fear of exploitation i.e. unfair distribution of risks and benefits. Establishment of Biobanks and producing effective scientific outcomes based on the Biobanking resources is difficult without a proper legislative, regulatory and governance framework. Conclusion: These two case studies from different LMICs settings show that although in both settings there is strong awareness of the scientific and population health value of Biobanks and strong commitment to their establishment, regulatory and ethical guidance show gaps that need to be addressed.
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Affiliation(s)
- Hellen Nansumba
- Central Public Health Laboratories (CPHL), Ministry of Health of Uganda, Kampala, P.O.BOX 7272, Uganda
| | - Isaac Ssewanyana
- Central Public Health Laboratories (CPHL), Ministry of Health of Uganda, Kampala, P.O.BOX 7272, Uganda
| | - Micheal Tai
- Chung Shan Medical University, Taichung, Taiwan.,Ethics Governance Council (EGC), Taiwan Biobank, Taiwan, Taiwan
| | - Douglas Wassenaar
- South African Research Ethics Training Initiative (SARETI), University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Nansumba H, Ssewanyana I, Tai M, Wassenaar D. Role of a regulatory and governance framework in human biological materials and data sharing in National Biobanks: Case studies from Biobank Integrating Platform, Taiwan and the National Biorepository, Uganda. Wellcome Open Res 2020; 4:171. [PMID: 32954012 PMCID: PMC7479498 DOI: 10.12688/wellcomeopenres.15442.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 01/11/2023] Open
Abstract
Background: In the last decade, Low- and Middle-Income Countries (LMICs) have set up Biobanks to collect human biological materials and associated data for genomic research and public health purposes. Biobanking gives rise to ethical challenges, such as informed consent, benefit sharing, confidentiality, ownership, commercialization and public participation which are harder to navigate in LMIC settings due to disparities in research infrastructure and capacity. This paper summarizes presentations on Biobank related case studies from two countries, with a focus on challenges in the regulatory and governance framework and suggestions on how to mitigate them. Methods: Two case studies of Biobanks from LMICs have been used . The case studies were presented at the 2018 Global Forum on Bioethics in Research (GFBR) meeting on the "Ethics of data sharing and Biobanking in health research". Results: The case studies show that an integrated, well-regulated platform for human biological materials and data ensures good quality of human biological materials, saves resources and promotes mutual collaboration of work among researchers. National regulatory bodies are required to generate Biobanking guidelines and policies to facilitate guidance to the rapidly changing landscape of science. Discussion: In general, LMICs have weaker research regulatory infrastructure and governance mechanisms for Biobanks than high-income countries. This has increased the fear of exploitation i.e. unfair distribution of risks and benefits. Establishment of Biobanks and producing effective scientific outcomes based on the Biobanking resources is difficult without a proper legislative, regulatory and governance framework. Conclusion: These two case studies from different LMICs settings show that although in both settings there is strong awareness of the scientific and population health value of Biobanks and strong commitment to their establishment, regulatory and ethical guidance show gaps that need to be addressed.
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Affiliation(s)
- Hellen Nansumba
- Central Public Health Laboratories (CPHL), Ministry of Health of Uganda, Kampala, P.O.BOX 7272, Uganda
| | - Isaac Ssewanyana
- Central Public Health Laboratories (CPHL), Ministry of Health of Uganda, Kampala, P.O.BOX 7272, Uganda
| | - Micheal Tai
- Chung Shan Medical University, Taichung, Taiwan.,Ethics Governance Council (EGC), Taiwan Biobank, Taiwan, Taiwan
| | - Douglas Wassenaar
- South African Research Ethics Training Initiative (SARETI), University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Sodeke SO, Powell LR. Paying Tribute to Henrietta Lacks at Tuskegee University and at The Virginia Henrietta Lacks Commission, Richmond, Virginia. J Health Care Poor Underserved 2020; 30:1-11. [PMID: 31735712 DOI: 10.1353/hpu.2019.0109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Rego S, Grove ME, Cho MK, Ormond KE. Informed Consent in the Genomics Era. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036582. [PMID: 31570382 DOI: 10.1101/cshperspect.a036582] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Informed consent, the process of gathering autonomous authorization for a medical intervention or medical research participation, is a fundamental component of medical practice. Medical informed consent assumes decision-making capacity, voluntariness, comprehension, and adequate information. The increasing use of genetic testing, particularly genomic sequencing, in clinical and research settings has presented many new challenges for clinicians and researchers when obtaining informed consent. Many of these challenges revolve around the need for patient comprehension of sufficient information. Genomic sequencing is complex-all of the possible results are too numerous to explain, and many of the risks and benefits remain unknown. Thus, historical standards of consent are difficult to apply. Alternative models of consent have been proposed to increase patient understanding, and several have empirically demonstrated effectiveness. However, there is still a striking lack of consensus in the genetics community about what constitutes informed consent in the context of genomic sequencing. Multiple approaches are needed to address this challenge, including consensus building around standards, targeted use of genetic counselors in nongenetics clinics in which genomic testing is ordered, and the development and testing of alternative models for obtaining informed consent.
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Affiliation(s)
- Shannon Rego
- Institute for Human Genetics, University of California San Francisco, San Francisco, California 94143, USA
| | - Megan E Grove
- Stanford Medicine Clinical Genomics Program, Stanford, California 94305, USA
| | - Mildred K Cho
- Division of Medical Genetics, Stanford University Department of Pediatrics, Stanford, California 94305, USA.,Stanford Center for Biomedical Ethics, Stanford, California 94305, USA
| | - Kelly E Ormond
- Stanford Center for Biomedical Ethics, Stanford, California 94305, USA.,Department of Genetics, Stanford University School of Medicine, Stanford, California 94305, USA
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Bukini D, Mbekenga C, Nkya S, Purvis L, McCurdy S, Parker M, Makani J. A qualitative study on aspects of consent for genomic research in communities with low literacy. BMC Med Ethics 2020; 21:48. [PMID: 32532327 PMCID: PMC7291634 DOI: 10.1186/s12910-020-00488-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low literacy of study participants in Sub - Saharan Africa has been associated with poor comprehension during the consenting process in research participation. The concerns in comprehension are far greater when consenting to participate in genomic studies due to the complexity of the science involved. While efforts are made to explore possibilities of applying genomic technologies in diseases prevalent in Sub Saharan Africa, we ought to develop methods to improve participants' comprehension for genomic studies. The purpose of this study was to understand different approaches that can be used to seek consent from individuals with low literacy in Sub-Saharan African countries in genomic research to improve comprehension. METHODS Using qualitative study design, we conducted focus-group discussions, in-depth interviews and participant observations as data collection methods. This study was embedded in a hospital based genomic study on Sickle Cell Disease at Muhimbili National Hospital in Tanzania. Thematic content analysis was used to analyse the transcripts and field notes. RESULTS Findings from this study show that literacy level has little influence on understanding the research details. According to the participants of this study, the methods used to provide information, the language, and time spent with the study participants were the key factors influencing understanding. The availability of group sessions held before individual consent to allow for a detailed questions and answers format was agreed to be the best method to facilitate the comprehension. CONCLUSION The quality of the consenting process of participants will be influence by a number of factors. The type of research consented for, where the research will be implemented and who are the potential study participants are amongst the factors that need to be assessed during the consenting. Measures to improve participants' comprehension need to be developed when consenting participants with low literacy level in genomic studies.
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Affiliation(s)
- Daima Bukini
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania.
| | - Columba Mbekenga
- School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania
| | - Siana Nkya
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
| | - Lisa Purvis
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Centre, Hanover, NH, USA
| | - Sheryl McCurdy
- University of Texas Health Science Centre at Houston, School of Public Health, Houston, TX, USA
| | - Michael Parker
- Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Julie Makani
- Sickle Cell Programme, Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, UN Road, Upanga, Block 9, Dar es Salaam, Tanzania
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Davies G, Butow P, Napier CE, Bartley N, Juraskova I, Meiser B, Ballinger ML, Thomas DM, Schlub TE, Best MC. Advanced Cancer Patient Knowledge of and Attitudes towards Tumor Molecular Profiling. Transl Oncol 2020; 13:100799. [PMID: 32450551 PMCID: PMC7256320 DOI: 10.1016/j.tranon.2020.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/24/2023] Open
Abstract
Limited research has indicated that despite their overwhelming interest in tumor molecular profiling (MP),1 cancer patients have poor knowledge about MP. The current study aimed to investigate demographic and psychological predictors of knowledge and perceived importance of MP in an advanced cancer patient cohort. Eligible participants had advanced solid cancers of any histological type with sufficient accessible tissue for MP and were enrolled in the Molecular Screening and Therapeutics (MoST) Program. A questionnaire was completed by 1074 participants (91% response rate) after consent, prior to undergoing MP. Overall, participants had poor to moderate knowledge of MP, yet perceived MP to have high importance. Higher education, speaking English at home, and greater satisfaction with the decision to undergo MP were associated with higher knowledge scores. More negative attitudes towards uncertainty, greater self-efficacy to cope with results, and lower perceived likelihood of cancer progression were associated with greater perceived importance of MP. Less educated participants and those who do not speak English at home will need clear explanations, visual aids and ample opportunity to ask questions about MP at the time of their decision-making. Clinicians also need to consider psychological factors relevant to patients' decision to pursue MP. Given the increased awareness of and demand for cancer genomic information and the rapidly changing nature of the actionability of MP, these findings will help inform an important ongoing debate on how to facilitate ethical and informed consent and manage patient expectations about personalized treatments.
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Affiliation(s)
- Grace Davies
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Phyllis Butow
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Christine E Napier
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia.
| | - Nicci Bartley
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Sydney, NSW 2032, Australia.
| | - Mandy L Ballinger
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; St Vincent's Clinical School, University of NSW, Sydney, NSW 2010, Australia.
| | - David M Thomas
- Cancer Division, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia; St Vincent's Clinical School, University of NSW, Sydney, NSW 2010, Australia.
| | - Timothy E Schlub
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney, NSW 2006, Australia.
| | - Megan C Best
- The University of Sydney, Faculty of Science, School of Psychology, Psycho-Oncology Co-operative Research Group, Sydney, NSW 2006, Australia.
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Raspa M, Moultrie R, Wagner L, Edwards A, Andrews S, Frisch MK, Turner-Brown L, Wheeler A. Ethical, Legal, and Social Issues Related to the Inclusion of Individuals With Intellectual Disabilities in Electronic Health Record Research: Scoping Review. J Med Internet Res 2020; 22:e16734. [PMID: 32436848 PMCID: PMC7273235 DOI: 10.2196/16734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/17/2020] [Accepted: 02/22/2020] [Indexed: 01/31/2023] Open
Abstract
Background Data from electronic health records (EHRs) are increasingly used in the field of genetic research to further precision medicine initiatives. However, many of these efforts exclude individuals with intellectual disabilities, which often stem from genetic conditions. To include this important subpopulation in EHR research, important ethical, legal, and social issues should be considered. Objective The goal of this study was to review prior research to better understand what ethical, legal, and social issues may need further investigation when considering the research use of EHRs for individuals with genetic conditions that may result in intellectual disability. This information will be valuable in developing methods and best practices for involving this group in research given they are considered a vulnerable population that may need special research protections. Methods We conducted a scoping review to examine issues related to the use of EHRs for research purposes and those more broadly associated with genetic research. The initial search yielded a total of 460 unique citations. We used an evaluative coding process to determine relevancy for inclusion. Results This approach resulted in 59 articles in the following areas: informed consent, privacy and security, return of results, and vulnerable populations. The review included several models of garnering informed consent in EHR or genetic research, including tiered or categorical, blanket or general, open, and opt-out models. Second, studies reported on patients’ concerns regarding the privacy and security of EHR or genetic data, such as who has access, type of data use in research, identifiability, and risks associated with privacy breach. The literature on return of research results using biospecimens examined the dissension in the field, particularly when sharing individualized genetic results. Finally, work involving vulnerable populations highlighted special considerations when conducting EHR or genetic research. Conclusions The results frame important questions for researchers to consider when designing EHR studies, which include individuals with intellectual disabilities, including appropriate safeguards and protections.
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Affiliation(s)
- Melissa Raspa
- RTI International, Research Triangle Park, NC, United States
| | | | - Laura Wagner
- RTI International, Research Triangle Park, NC, United States
| | - Anne Edwards
- RTI International, Research Triangle Park, NC, United States
| | - Sara Andrews
- RTI International, Research Triangle Park, NC, United States
| | - Mary Katherine Frisch
- The University of North Carolina at Chapel Hill, TEACCH Autism Program, Chapel Hill, NC, United States
| | - Lauren Turner-Brown
- The University of North Carolina at Chapel Hill, TEACCH Autism Program, Chapel Hill, NC, United States
| | - Anne Wheeler
- RTI International, Research Triangle Park, NC, United States
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Dankar FK, Gergely M, Malin B, Badji R, Dankar SK, Shuaib K. Dynamic-informed consent: A potential solution for ethical dilemmas in population sequencing initiatives. Comput Struct Biotechnol J 2020; 18:913-921. [PMID: 32346464 PMCID: PMC7182686 DOI: 10.1016/j.csbj.2020.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 01/13/2023] Open
Abstract
While the majority of population-level genome sequencing initiatives claim to follow the principles of informed consent, the requirements for informed consent have not been-well defined in this context. In fact, the implementation of informed consent differs greatly across these initiatives - spanning broad consent, blanket consent, and tiered consent among others. As such, this calls for an investigation into the requirements for consent to be "informed" in the context of population genomics. One particular strategy that claims to be fully informed and to continuously engage participants is called "dynamic consent". Dynamic consent is based on a personalised communication platform that aims to facilitate the consent process. It is oriented to support continuous two-way communication between researchers and participants. In this paper, we analyze the requirements of informed consent in the context of population genomics, review various current implementations of dynamic consent, assess whether they fulfill the requirement of informed consent, and, in turn, enable participants to make autonomous and informed choices on whether or not to participate in research projects.
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Affiliation(s)
- Fida K. Dankar
- College of Information Technology, UAEU, Al-Ain, United Arab Emirates
| | - Marton Gergely
- College of Information Technology, UAEU, Al-Ain, United Arab Emirates
| | - Bradley Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | | | | | - Khaled Shuaib
- College of Information Technology, UAEU, Al-Ain, United Arab Emirates
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Alkaraki AK, Khabour OF, Alzoubi KH, Al-Ebbini LMK, Altaany Z. Informed Consent Form Challenges for Genetic Research in Jordan. J Multidiscip Healthc 2020; 13:235-239. [PMID: 32184613 PMCID: PMC7062388 DOI: 10.2147/jmdh.s243669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/13/2020] [Indexed: 01/27/2023] Open
Abstract
Background Informed consent is an obligatory requirement for research engaging human subjects. Informed consent form (ICF) should be provided for human subjects to confirm their willingness for voluntary participation in a study. Ethical and legal obligations necessitate the presence of informed consent essential items to be built into the ICF. Objective To evaluate the content of ICFs obtained from different genetic studies accomplished in Jordan and their adherence to ethical guidelines proposed by the International Conference on Harmonization—Good Clinical Practice (ICHGCP). Methods and Measures A total of 44 ICFs obtained from master theses and grant proposals at two major universities in Jordan were analyzed according to the good clinical practice criteria proposed by ICHGCP. ICFs were scored for the presence or absence of ICF main items/categories. Results Results show inadequate information present in the examined ICFs. The highest information score was 17 out of 20, while the lowest score was one out of 20. The average score for all studied ICFs was 6.18±3.65. Among essential items/categories that were absent from the majority of studied ICFs were a statement about voluntary participation, confidentiality of data, compensation to study participants, risk/benefits of the study, and researchers’ contact information. Conclusion The ICFs were missing a number of required items. This could reflect inadequate knowledge about minimal informed consent requirements among Jordanian investigators highlighting the need for research ethical training in the country.
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Affiliation(s)
- Almuthanna K Alkaraki
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid 21163, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Lina M K Al-Ebbini
- Department of Biomedical Systems and Informatics Engineering, Hijjawi for Engineering Technology, Yarmouk University, Irbid 21163, Jordan
| | - Zaid Altaany
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
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Bromley E, Mendoza-Graf A, Berry S, Nebeker C, Khodyakov D. From "Informed" to "Engaged" Consent: Risks and Obligations in Consent for Participation in a Health Data Repository. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:172-182. [PMID: 32342789 DOI: 10.1177/1073110520917007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The development and use of large and dynamic health data repositories designed to support research pose challenges to traditional informed consent models. We used semi-structured interviewing (n=44) to elicit diverse research stakeholders' views of a model of consent appropriate to participation in initiatives that entail collection, long-term storage, and undetermined future research use of multiple types of health data. We demonstrate that, when considering health data repositories, research stakeholders replace a concept of consent as informed with one in which consent is engaged. In engaged consent, a participant's ongoing relationship with a repository serves as a substitute or adjunct to information exchange at enrollment. We detail research stakeholders' views of the risks of engaged consent and suggest questions for further study about engagement and consent procedures in initiatives that aim to store data for future unspecified research purposes.
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Affiliation(s)
- Elizabeth Bromley
- Elizabeth Bromley, M.D., Ph.D., is Associate Professor in Residence in the Departments of Psychiatry and Anthropology at the University of California, Los Angeles. Alexandra Mendoza-Graf, M.A., is an Assistant Policy Researcher at RAND and Doctoral Fellow at the Pardee RAND Graduate School in Los Angeles, CA. Her research focuses on the social determinants of health. Sandra Berry, M.A., is a senior behavioral scientist at RAND Corporation and senior director of RAND's Survey Research Group. Camille Nebeker, Ph.D., is Director of the Research Center for Optimal Digital Ethics (ReCODE.health) at UC San Diego. Her faculty appointment is with the Division of Behavioral Medicine in the Department of Family Medicine and Public Health at UC San Diego. Dmitry Khodyakov, Ph.D., is a Senior Behavioral/Social Scientist at the RAND Corporation. His research focuses on research ethics, partnered research, stakeholder engagement, and methods of expert elicitation
| | - Alexandra Mendoza-Graf
- Elizabeth Bromley, M.D., Ph.D., is Associate Professor in Residence in the Departments of Psychiatry and Anthropology at the University of California, Los Angeles. Alexandra Mendoza-Graf, M.A., is an Assistant Policy Researcher at RAND and Doctoral Fellow at the Pardee RAND Graduate School in Los Angeles, CA. Her research focuses on the social determinants of health. Sandra Berry, M.A., is a senior behavioral scientist at RAND Corporation and senior director of RAND's Survey Research Group. Camille Nebeker, Ph.D., is Director of the Research Center for Optimal Digital Ethics (ReCODE.health) at UC San Diego. Her faculty appointment is with the Division of Behavioral Medicine in the Department of Family Medicine and Public Health at UC San Diego. Dmitry Khodyakov, Ph.D., is a Senior Behavioral/Social Scientist at the RAND Corporation. His research focuses on research ethics, partnered research, stakeholder engagement, and methods of expert elicitation
| | - Sandra Berry
- Elizabeth Bromley, M.D., Ph.D., is Associate Professor in Residence in the Departments of Psychiatry and Anthropology at the University of California, Los Angeles. Alexandra Mendoza-Graf, M.A., is an Assistant Policy Researcher at RAND and Doctoral Fellow at the Pardee RAND Graduate School in Los Angeles, CA. Her research focuses on the social determinants of health. Sandra Berry, M.A., is a senior behavioral scientist at RAND Corporation and senior director of RAND's Survey Research Group. Camille Nebeker, Ph.D., is Director of the Research Center for Optimal Digital Ethics (ReCODE.health) at UC San Diego. Her faculty appointment is with the Division of Behavioral Medicine in the Department of Family Medicine and Public Health at UC San Diego. Dmitry Khodyakov, Ph.D., is a Senior Behavioral/Social Scientist at the RAND Corporation. His research focuses on research ethics, partnered research, stakeholder engagement, and methods of expert elicitation
| | - Camille Nebeker
- Elizabeth Bromley, M.D., Ph.D., is Associate Professor in Residence in the Departments of Psychiatry and Anthropology at the University of California, Los Angeles. Alexandra Mendoza-Graf, M.A., is an Assistant Policy Researcher at RAND and Doctoral Fellow at the Pardee RAND Graduate School in Los Angeles, CA. Her research focuses on the social determinants of health. Sandra Berry, M.A., is a senior behavioral scientist at RAND Corporation and senior director of RAND's Survey Research Group. Camille Nebeker, Ph.D., is Director of the Research Center for Optimal Digital Ethics (ReCODE.health) at UC San Diego. Her faculty appointment is with the Division of Behavioral Medicine in the Department of Family Medicine and Public Health at UC San Diego. Dmitry Khodyakov, Ph.D., is a Senior Behavioral/Social Scientist at the RAND Corporation. His research focuses on research ethics, partnered research, stakeholder engagement, and methods of expert elicitation
| | - Dmitry Khodyakov
- Elizabeth Bromley, M.D., Ph.D., is Associate Professor in Residence in the Departments of Psychiatry and Anthropology at the University of California, Los Angeles. Alexandra Mendoza-Graf, M.A., is an Assistant Policy Researcher at RAND and Doctoral Fellow at the Pardee RAND Graduate School in Los Angeles, CA. Her research focuses on the social determinants of health. Sandra Berry, M.A., is a senior behavioral scientist at RAND Corporation and senior director of RAND's Survey Research Group. Camille Nebeker, Ph.D., is Director of the Research Center for Optimal Digital Ethics (ReCODE.health) at UC San Diego. Her faculty appointment is with the Division of Behavioral Medicine in the Department of Family Medicine and Public Health at UC San Diego. Dmitry Khodyakov, Ph.D., is a Senior Behavioral/Social Scientist at the RAND Corporation. His research focuses on research ethics, partnered research, stakeholder engagement, and methods of expert elicitation
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Naufel S, Klein E. Brain–computer interface (BCI) researcher perspectives on neural data ownership and privacy. J Neural Eng 2020; 17:016039. [DOI: 10.1088/1741-2552/ab5b7f] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Background: The Federal Policy for the Protection of Human Subjects-the Common Rule-was revised in 2017 to reduce administrative burdens for low-risk research while enhancing protections for human subjects enrolled in greater-than-minimal-risk trials. These enhanced protections involve changes to the consent process. Methods: We review the general requirements applicable to the consent process, as well as the additional elements of consent mandated by the revisions to the Common Rule. The regulations apply to federally funded studies and are optional for non-federally funded studies. Results: Two new general requirements for the consent process, one basic required element for the consent form, and three optional additional elements for the consent form were added in an effort to improve potential subjects' understanding of research studies and to facilitate the exchange of information between the research staff and potential subjects. Important information about the study should be extracted into a concise key information section to help potential subjects make informed decisions regarding participation. Conclusion: The revisions to the Common Rule are intended to enhance human subject protection by providing more information in an understandable form during the consent process. The new consent elements aim to increase transparency and help improve clarity.
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Affiliation(s)
- Leah L. LeCompte
- Department of Rehabilitation Services, Ochsner Clinic Foundation, New Orleans, LA
| | - Sylvia J. Young
- Human Research Protection Program, Ochsner Clinic Foundation, New Orleans, LA
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Solberg B, Ursin L. Being Polite: Why Biobank Consent Comprehension Is Neither a Requirement nor an Aspiration. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:31-33. [PMID: 31090521 DOI: 10.1080/15265161.2019.1587032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Berge Solberg
- a The Norwegian University of Science and Technology
| | - Lars Ursin
- a The Norwegian University of Science and Technology
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