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Lee AR, Koo D, Kim IK, Lee E, Kim HH, Yoo S, Kim JH, Choi EK, Lee HY. Identifying facilitators of and barriers to the adoption of dynamic consent in digital health ecosystems: a scoping review. BMC Med Ethics 2023; 24:107. [PMID: 38041034 PMCID: PMC10693132 DOI: 10.1186/s12910-023-00988-9] [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: 06/07/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Conventional consent practices face ethical challenges in continuously evolving digital health environments due to their static, one-time nature. Dynamic consent offers a promising solution, providing adaptability and flexibility to address these ethical concerns. However, due to the immaturity of the concept and accompanying technology, dynamic consent has not yet been widely used in practice. This study aims to identify the facilitators of and barriers to adopting dynamic consent in real-world scenarios. METHODS This scoping review, conducted in December 2022, adhered to the PRISMA Extension for Scoping Reviews guidelines, focusing on dynamic consent within the health domain. A comprehensive search across Web of Science, PubMed, and Scopus yielded 22 selected articles based on predefined inclusion and exclusion criteria. RESULTS The facilitators for the adoption of dynamic consent in digital health ecosystems were the provision of multiple consent modalities, personalized alternatives, continuous communication, and the dissemination of up-to-date information. Nevertheless, several barriers, such as consent fatigue, the digital divide, complexities in system implementation, and privacy and security concerns, needed to be addressed. This study also investigated current technological advancements and suggested considerations for further research aimed at resolving the remaining challenges surrounding dynamic consent. CONCLUSIONS Dynamic consent emerges as an ethically advantageous method for digital health ecosystems, driven by its adaptability and support for continuous, two-way communication between data subjects and consumers. Ethical implementation in real-world settings requires the development of a robust technical framework capable of accommodating the diverse needs of stakeholders, thereby ensuring ethical integrity and data privacy in the evolving digital health landscape.
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Affiliation(s)
- Ah Ra Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dongjun Koo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Il Kon Kim
- School of Computer Science & Engineering, College of IT Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Eunjoo Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Ho Kim
- Department of Pediatrics, Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Eun Kyung Choi
- Department of Medical Humanities and Medical Education, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Ho-Young Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Wang S, Bonomi L, Dai W, Chen F, Cheung C, Bloss CS, Cheng S, Jiang X. Big Data Privacy in Biomedical Research. IEEE TRANSACTIONS ON BIG DATA 2020; 6:296-308. [PMID: 32478127 PMCID: PMC7258042 DOI: 10.1109/tbdata.2016.2608848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Biomedical research often involves studying patient data that contain personal information. Inappropriate use of these data might lead to leakage of sensitive information, which can put patient privacy at risk. The problem of preserving patient privacy has received increasing attentions in the era of big data. Many privacy methods have been developed to protect against various attack models. This paper reviews relevant topics in the context of biomedical research. We discuss privacy preserving technologies related to (1) record linkage, (2) synthetic data generation, and (3) genomic data privacy. We also discuss the ethical implications of big data privacy in biomedicine and present challenges in future research directions for improving data privacy in biomedical research.
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Affiliation(s)
- Shuang Wang
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Luca Bonomi
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Wenrui Dai
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Feng Chen
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
| | - Cynthia Cheung
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093
| | - Cinnamon S Bloss
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093
| | - Samuel Cheng
- School of Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK, 74135
| | - Xiaoqian Jiang
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA 92093
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Yakubu A, Tindana P, Matimba A, Littler K, Munung NS, Madden E, Staunton C, De Vries J. Model framework for governance of genomic research and biobanking in Africa - a content description. AAS Open Res 2018; 1:13. [PMID: 30714023 PMCID: PMC6354903 DOI: 10.12688/aasopenres.12844.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
Genomic research and biobanking are expanding globally, with a promise to fast-track the research needed to improve approaches to disease treatment and prevention through scientific collaborations such as the Human Heredity and Health in Africa (H3Africa) initiative. Integral to this type of research is the availability of samples and data for research. The need for broad access brings along a host of ethical concerns, including those related to privacy and confidentiality, as well as fairness and equity in access and capacity to utilise these samples between scientists from the high income and low income countries. Addressing these concerns while promoting genomic research, especially in Africa, requires the implementation of a sound governance framework. In this paper, we describe the contents of a Framework for Best Practice for Genomics Research and biobanking in Africa that was developed, under the auspices of the H3Africa initiative. This framework is broad enough to be used and adapted by African countries to facilitate the development of country-specific guidelines and to help improve the conduct and governance of genomics research.
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Affiliation(s)
- Aminu Yakubu
- Department of Health Planning, Research & Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Alice Matimba
- Wellcome Genome Campus Advanced Courses and Scientific Conferences, Cambridge, UK
| | | | | | - Ebony Madden
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Jantina De Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Yakubu A, Tindana P, Matimba A, Littler K, Munung NS, Madden E, Staunton C, De Vries J. Model framework for governance of genomic research and biobanking in Africa - a content description. AAS Open Res 2018; 1:13. [PMID: 30714023 DOI: 10.12688/aasopenres.12844.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Genomic research and biobanking are expanding globally, with a promise to fast-track the research needed to improve approaches to disease treatment and prevention through scientific collaborations such as the Human Heredity and Health in Africa (H3Africa) initiative. Integral to this type of research is the availability of samples and data for research. The need for broad access brings along a host of ethical concerns, including those related to privacy and confidentiality, as well as fairness and equity in access and capacity to utilise these samples between scientists from the high income and low income countries. Addressing these concerns while promoting genomic research, especially in Africa, requires the implementation of a sound governance framework. In this paper, we describe the contents of a Framework for Best Practice for Genomics Research and biobanking in Africa that was developed, under the auspices of the H3Africa initiative. This framework is broad enough to be used and adapted by African countries to facilitate the development of country-specific guidelines and to help improve the conduct and governance of genomics research.
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Affiliation(s)
- Aminu Yakubu
- Department of Health Planning, Research & Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Alice Matimba
- Wellcome Genome Campus Advanced Courses and Scientific Conferences, Cambridge, UK
| | | | | | - Ebony Madden
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Jantina De Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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5
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Yoshizawa G, Sasongko TH, Ho CH, Kato K. Social and Communicative Functions of Informed Consent Forms in East Asia and Beyond. Front Genet 2017; 8:99. [PMID: 28775738 PMCID: PMC5517404 DOI: 10.3389/fgene.2017.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/05/2017] [Indexed: 12/18/2022] Open
Abstract
The recent research and technology development in medical genomics has raised new issues that are profoundly different from those encountered in traditional clinical research for which informed consent was developed. Global initiatives for international collaboration and public participation in genomics research now face an increasing demand for new forms of informed consent which reflect local contexts. This article analyzes informed consent forms (ICFs) for genomic research formulated by four selected research programs and institutes in East Asia – the Medical Genome Science Program in Japan, Universiti Sains Malaysia Human Research Ethics Committee in Malaysia, and the Taiwan Biobank and the Taipei Medical University- Joint Institutional Review Board in Taiwan. The comparative text analysis highlights East Asian contexts as distinct from other regions by identifying communicative and social functions of consent forms. The communicative functions include re-contact options and offering interactive support for research participants, and setting opportunities for family or community engagement in the consent process. This implies that informed consent cannot be validated solely with the completion of a consent form at the initial stage of the research, and informed consent templates can facilitate interactions between researchers and participants through (even before and after) the research process. The social functions consist of informing participants of possible social risks that include genetic discrimination, sample and data sharing, and highlighting the role of ethics committees. Although international ethics harmonization and the subsequent coordination of consent forms may be necessary to maintain the quality and consistency of consent process for data-intensive international research, it is also worth paying more attention to the local values and different settings that exist where research participants are situated for research in medical genomics. More than simply tools to gain consent from research participants, ICFs function rather as a device of social communication between research communities and civic communities in liaison with intermediary agents like ethics committees, genetic counselors, and public biobanks and databases.
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Affiliation(s)
- Go Yoshizawa
- Graduate School of Medicine, Osaka UniversitySuita, Japan
| | - Teguh H Sasongko
- Division of Human Biology, School of Medicine, International Medical UniversityKuala Lumpur, Malaysia.,Human Research Ethics Committee, Universiti Sains Malaysia Health CampusKubang Kerian, Malaysia
| | - Chih-Hsing Ho
- Institute of European and American Studies, Academia SinicaTaipei, Taiwan
| | - Kazuto Kato
- Graduate School of Medicine, Osaka UniversitySuita, Japan
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6
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Mostert M, Bredenoord AL, Biesaart MCIH, van Delden JJM. Big Data in medical research and EU data protection law: challenges to the consent or anonymise approach. Eur J Hum Genet 2016; 24:956-60. [PMID: 26554881 PMCID: PMC5070890 DOI: 10.1038/ejhg.2015.239] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/16/2015] [Accepted: 10/13/2015] [Indexed: 12/14/2022] Open
Abstract
Medical research is increasingly becoming data-intensive; sensitive data are being re-used, linked and analysed on an unprecedented scale. The current EU data protection law reform has led to an intense debate about its potential effect on this processing of data in medical research. To contribute to this evolving debate, this paper reviews how the dominant 'consent or anonymise approach' is challenged in a data-intensive medical research context, and discusses possible ways forwards within the EU legal framework on data protection. A large part of the debate in literature focuses on the acceptability of adapting consent or anonymisation mechanisms to overcome the challenges within these approaches. We however believe that the search for ways forward within the consent or anonymise paradigm will become increasingly difficult. Therefore, we underline the necessity of an appropriate research exemption from consent for the use of sensitive personal data in medical research to take account of all legitimate interests. The appropriate conditions of such a research exemption are however subject to debate, and we expect that there will be minimal harmonisation of these conditions in the forthcoming EU Data Protection Regulation. Further deliberation is required to determine when a shift away from consent as a legal basis is necessary and proportional in a data-intensive medical research context, and what safeguards should be put in place when such a research exemption from consent is provided.
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Affiliation(s)
- Menno Mostert
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique C I H Biesaart
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Kaye J, Whitley EA, Lund D, Morrison M, Teare H, Melham K. Dynamic consent: a patient interface for twenty-first century research networks. Eur J Hum Genet 2015; 23:141-6. [PMID: 24801761 PMCID: PMC4130658 DOI: 10.1038/ejhg.2014.71] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/25/2014] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
Biomedical research is being transformed through the application of information technologies that allow ever greater amounts of data to be shared on an unprecedented scale. However, the methods for involving participants have not kept pace with changes in research capability. In an era when information is shared digitally at the global level, mechanisms of informed consent remain static, paper-based and organised around national boundaries and legal frameworks. Dynamic consent (DC) is both a specific project and a wider concept that offers a new approach to consent; one designed to meet the needs of the twenty-first century research landscape. At the heart of DC is a personalised, digital communication interface that connects researchers and participants, placing participants at the heart of decision making. The interface facilitates two-way communication to stimulate a more engaged, informed and scientifically literate participant population where individuals can tailor and manage their own consent preferences. The technical architecture of DC includes components that can securely encrypt sensitive data and allow participant consent preferences to travel with their data and samples when they are shared with third parties. In addition to improving transparency and public trust, this system benefits researchers by streamlining recruitment and enabling more efficient participant recontact. DC has mainly been developed in biobanking contexts, but it also has potential application in other domains for a variety of purposes.
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Affiliation(s)
- Jane Kaye
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Edgar A Whitley
- Information Systems and Innovation Group, Department of Management, London School of Economics and Political Science, London, UK
| | - David Lund
- HW Communications Ltd, Parkfield, Lancaster, UK
| | - Michael Morrison
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Harriet Teare
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karen Melham
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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8
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Kaye J. The Tension Between Data Sharing and the Protection of Privacy in Genomics Research. ETHICS, LAW AND GOVERNANCE OF BIOBANKING 2015. [DOI: 10.1007/978-94-017-9573-9_8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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9
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Khan A, Capps BJ, Sum MY, Kuswanto CN, Sim K. Informed consent for human genetic and genomic studies: a systematic review. Clin Genet 2014; 86:199-206. [PMID: 24646408 DOI: 10.1111/cge.12384] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/08/2014] [Accepted: 03/17/2014] [Indexed: 01/23/2023]
Abstract
As genetic and genomic studies grow in scale, there are ethical concerns related to the collection and use of genetic information. The emergence of large public databases potentially redefine the terms of participation in genetic and genomic research, and suggests the changing application of traditional ethical principles such as privacy or consent. For this study, we wanted to see whether such developments are reflected in the informed consent processes in human genetic and genomic studies. Therefore, we performed a systematic review of the empirical studies that examined informed consent involving large genetic databases in human genetic and genomic studies, grouped the identified issues related to the different stakeholders (including subjects, researchers, and institutional review boards) and discussed the limitations and implications of these findings. Major themes related to the place of bioethical considerations, procured tissues, people involved, process of informed consent and study procedures. Frequently raised issues included confidentiality of participants, documentation of informed consent, public attitudes, future use of participant samples or data, and disclosure of results. Awareness and attention to these bioethical issues as well as assiduousness in managing these concerns in genetic/genomic research would further strengthen and safeguard the rights, safety and well-being of genetic research participants.
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Affiliation(s)
- A Khan
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
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10
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Dove ES, Avard D, Black L, Knoppers BM. Emerging issues in paediatric health research consent forms in Canada: working towards best practices. BMC Med Ethics 2013; 14:5. [PMID: 23363554 PMCID: PMC3571865 DOI: 10.1186/1472-6939-14-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/29/2012] [Indexed: 12/20/2022] Open
Abstract
Background Obtaining a research participant’s voluntary and informed consent is the bedrock of sound ethics practice. Greater inclusion of children in research has led to questions about how paediatric consent operates in practice to accord with current and emerging legal and socio-ethical issues, norms, and requirements. Methods Employing a qualitative thematic content analysis, we examined paediatric consent forms from major academic centres and public organisations across Canada dated from 2008–2011, which were purposively selected to reflect different types of research ethics boards, participants, and studies. The studies included biobanking, longitudinal studies, and gene-environment studies. Our purpose was to explore the following six emerging issues: (1) whether the scope of parental consent allows for a child’s assent, dissent, or future consent; (2) whether the concepts of risk and benefit incorporate the child’s psychological and social perspective; (3) whether a child’s ability to withdraw is respected and to what extent withdrawal is permitted; (4) whether the return of research results includes individual results and/or incidental findings and the processes involved therein; (5) whether privacy and confidentiality concerns adequately address the child’s perspective and whether standard data and/or sample identifiability nomenclature is used; and (6) whether retention of and access to paediatric biological samples and associated medical data are addressed. Results The review suggests gaps and variability in the consent forms with respect to addressing each of the six issues. Many forms did not discuss the possibility of returning research results, be they individual or general/aggregate results. Forms were also divided in terms of the scope of parental consent (specific versus broad), and none discussed a process for resolving disputes that can arise when either the parents or the child wishes to withdraw from the study. Conclusions The analysis provides valuable insight and evidence into how consent forms address current ethical issues. While we do not thoroughly explore the contexts and reasons behind consent form gaps and variability, we do advocate and formulate the development of best practices for drafting paediatric health research consent forms. This can greatly ameliorate current gaps and facilitate harmonised and yet contextualised approaches to paediatric health research ethics.
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Affiliation(s)
- Edward S Dove
- Department of Human Genetics, Centre of Genomics and Policy, Faculty of Medicine, McGill University, Montreal, QC, H3A 0G1, Canada.
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Whitley EA, Kanellopoulou N, Kaye J. Consent and research governance in biobanks: evidence from focus groups with medical researchers. Public Health Genomics 2012; 15:232-42. [PMID: 22722687 DOI: 10.1159/000336544] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Much is known about patient attitudes to ethical and legal questions in the context of biobanking, particularly regarding privacy protection and consent. However, little is known about the attitudes of medical researchers who use biobanks for research to these issues. Four focus groups with medical researchers in the UK were conducted in 2010-2011. The study highlights a range of issues associated with the research oversight and consent process (including obtaining ethical approval to use biobank samples and particular concerns for international studies), the benefits and limitations of broad consent and the possibilities of revoking consent. Many of these issues originate in the relatively static consent processes that currently govern the biobanking process. However, it is now possible to develop reliable, dynamic processes using information technology that can resolve many of these ethical and legal concerns. The 'dynamic consent' approach therefore offers the opportunity to fundamentally transform the process of medical research in a manner that addresses the concerns of both patients and medical researchers.
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Affiliation(s)
- E A Whitley
- Information Systems and Innovation Group, London School of Economics and Political Science, London, UK.
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12
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Kaye J. The tension between data sharing and the protection of privacy in genomics research. Annu Rev Genomics Hum Genet 2012; 13:415-31. [PMID: 22404490 DOI: 10.1146/annurev-genom-082410-101454] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Next-generation sequencing and global data sharing challenge many of the governance mechanisms currently in place to protect the privacy of research participants. These challenges will make it more difficult to guarantee anonymity for participants, provide information to satisfy the requirements of informed consent, and ensure complete withdrawal from research when requested. To move forward, we need to improve the current governance systems for research so that they are responsive to individual privacy concerns but can also be effective at a global level. We need to develop a system of e-governance that can complement existing governance systems but that places greater reliance on the use of technology to ensure compliance with ethical and legal requirements. These new governance structures must be able to address the concerns of research participants while at the same time ensuring effective data sharing that promotes public trust in genomics research.
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Affiliation(s)
- Jane Kaye
- HeLEX, Department of Public Health, University of Oxford, Oxford OX3 7LF, UK.
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