1
|
Janssen ERC, Punt IM, van Soest J, Heerkens YF, Stallinga HA, Ten Napel H, van Rhijn LW, Mons B, Dekker A, Willems PC, van Meeteren NLU. Operationalizing and digitizing person-centered daily functioning: a case for functionomics. BMC Med Inform Decis Mak 2024; 24:184. [PMID: 38937817 PMCID: PMC11212415 DOI: 10.1186/s12911-024-02584-2] [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: 04/04/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
An ever-increasing amount of data on a person's daily functioning is being collected, which holds information to revolutionize person-centered healthcare. However, the full potential of data on daily functioning cannot yet be exploited as it is mostly stored in an unstructured and inaccessible manner. The integration of these data, and thereby expedited knowledge discovery, is possible by the introduction of functionomics as a complementary 'omics' initiative, embracing the advances in data science. Functionomics is the study of high-throughput data on a person's daily functioning, that can be operationalized with the International Classification of Functioning, Disability and Health (ICF).A prerequisite for making functionomics operational are the FAIR (Findable, Accessible, Interoperable, and Reusable) principles. This paper illustrates a step by step application of the FAIR principles for making functionomics data machine readable and accessible, under strictly certified conditions, in a practical example. Establishing more FAIR functionomics data repositories, analyzed using a federated data infrastructure, enables new knowledge generation to improve health and person-centered healthcare. Together, as one allied health and healthcare research community, we need to consider to take up the here proposed methods.
Collapse
Affiliation(s)
- Esther R C Janssen
- Radboud Institute for Health Sciences, IQ health, Radboud university medical centre, Nijmegen, The Netherlands.
- School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
- Department of Orthopedic Surgery, VieCuri Medical Centre, Tegelseweg 210, Venlo, 5912 BL, The Netherlands.
| | - Ilona M Punt
- Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Johan van Soest
- Brightlands Institute for Smart Society (BISS), Faculty of Science and Engineering (FSE), Maastricht University, Heerlen, The Netherlands
- Department of Radiation Oncology (Maastro), GROW-School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Yvonne F Heerkens
- Dutch Institute of Allied Health Care (NPi), Amersfoort, The Netherlands
- Research Group Occupation & Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Hillegonda A Stallinga
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib Ten Napel
- RIVM/ Dutch WHO-FIC Collaborating Centre, Bilthoven, The Netherlands
| | | | - Barend Mons
- Leiden University Medical Centre, Leiden, The Netherlands
- GO FAIR International Support & Coordination Office (GFISCO), Leiden, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (Maastro), GROW-School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Paul C Willems
- Department of Orthopedics and Research School Caphri, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nico L U van Meeteren
- Top Sector Life Sciences and Health (Health~Holland), The Hague, The Netherlands
- Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
2
|
McEnhill R, Borghese H, Moore SA. Pet owner perspectives, motivators and concerns about veterinary biobanking. Front Vet Sci 2024; 11:1359546. [PMID: 38444781 PMCID: PMC10912476 DOI: 10.3389/fvets.2024.1359546] [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] [Received: 12/21/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Veterinary biobanks store samples for future use and distribute samples to academic researchers and industry entities; however, informed consent provided by owners for pets contributing to biobanks can be complicated by limited understanding of goals, purpose, and logistics of biobanking. Methods This survey-based study aimed to gather feedback from pet owners on how they viewed allowing their pet to contribute to a veterinary biobank, with the goal of identifying opportunities to improve education, awareness of veterinary biobanking initiatives, and the consent processes. An electronic survey was distributed to a listserv of 2,119 pet owners and responses were received from 118 respondents (5.6%). Results Most respondents (67%) were not familiar with the concept of veterinary biobanking prior to having responded to the survey. Most (89%) were willing to allow their healthy pet to contribute samples to a veterinary biobanking program. Ninety-five percent would allow their sick pet to contribute. Most were neutral about financial incentives as a motivator to participate, although 40% indicated that if their pet's condition resulted in a decision to humanely euthanize, they would be more likely to contribute to the biobank if the veterinary biobanking program covered the cost of euthanasia. Common concerns included security/confidentiality (36%), that results would not be shared with them (33%) or that samples would be used for other purposes beyond those advertised (22%). Discussion These results suggest veterinary biobanking initiatives are well received by owners and most are willing to allow their pets to participate. Respondent concerns represent opportunities for veterinary biobanks to improve messaging and dissemination of results from work they support.
Collapse
Affiliation(s)
- Richard McEnhill
- Blue Buffalo Veterinary Clinical Trials Office, Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
- MedVet Medical and Cancer Centers for Pets, Columbus, OH, United States
| | - Holly Borghese
- Blue Buffalo Veterinary Clinical Trials Office, Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Sarah A. Moore
- Blue Buffalo Veterinary Clinical Trials Office, Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
- BluePearl Science, Tampa, FL, United States
| |
Collapse
|
3
|
Lieb W, Strathmann EA, Röder C, Jacobs G, Gaede KI, Richter G, Illig T, Krawczak M. Population-Based Biobanking. Genes (Basel) 2024; 15:66. [PMID: 38254956 PMCID: PMC10815030 DOI: 10.3390/genes15010066] [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: 11/28/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Population-based biobanking is an essential element of medical research that has grown substantially over the last two decades, and many countries are currently pursuing large national biobanking initiatives. The rise of individual biobanks is paralleled by various networking activities in the field at both the national and international level, such as BBMRI-ERIC in the EU. A significant contribution to population-based biobanking comes from large cohort studies and national repositories, including the United Kingdom Biobank (UKBB), the CONSTANCES project in France, the German National Cohort (NAKO), LifeLines in the Netherlands, FinnGen in Finland, and the All of Us project in the U.S. At the same time, hospital-based biobanking has also gained importance in medical research. We describe some of the scientific questions that can be addressed particularly well by the use of population-based biobanks, including the discovery and calibration of biomarkers and the identification of molecular correlates of health parameters and disease states. Despite the tremendous progress made so far, some major challenges to population-based biobanking still remain, including the need to develop strategies for the long-term sustainability of biobanks, the handling of incidental findings, and the linkage of sample-related and sample-derived data to other relevant resources.
Collapse
Affiliation(s)
- Wolfgang Lieb
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Eike A. Strathmann
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
| | - Christian Röder
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- Institute for Experimental Cancer Research (IET), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Gunnar Jacobs
- Institute of Epidemiology and Biobank Popgen, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany; (E.A.S.); (C.R.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Karoline I. Gaede
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- BioMaterialBank (BMB) North, Research Center Borstel, Leibniz Lung Center, 23845 Borstel, Germany
| | - Gesine Richter
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- Institute of Experimental Medicine (IEM), Division of Biomedical Ethics, Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Thomas Illig
- German Centre for Lung Research (DZL), Airway Research Centre North (ARCN), 22927 Großhansdorf, Germany; (K.I.G.); (G.R.); (T.I.)
- Hannover Unified Biobank (HUB), Hannover Medical School, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), 30625 Hannover, Germany
| | - Michael Krawczak
- PopGen 2.0 Biobanking Network (P2N), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
- Institute of Medical Informatics and Statistics (IMIS), Kiel University, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| |
Collapse
|
4
|
Maseme M, Gardner J, Mahomed S. Broad consent for biobank research in South Africa - Towards an enabling ethico-legal framework. Glob Bioeth 2023; 35:2288331. [PMID: 38179086 PMCID: PMC10763822 DOI: 10.1080/11287462.2023.2288331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
Broad consent is permitted by the South African National Department of Health Ethics Guidelines but appears to be prohibited by section 13(1) of the Protection of Personal Information Act 4 of 2013. Additionally, the Act mandates that all personal data (including biobank sample data) be collected for lawful, explicit, and clearly defined purposes. There is possibility for ambiguity in interpretation because of this discrepancy between the two instruments. Given the association between the transfer of samples and data, the long-term nature of biobanking, which makes it impractical to provide too much or enough information because it is simply not available at the time of sample collection, and the various ways that the Protection of Personal Information Act 4 of 2013 have been interpreted, we aim to demonstrate that South Africa's current regulatory framework should appropriately permit broad consent use for biobank research where the transfer of samples and their associated data are contemplated. In summary, the proposed amendments include removing regulatory ambiguity regarding broad consent use, ensuring adequate safeguards for research participants by specifying rules for data access and personal information processing, and incorporating consent form information requirements into the national Consent Template.
Collapse
Affiliation(s)
- Mantombi Maseme
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Biobank, National Health Laboratory Service, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jillian Gardner
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Safia Mahomed
- Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Law, University of South Africa, Pretoria, South Africa
| |
Collapse
|
5
|
Zhang M, Sankaranarayanapillai M, Du J, Xiang Y, Manion FJ, Harris MR, Stansbury C, Pham HA, Tao C. Machine learning-based donor permission extraction from informed consent documents. BMC Bioinformatics 2023; 24:477. [PMID: 38102593 PMCID: PMC10724888 DOI: 10.1186/s12859-023-05568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND With more clinical trials are offering optional participation in the collection of bio-specimens for biobanking comes the increasing complexity of requirements of informed consent forms. The aim of this study is to develop an automatic natural language processing (NLP) tool to annotate informed consent documents to promote biorepository data regulation, sharing, and decision support. We collected informed consent documents from several publicly available sources, then manually annotated them, covering sentences containing permission information about the sharing of either bio-specimens or donor data, or conducting genetic research or future research using bio-specimens or donor data. RESULTS We evaluated a variety of machine learning algorithms including random forest (RF) and support vector machine (SVM) for the automatic identification of these sentences. 120 informed consent documents containing 29,204 sentences were annotated, of which 1250 sentences (4.28%) provide answers to a permission question. A support vector machine (SVM) model achieved a F-1 score of 0.95 on classifying the sentences when using a gold standard, which is a prefiltered corpus containing all relevant sentences. CONCLUSIONS This study provides the feasibility of using machine learning tools to classify permission-related sentences in informed consent documents.
Collapse
Affiliation(s)
- Meng Zhang
- McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Madhuri Sankaranarayanapillai
- McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Jingcheng Du
- McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Yang Xiang
- McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Frank J Manion
- School of Nursing, University of Michigan, Ann Arbor, MI, 48104, USA
| | | | - Cooper Stansbury
- School of Nursing, University of Michigan, Ann Arbor, MI, 48104, USA
| | - Huy Anh Pham
- McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Cui Tao
- McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
- Department of Artificial Intelligence and Informatics , Mayo Clinic, Jacksonville, FL, 32224, USA.
| |
Collapse
|
6
|
Sulaieva ON, Artamonova O, Dudin O, Semikov R, Urakov D, Zakharash Y, Kacharian A, Strilka V, Mykhalchuk I, Haidamak O, Serdyukova O, Kobyliak N. Ethical navigation of biobanking establishment in Ukraine: learning from the experience of developing countries. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109129. [PMID: 37945338 DOI: 10.1136/jme-2023-109129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
Building a biobank network in developing countries is essential to foster genomic research and precision medicine for patients' benefit. However, there are serious barriers to establishing biobanks in low-income and middle-income countries (LMICs), including Ukraine. Here, we outline key barriers and essential milestones for the successful expansion of biobanks, genomic research and personalised medicine in Ukraine, drawing from the experience of other LMICs. A lack of legal and ethical governance in conjunction with limited awareness about biobanking and community distrust are the principal threats to establishing biobanks. The experiences of LMICs suggest that Ukraine urgently needs national guidelines covering ethical and legal aspects of biospecimen-related research. National guidelines must be consistent with international ethical recommendations for safeguarding participants' rights, welfare and privacy. Additionally, efforts to educate and engage physicians and patient communities are essential for achieving biobanking goals and benefits for precision medicine and future patients.
Collapse
Affiliation(s)
- Oksana N Sulaieva
- Department of Pathology, Medical Laboratory CSD, Kyiv, Ukraine
- Doctorate in Bioethics, Neiswanger Institute for Bioethics, Loyola University Chicago, Chicago, Illinois, USA
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
| | | | - Oleksandr Dudin
- Department of Pathology, Medical Laboratory CSD, Kyiv, Ukraine
| | - Rostyslav Semikov
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
- Audubon Bioscience, Kyiv, Ukraine
| | - Dmytro Urakov
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
| | | | | | | | - Ivan Mykhalchuk
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
- Audubon Bioscience, Kyiv, Ukraine
| | | | - Olena Serdyukova
- Ukrainian Association of Research Biobanks, Kyiv, Ukraine
- Audubon Bioscience, Kyiv, Ukraine
| | - Nazarii Kobyliak
- Department of Pathology, Medical Laboratory CSD, Kyiv, Ukraine
- Department of Endocrinology, Bogomolets National Medical University, Kyiv, Ukraine
| |
Collapse
|
7
|
Arregui Egido L, Villalobos-Quesada M. Improving the Practice of Obtaining Informed Consent for Biobanking in Clinical Settings. Biopreserv Biobank 2023; 21:442-449. [PMID: 36173759 DOI: 10.1089/bio.2021.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Biobanks form key research support infrastructures that ensure the highest sample quality for scientific research. Their activity must align closely and proportionally to the interests of researchers, donors, and society. Informed consent (IC) is a central tool to guarantee the protection of donors' rights and interests. Aim: This study aimed to analyze the challenges of obtaining IC for biobanking in clinical settings and ways to improve this process. Methods: Biobank Bellvitge University Hospital HUB-ICO-IDIBELL in Barcelona received 8671 IC forms between 2017 and 2020. The mistakes that caused IC forms to be rejected by the Biobank were analyzed. In addition, interventions aimed at physicians to improve the IC process were evaluated through a calculation of the relative risk (RR). Finally, physicians who submitted samples to the Biobank, most of whom are involved in research activities, were surveyed about the barriers to collecting IC and how to improve this process. Results: During 2017-2020, 19.6% of IC forms were rejected. The most relevant cause of rejection was the use of outdated IC forms, followed by missing patient information or mistakes having been made by the physician. Evaluation of the rejection rates before and after interventions to improve the IC process suggests significant improvement (27.7% before interventions (January 2017-May 2018) compared to 9.6% after interventions (February-December 2020), RR 0.4 95% CI 0.34-0.47; p < 0.0001). According to the physicians, the most important barrier to collecting IC is the time constraint, and they consider digitalization as a viable solution. Conclusions: Our research offers a view of the less well-understood practical challenges that physicians and biobanks face when collecting IC in clinical settings. It suggests that, despite multiple challenges, continuous monitoring, training, and information programs for physicians are key to optimizing the IC process in clinical settings.
Collapse
Affiliation(s)
- Laura Arregui Egido
- HUB-ICO-IDIBELL Biobank, Bellvitge Medical Research Institute (IDIBELL), Barcelona, Spain
- Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - María Villalobos-Quesada
- Bioethics and Law Observatory, University of Barcelona, Barcelona, Spain
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
8
|
Bak MA, Vroonland JC, Blom MT, Damjanovic D, Willems DL, Tan HL, Corrette Ploem M. Data-driven sudden cardiac arrest research in Europe: Experts' perspectives on ethical challenges and governance strategies. Resusc Plus 2023; 15:100414. [PMID: 37363125 PMCID: PMC10285638 DOI: 10.1016/j.resplu.2023.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background Observational studies using large-scale databases and biobanks help improve prevention and treatment of sudden cardiac arrest (SCA) but the lack of guidance on data protection issues in this setting may harm patients' rights and the research enterprise itself. This qualitative study explored the ethical aspects of observational SCA research, as well as solutions. Methods European experts in SCA research, medical ethics and health law reflected on this topic through semi-structured interviews (N = 29) and a virtual roundtable conference (N = 18). The ESCAPE-NET project served as a discussion case. Findings were coded and thematically analysed. Results The first theme concerned the potential benefits and harms (at individual and group level) of observational data-based SCA studies and included the following sub-themes: societal value, scientific validity, data privacy, disclosure of genetic findings, stigma and discrimination, and medicalisation of sudden death. The second theme involved governance through 'privacy by design', 'privacy by policy' and associated regulation and oversight. Sub-themes were: de-identification of data, informed consent (broad and deferred), ethics review, and harmonisation. Conclusions Researchers and scientific societies should be aware that ethico-legal issues may arise during data-driven studies in SCA and other emergencies. These can be mitigated by combining technical data protection safeguards with appropriate informed consent policies and proportional ethics oversight. To ensure responsible conduct of data research in emergency medicine, we recommend the establishment of 'codes of conduct' which should be developed in interdisciplinary groups and together with patient representatives.
Collapse
Affiliation(s)
- Marieke A.R. Bak
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, The Netherlands
| | | | - Marieke T. Blom
- Department of Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Chronic Disease & Health Behaviour, Amsterdam, The Netherlands
| | - Domagoj Damjanovic
- Department of Cardiovascular Surgery, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Dick L. Willems
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Hanno L. Tan
- Department of Experimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - M. Corrette Ploem
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, The Netherlands
| |
Collapse
|
9
|
Richter JG, Filla T, Acar H, Bleck E, Kernder A, Düsing C, Vordenbäumen S, Schröder M, Hansen R, Distler JHW, Schneider M. Sustained agreement rates in the longitudinal assessment of lupus patients to a Broad Consent for personal data and specimen usage in the RHINEVIT biobank. Front Med (Lausanne) 2023; 10:1208006. [PMID: 37415767 PMCID: PMC10321663 DOI: 10.3389/fmed.2023.1208006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Background Biobanks are essential structures for scientific research. The RHINEVIT biobank is used to recruit biomaterials from rheumatology patients in outpatient care and to conduct clinical research studies (e.g., cohort studies) and basic research. RHINEVIT established Broad Consents (BC) to allow extensive and relevant usage of data and biospecimens without the need for specific project restrictions. For quality assurance, we compared the consent rate of individual items of the BC versions in patients with systemic lupus erythematosus (SLE) in the longitudinal study. Methods BCs were used for biomaterial donation. Informed consent data from RHINEVIT were analyzed. Due to the content restructuring of the BC items due to changes from the templates of the working group of the Medical Ethics Commissions in the Federal Republic of Germany and GDPR requirements, content mapping of the items was performed for the analysis. Results From September 2015 to March 2022, 291 SLE outpatients donated biomaterials. In 119 patients, the BC was renewed at least once in a subsequent biomaterial donation. Three biomaterial donations were obtained from 21 patients and four from six patients using the respective BC. However, one consent was later revoked. Consent to the BC topics showed consistently high rates of agreement (range 97.5%-100%), with only some patients disagreeing with individual topics. This remained stable over time (median 526 days [Q1 400, Q3 844]). None of the patients disagreed with a certain topic in two consecutive visits. Conclusion Modifications to the BC did not result in any relevant changes in the approval rates for SLE patients. RHINEVIT's BC is successfully used for the quality-assured handling of excellently annotated biomaterial. The long-term use of these highly valuable biospecimens for unrestricted research, also in an international context, remains assured.
Collapse
Affiliation(s)
- Jutta G. Richter
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Tim Filla
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Hasan Acar
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Ellen Bleck
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Kernder
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Christina Düsing
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Meerbusch, Germany
| | | | | | - Jörg H. W. Distler
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Matthias Schneider
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| |
Collapse
|
10
|
Bak MAR, Ploem MC, Tan HL, Blom MT, Willems DL. Towards trust-based governance of health data research. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:185-200. [PMID: 36633724 PMCID: PMC9835739 DOI: 10.1007/s11019-022-10134-8] [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: 12/12/2022] [Indexed: 05/13/2023]
Abstract
Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research-among researchers and with data subjects-is grounded in trust, which should be more explicitly recognised in the governance of health data research.
Collapse
Affiliation(s)
- Marieke A R Bak
- Department of Ethics, Law and Humanities, Amsterdam UMC (Location AMC), University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - M Corrette Ploem
- Department of Ethics, Law and Humanities, Amsterdam UMC (Location AMC), University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Amsterdam UMC (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - M T Blom
- Department of Cardiology, Amsterdam UMC (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Department of Ethics, Law and Humanities, Amsterdam UMC (Location AMC), University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Bettio V, Mazzucco E, Aleni C, Cracas S, Rinaldi C, Antona A, Varalda M, Venetucci J, Ferrante D, Rimedio A, Capello D. UPO Biobank: The Challenge of Integrating Biobanking into the Academic Environment to Support Translational Research. J Pers Med 2023; 13:911. [PMID: 37373900 DOI: 10.3390/jpm13060911] [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: 04/05/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Biobanks are driving motors of precision and personalized medicine by providing high-quality biological material/data through the standardization and harmonization of their collection, preservation, and distribution. UPO Biobank was established in 2020 as an institutional, disease, and population biobank within the University of Piemonte Orientale (UPO) for the promotion and support of high-quality, multidisciplinary studies. UPO Biobank collaborates with UPO researchers, sustaining academic translational research, and supports the Novara Cohort Study, a longitudinal cohort study involving the population in the Novara area that will collect data and biological specimens that will be available for epidemiological, public health, and biological studies on aging. UPO Biobank has been developed by implementing the quality standards for the field and the ethical and legal issues and normative about privacy protection, data collection, and sharing. As a member of the "Biobanking and Biomolecular Resources Research Infrastructure" (BBMRI) network, UPO Biobank aims to expand its activity worldwide and launch cooperation with new national and international partners and researchers. The objective of this manuscript is to report an institutional and operational experience through the description of the technical and procedural solutions and ethical and scientific implications associated with the establishment of this university research biobank.
Collapse
Affiliation(s)
- Valentina Bettio
- UPO Biobank, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Eleonora Mazzucco
- UPO Biobank, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Chiara Aleni
- Department of Sustainable Development and Ecological Transition, University of Piemonte Orientale, 13100 Vercelli, Italy
| | - Silvia Cracas
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Carmela Rinaldi
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
- Learning and Research Area, A.O.U. Maggiore della Carità, 28100 Novara, Italy
| | - Annamaria Antona
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Marco Varalda
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Jacopo Venetucci
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Antonio Rimedio
- Ethics Committee of the University "Hospital Major of Charity" in Novara, Local Health Authorities Biella, 28100 Novara, Italy
| | - Daniela Capello
- UPO Biobank, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, Center of Excellence in Aging Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| |
Collapse
|
12
|
Caroline D, Marie-France M. Get this thing out of my body! Factors determining consent for translational oncology research: a qualitative research. J Transl Med 2023; 21:336. [PMID: 37211597 DOI: 10.1186/s12967-023-04039-0] [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: 12/15/2022] [Accepted: 03/05/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Depending on the needs of scientific research at a given time, biobanks make biological samples and data available to researchers. In this article, we aim to describe the reasons and underlying logic that determine the decision to grant or deny consent to the conservation of tumour samples in a biological resource platform for research purposes. We make use of the CARPEM biological resource platform model, where broad consent is required. METHODS The results are based on semi-structured interviews, conducted between 2019 and 2021, with 25 individuals having various profiles. RESULTS All the people interviewed readily accepted the principle of conserving a tumour sample for research purposes. They explained their decision by citing the desire to participate in research dedicated to improving therapeutic medicine. Their trust in research institutions or in doctors was an important factor in their consent. The tumorous nature of the samples also played an important role, as did the absence of constraints. Finally, the high level of consent was also based on the difficulty they had in conceiving what the future risks might be once the sample had been taken, whereas the fact that they did not know the nature or purpose of the research to be carried out when they signed the consent form posed some problems. These results stem from a lack of a culture of ethics among the people interviewed. CONCLUSION The information provided in the context of consent at the CARPEM tumour bank seems inadequate for consent to be considered 'informed', given the low level of knowledge that people have of the risks and issues. Information is missing even though we feel it would not change consent or only marginally. This raises questions, since part of the act of granting consent is based on the implicit trust French people have in the hospital that collects the data and in research practices in general. In the minds of those who participate, transparency is the ground on which trust rests. Lack of transparency could be deleterious for future research practices. However, it is not by striving to improve information leaflets that the consent-related information will improve but, rather, by more effectively helping future patients to assimilate that information.
Collapse
Affiliation(s)
- Desprès Caroline
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm, Laboratoire Êtres, Unité Fonctionnelle d'Éthique Médicale, Hôpital Necker-Enfants Malades, APHP, Paris, France.
| | - Mamzer Marie-France
- Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm, Laboratoire Êtres, Unité Fonctionnelle d'Éthique Médicale, Hôpital Necker-Enfants Malades, APHP, Paris, France
| |
Collapse
|
13
|
Eysenbach G, Hagens S, Kemp J, Roble H, Carter-Langford A, Shen N. Patient Perspectives and Preferences for Consent in the Digital Health Context: State-of-the-art Literature Review. J Med Internet Res 2023; 25:e42507. [PMID: 36763409 PMCID: PMC9960046 DOI: 10.2196/42507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/05/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The increasing integration of digital health tools into care may result in a greater flow of personal health information (PHI) between patients and providers. Although privacy legislation governs how entities may collect, use, or share PHI, such legislation has not kept pace with digital health innovations, resulting in a lack of guidance on implementing meaningful consent. Understanding patient perspectives when implementing meaningful consent is critical to ensure that it meets their needs. Consent for research in the context of digital health is limited. OBJECTIVE This state-of-the-art review aimed to understand the current state of research as it relates to patient perspectives on digital health consent. Its objectives were to explore what is known about the patient perspective and experience with digital health consent and provide recommendations on designing and implementing digital health consent based on the findings. METHODS A structured literature search was developed and deployed in 4 electronic databases-MEDLINE, IEEE Xplore, Scopus, and Web of Science-for articles published after January 2010. The initial literature search was conducted in March 2021 and updated in March 2022. Articles were eligible for inclusion if they discussed electronic consent or consent, focused on the patient perspective or preference, and were related to digital health or digital PHI. Data were extracted using an extraction template and analyzed using qualitative content analysis. RESULTS In total, 75 articles were included for analysis. Most studies were published within the last 5 years (58/75, 77%) and conducted in a clinical care context (33/75, 44%) and in the United States (48/75, 64%). Most studies aimed to understand participants' willingness to share PHI (25/75, 33%) and participants' perceived usability and comprehension of an electronic consent notice (25/75, 33%). More than half (40/75, 53%) of the studies did not describe the type of consent model used. The broad open consent model was the most explored (11/75, 15%). Of the 75 studies, 68 (91%) found that participants were willing to provide consent; however, their consent behaviors and preferences were context-dependent. Common patient consent requirements included clear and digestible information detailing who can access PHI, for what purpose their PHI will be used, and how privacy will be ensured. CONCLUSIONS There is growing interest in understanding the patient perspective on digital health consent in the context of providing clinical care. There is evidence suggesting that many patients are willing to consent for various purposes, especially when there is greater transparency on how the PHI is used and oversight mechanisms are in place. Providing this transparency is critical for fostering trust in digital health tools and the innovative uses of data to optimize health and system outcomes.
Collapse
Affiliation(s)
| | | | - Jessica Kemp
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Heba Roble
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Nelson Shen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Lensink MA, Jongsma KR, Boers SN, Bredenoord AL. Better governance starts with better words: why responsible human tissue research demands a change of language. BMC Med Ethics 2022; 23:90. [PMID: 36050689 PMCID: PMC9438266 DOI: 10.1186/s12910-022-00823-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
The rise of precision medicine has led to an unprecedented focus on human biological material in biomedical research. In addition, rapid advances in stem cell technology, regenerative medicine and synthetic biology are leading to more complex human tissue structures and new applications with tremendous potential for medicine. While promising, these developments also raise several ethical and practical challenges which have been the subject of extensive academic debate. These debates have led to increasing calls for longitudinal governance arrangements between tissue providers and biobanks that go beyond the initial moment of obtaining consent, such as closer involvement of tissue providers in what happens to their tissue, and more active participatory approaches to the governance of biobanks. However, in spite of these calls, such measures are being adopted slowly in practice, and there remains a strong tendency to focus on the consent procedure as the tool for addressing the ethical challenges of contemporary biobanking. In this paper, we argue that one of the barriers to this transition is the dominant language pervading the field of human tissue research, in which the provision of tissue is phrased as a 'donation' or 'gift', and tissue providers are referred to as 'donors'. Because of the performative qualities of language, the effect of using 'donation' and 'donor' shapes a professional culture in which biobank participants are perceived as passive providers of tissue free from further considerations or entitlements. This hampers the kind of participatory approaches to governance that are deemed necessary to adequately address the ethical challenges currently faced in human tissue research. Rather than reinforcing this idea through language, we need to pave the way for the kind of participatory approaches to governance that are being extensively argued for by starting with the appropriate terminology.
Collapse
Affiliation(s)
- Michael A Lensink
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Karin R Jongsma
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Sarah N Boers
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| |
Collapse
|
15
|
Sylvia N, Joseph O, David KM, Ian M, Janet N, Nelson NF, John B, Betty K, Charles I, Adelline T, Nelson S, Erisa Sabakaki M. Experiences and practices of key research team members in obtaining informed consent for pharmacogenetic research among people living with HIV: a qualitative study. RESEARCH ETHICS 2022; 18:193-209. [PMID: 36213304 PMCID: PMC9536131 DOI: 10.1177/17470161221076974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to explore experiences and practices of key research team members in obtaining informed consent for pharmacogenetics research and to identify the approaches used for enhancing understanding during the consenting process. Data collection involved 15 qualitative, in-depth interviews with key researchers who were involved in obtaining informed consent from HIV infected individuals in Uganda for participation in pharmacogenetic clinical trials. The study explored two prominent themes: approaches used to convey information and enhance research participants’ understanding and challenges faced during the consenting process. Several barriers and facilitators for obtaining consent were identified. Innovative and potentially effective consenting strategies were identified in this study that should be studied and independently verified.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Barugahare John
- Makerere University College of Humanities and Social Sciences, Uganda
| | | | | | | | | | - Mwaka Erisa Sabakaki
- Makerere University College of Health Sciences, Uganda
- Infectious Diseases Institute, Uganda
| |
Collapse
|
16
|
Amayoa FA, Nakwagala FN, Barugahare J, Munabi IG, Mwaka ES. Understanding of Critical Elements of Informed Consent in Genomic Research: A Case of a Paediatric HIV-TB Research Project in Uganda. J Empir Res Hum Res Ethics 2022; 17:483-493. [PMID: 35548950 DOI: 10.1177/15562646221100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several studies have reported inadequate comprehension of informed consent for genomic research. This study aimed to assess research participants' understanding of critical elements of informed consent for genomic research. A cross-sectional survey involving 123 parents/caregivers of children participating in a paediatric genomic TB/HIV study was conducted. Only 47.2% of the participants had adequate understanding of consent information. The mean objective (actual) and subjective (perceived) understanding scores were 78.7% and 91.7% respectively. Participants adequately understood most elements of consent however, some elements were poorly understood including foreseeable risks, protection of confidentiality and compensation for research related injury. Overall there was inadequate comprehension of critical elements of informed consent and there was dissonance between actual and perceived comprehension of informed consent.
Collapse
Affiliation(s)
| | | | - John Barugahare
- College of Humanities and Social Sciences, Makerere University, Uganda
| | | | | |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
McCormick JB, Hopkins M, Lehman EB, Green MJ. Mining the Data: Exploring Rural Patients' Attitudes about the Use of Their Personal Information in Research. AJOB Empir Bioeth 2022; 13:89-106. [PMID: 35271430 PMCID: PMC10038193 DOI: 10.1080/23294515.2022.2040644] [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: 10/18/2022]
Abstract
BACKGROUND This study examines rural patients' perceived importance of knowing or being consulted about researchers' access and use of their personal data (identifiable and de-identified health information, and identifiable and de-identified non-health information) across five scenarios. This study also examines their views on stewardship or governance of their personal information by researchers in their healthcare systems. METHODS We conducted a survey by mail. Data were analyzed using descriptive statistics. Multivariable regression analyses were conducted across each scenario and type of personal data with the same variables included in each model. RESULTS The majority of participants said it was "very important/absolutely essential" to know the purpose of the study, to be asked every time, and to know the policies governing researcher access and use of their identifiable health information. Just over two-thirds of respondents thought it "very important/absolutely essential" to know who serves on the data governance committee and to have a community member serve. Distrust in healthcare organizations was positively correlated with the scenarios while willingness to give permission to donate leftover biological specimens was negatively correlated. CONCLUSION Our study findings indicate that the type of personal information being accessed and used generally matters to 1,407 patients living in rural Pennsylvania. We also demonstrate that knowing their healthcare organizations' governance policies and practices for managing their personal data is important to many rural Pennsylvania patients. Biomedical researchers need to recognize and attend to those differences as much as possible in order to expand opportunities for and participation in research by residents of these rural communities. Supplemental data for this article is available online at.
Collapse
Affiliation(s)
- Jennifer B McCormick
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Margaret Hopkins
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
19
|
Simon CM, Wang K, Shinkunas LA, Stein DT, Meissner P, Smith M, Pentz R, Klein DW. Communicating With Diverse Patients About Participating in a Biobank: A Randomized Multisite Study Comparing Electronic and Face-to-Face Informed Consent Processes. J Empir Res Hum Res Ethics 2022; 17:144-166. [PMID: 34410195 PMCID: PMC8712348 DOI: 10.1177/15562646211038819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Some individuals' understanding of informed consent (IC) information may improve with electronic delivery, but others may benefit from face-to-face (F2F). This randomized, multisite study explores how individuals from diverse backgrounds understand electronic IC documents versus F2F, their confidence in understanding, and enrollment in research. A total of 501 patients at two U.S. biobanks with diverse populations participated. There were no overall differences between electronic and F2F understanding, but F2F predicted higher confidence in understanding and enrollment. Ethnicity and a higher educational level predicted higher understanding and confidence. Study findings suggest that electronic consent may lead to better understanding for non-Hispanic patients of higher socioeconomic status. F2F processes may lead to better understanding and higher enrollment of patients from Hispanic and lower socioeconomic levels. Researchers should carefully consider how they implement electronic IC processes and whether to maintain an F2F process to better address the needs and limitations of some populations.
Collapse
Affiliation(s)
| | - Kai Wang
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | | - Rebecca Pentz
- School of Medicine, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
20
|
VandeVusse A, Mueller J, Karcher S. Qualitative Data Sharing: Participant Understanding, Motivation, and Consent. QUALITATIVE HEALTH RESEARCH 2022; 32:182-191. [PMID: 34847803 PMCID: PMC8739617 DOI: 10.1177/10497323211054058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Expectations to share data underlying studies are increasing, but research on how participants, particularly those in qualitative research, respond to requests for data sharing is limited. We studied research participants' willingness to, understanding of, and motivations for data sharing. As part of a larger qualitative study on abortion reporting, we conducted interviews with 64 cisgender women in two states in early 2020 and asked for consent to share de-identified data. At the end of interviews, we asked participants to reflect on their motivations for agreeing or declining to share their data. The vast majority of respondents consented to data sharing and reported that helping others was a primary motivation for agreeing to share their data. However, a substantial number of participants showed a limited understanding of the concept of "data sharing." Additional research is needed on how to improve participants' understanding of data sharing and thus ensure fully informed consent.
Collapse
|
21
|
Kasperbauer TJ, Halverson C, Garcia A, Schmidt KK, Schwartz PH. Biobank Participants' Attitudes toward Requiring Understanding for Biobank Consent. Ethics Hum Res 2021; 44:18-28. [PMID: 34936236 DOI: 10.1002/eahr.500114] [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] [Indexed: 11/09/2022]
Abstract
Biobank participants often do not understand the information they are provided during the informed consent process. Ethicists and other stakeholders have disagreed, however, on the appropriate response to these failures in understanding. This paper describes an attempt to address this issue by conducting knowledge tests with 22 recent biobank enrollees, followed by in-depth, semistructured interviews about the goal of understanding in biobank consent. The interviews revealed that while biobank enrollees thought the information on the knowledge test was important, they did not think that performance on the test should affect whether individuals are permitted to enroll in a biobank. Three main themes emerged from the interviews: helping others by contributing to research is more important than understanding consent forms, less understanding is required because biobank-based research is low risk, and only a small amount of information in the consent form is really essential. These perspectives should be considered in discussing the ethics and governance of biobank consent processes.
Collapse
Affiliation(s)
- T J Kasperbauer
- Postdoctoral fellow at the Indiana University Center for Bioethics at the Indiana University School of Medicine
| | - Colin Halverson
- Faculty investigator at the Indiana University Center for Bioethics and an assistant professor of medicine at the Indiana University School of Medicine
| | - Abigail Garcia
- Research assistant at the Indiana University Center for Bioethics at the Indiana University School of Medicine
| | - Karen K Schmidt
- Project manager at the Indiana University Center for Bioethics at the Indiana University School of Medicine
| | - Peter H Schwartz
- Director of the Indiana University Center for Bioethics and an associate professor of medicine at the Indiana University School of Medicine
| |
Collapse
|
22
|
Miller L, Rosenzweig M. Biobanking: How Oncology Nurses Can Contribute to Its Use. Clin J Oncol Nurs 2021; 25:637-639. [PMID: 34800097 DOI: 10.1188/21.cjon.637-639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biobanking is one of the most valuable tools in precision medicine. The ability of scientists to sequence tumors, blood, and normal tissue obtained from biorepositories has defined efficacious tumor targeting and a much better understanding of cancer pathology pathways. However, these biorepositories require a great deal of effort to establish and maintain. Oncology nurses are key in helping to bank tissue during routine procedures as well as complex surgeries. Nurses can obtain informed consent from patients and coordinate the banking of samples in a timely manner to ensure sample quality. Oncology nurses play an important role in informing patients of their biobanking options and connecting patients with the appropriate team for their biobanking needs.
Collapse
|
23
|
Amin L, Olesen A, Mahadi Z, Ibrahim M. Current Status and Future Challenges of Biobank Research in Malaysia. Asian Bioeth Rev 2021; 13:297-315. [PMID: 34295385 PMCID: PMC8245627 DOI: 10.1007/s41649-021-00171-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
The establishment of MyCohort in 2005 showed that there is a growing interest on the part of the Malaysian government in the creation of biobanks in the country. This project can be considered as the biggest and most comprehensive cohort study in Malaysia, where hundreds of thousands of human samples are stored for epidemiological and biomedical research. However, little is known about the current issues or the situation related to biobank research in Malaysia. There are pressing issues that need answers such as the governance of the national biobank as well as other privately owned biobanks in the nation, the public perspectives and perceptions regarding biobanks, and other matters such as the ethical, legal, and social issues related to biobank research. This article will highlight the status and issues related to biobank research in Malaysia and provide suggestions on future research practices that we feel need to be seriously considered. These suggestions are designed to advance and enlighten researchers' knowledge, as well as provide the public with information on issues associated to biobanking. Good governance increases public knowledge and trust, and religious acceptance of biobank research and accountability can lead to increased participation in biobank research. The direct implications of the discussion about the ethical, legal, and social issues of biobanks are pertinent for the foundation of knowledge relating to biobanks, as well as the forward gestures for future medicine for mankind.
Collapse
Affiliation(s)
- Latifah Amin
- Pusat Citra Universiti, Universiti Kebangsaan Malaysia, Bangi, Selangor Malaysia
| | - Angelina Olesen
- Pusat Citra Universiti, Universiti Kebangsaan Malaysia, Bangi, Selangor Malaysia
| | - Zurina Mahadi
- Pusat Citra Universiti, Universiti Kebangsaan Malaysia, Bangi, Selangor Malaysia
| | - Maznah Ibrahim
- Pusat Citra Universiti, Universiti Kebangsaan Malaysia, Bangi, Selangor Malaysia
| |
Collapse
|
24
|
Eisenhauer ER, Tait AR, Low LK, Arslanian-Engoren CM. Women's Choices Regarding Use of Their Newborns' Residual Dried Blood Samples in Research. J Obstet Gynecol Neonatal Nurs 2021; 50:424-438. [PMID: 34033759 DOI: 10.1016/j.jogn.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 09/30/2022] Open
Abstract
OBJECTIVE To determine the proportion of informed choices women made about donating their newborns' blood samples for research. DESIGN A quantitative analysis of informed choice using data on women's knowledge and attitudes from a descriptive, cross-sectional survey. SETTING The state of Michigan. PARTICIPANTS Women (N = 69, ≥18 years old) who had (a) newborns 0 to 3 months of age, (b) yes or no decisions regarding use of the blood sample for research on file, (c) no evidence of an infant death in the state database, (d) completed the knowledge scale, (e) completed the attitude scale, and (f) recalled the decision (i.e., yes or no) about donating blood samples. METHODS We used the multidimensional measure of informed choice to calculate the proportion of informed choices in data on women's knowledge, attitudes, and decisions about biospecimen research. RESULTS Fifty-five percent (38/69) of participants made informed choices about donating newborn blood samples for research, and 45% made uninformed choices (31/69). Inadequate knowledge about biospecimen research contributed to 87% of uniformed choices (27/31). Participants who declined to donate their newborns' blood samples struggled with making decisions consistent with their values. CONCLUSION Nearly half of the participants made uninformed choices about donating the blood samples of their newborns for research. Women need more information about genetics and the storage and research use of newborns' blood samples to make informed choices. Nurses need to be made aware of the ethical, legal, and social implications of such research because they are primary sources of advocacy, information, and support for childbearing women and may be charged with overseeing or obtaining informed consent. Additional research with larger, more diverse samples is needed.
Collapse
|
25
|
Kasperbauer TJ, Schmidt KK, Thomas A, Perkins SM, Schwartz PH. Incorporating Biobank Consent into a Healthcare Setting: Challenges for Patient Understanding. AJOB Empir Bioeth 2021; 12:113-122. [PMID: 33275086 DOI: 10.1080/23294515.2020.1851313] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Biobank participants often do not understand much of the information they are provided as part of the informed consent process, despite numerous attempts at simplifying consent forms and improving their readability. We report the first assessment of biobank enrollees' comprehension under an "integrated consent" process, where patients were asked to enroll in a research biobank as part of their normal healthcare experience. A number of healthcare systems have implemented similar integrated consent processes for biobanking, but it is unknown how much patients understand after enrolling under these conditions. Methods: We recruited patients who enrolled in a biobank while in a healthcare setting when receiving ordinary care. We assessed knowledge of consent materials using 11 true/false questions drawn from a well-known biobank knowledge test. After reviewing the results from 114 participants, we revised the consent form and repeated the knowledge assessment with 144 different participants. Results: Participants scored poorly on the knowledge test in both rounds, with no significant differences in overall scores or individual items between the rounds. In Phase 1, participants answered 53% of the questions correctly, 25% incorrectly, and 22% "I don't know." In Phase 2, participants answered 53% of questions correctly, 24% incorrectly, and 23% "I don't know." Participants scored particularly poorly on questions about data sharing and accessing medical records. Conclusions: Enrollees under an integrated consent model had significant misunderstandings that persisted despite an attempt to improve information specifically about those topics in a consent form. These results raise challenges for current approaches that attribute misunderstanding to overly complex consent forms. They also suggest that the pressures of the clinic may compound other problems with patient understanding of biobank consent. As health systems increasingly blend research and care, they may need to rethink their approach to educating patients about participation in a biobank.
Collapse
Affiliation(s)
- T J Kasperbauer
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Karen K Schmidt
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ariane Thomas
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan M Perkins
- Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter H Schwartz
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- School of Liberal Arts, Indiana University - Purdue University at Indianapolis, Indianapolis, Indiana, USA
| |
Collapse
|
26
|
O'Leary MC, Whitley RL, Press A, Provenzale D, Williams CD, Chesnut B, Jones R, Redding TS, Sims KJ. Development of a Multi-Study Repository to Support Research on Veteran Health: The VA Cooperative Studies Program Epidemiology Center-Durham (CSPEC-Durham) Data and Specimen Repository. Front Public Health 2021; 9:612806. [PMID: 33681131 PMCID: PMC7925406 DOI: 10.3389/fpubh.2021.612806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Federal agencies, including the Department of Veterans Affairs (VA), have prioritized improved access to scientific data and results collected through federally funded research. Our VA Cooperative Studies Program Epidemiology Center in Durham, North Carolina (CSPEC-Durham) assembled a repository of data and specimens collected through multiple studies on Veteran health issues to facilitate future research in these areas. We developed a single protocol, request process that includes scientific and ethical review of all applications, and a database architecture using metadata (common variable descriptors) to securely store and share data across diverse studies. In addition, we created a mechanism to allow data and specimens collected through older studies in which re-use was not addressed in the study protocol or consent forms to be shared if the future research is within the scope of the original consent. Our CSPEC-Durham Data and Specimen Repository currently includes research data, genomic data, and study specimens (e.g., DNA, blood) for three content areas: colorectal cancer, amyotrophic lateral sclerosis, and Gulf War research. The linking of the study specimens and research data can support additional genetic analyses and related research to improve Veterans' health.
Collapse
Affiliation(s)
- Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | | | - Ashlyn Press
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Blair Chesnut
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC, United States
| | - Rodney Jones
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC, United States
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| |
Collapse
|
27
|
Bak MAR, Veeken R, Blom MT, Tan HL, Willems DL. Health data research on sudden cardiac arrest: perspectives of survivors and their next-of-kin. BMC Med Ethics 2021; 22:7. [PMID: 33509184 PMCID: PMC7844916 DOI: 10.1186/s12910-021-00576-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/17/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Consent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and health-related data for observational research. METHODS We conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues. RESULTS Sudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients' data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives. CONCLUSIONS Sudden cardiac arrest patients' donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants' data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well.
Collapse
Affiliation(s)
- Marieke A R Bak
- Section of Medical Ethics, Department of General Practice, Amsterdam, UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Rens Veeken
- Faculty of Medicine, Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam, UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
28
|
de Melo-Martín I, Holtzman M, Hacker KS. "I Want to Do It, But I Want to Make Sure That I Do It Right." Views of Patients with Parkinson's Disease Regarding Early Stem Cell Clinical Trial Participation. AJOB Empir Bioeth 2020; 11:160-171. [PMID: 32516056 PMCID: PMC8212889 DOI: 10.1080/23294515.2020.1775721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: First-in-human clinical trials with stem cells for Parkinson's disease (PD) are on the horizon. Their epistemic success depends on ensuring the participation of a sufficient number and appropriately diverse group of patients with PD. Their ethical soundness requires that the research community ensures that subjects' decisions about whether to participate or not are consistent with participants' values, motivations, and goals. We sought to identify PD patients' knowledge, concerns, and expectations regarding early-phase stem cell research in PD. Methods: We conducted five semi-structured focus groups with patients with PD. Group discussions were recorded, transcribed, and coded to identify participants' knowledge, concerns, and expectations regarding participation in early stem cell clinical research in PD. Results: Four themes were generated from our data analysis: (1) participants' skepticism about the potential benefits of these trials; (2) their desire to obtain information about various aspects related to this research; (3) a recognition that accessing available knowledge was often difficult; and (4) the relevance of trusting relationships with various stakeholders. Conclusions: Participants expressed skepticism about the immediate impact of stem cell research. Nonetheless, such skepticism often reflected an appropriate consideration of the risks and potential benefits of participating in high-risk clinical trials. Despite their skepticism, participants were eager to learn more about stem cell research and clinical trials processes. They identified consistently trusted avenues of knowledge on these topics, but they often found it difficult to access relevant information or to determine its value.
Collapse
Affiliation(s)
- Inmaculada de Melo-Martín
- Weill Cornell Medical College, Division of Medical Ethics, 407 E.61st St., RR-212, New York, NY 10065
| | - Michael Holtzman
- The New School for Social Research, Psychology Department, 80 Fifth Avenue, 6 Floor, New York, NY 10011
| | - Katrina S. Hacker
- The New School for Social Research, Psychology Department, 80 Fifth Avenue, 6 Floor, New York, NY 10011
| |
Collapse
|
29
|
Moodley K, Beyer C. Tygerberg Research Ubuntu-Inspired Community Engagement Model: Integrating Community Engagement into Genomic Biobanking. Biopreserv Biobank 2019; 17:613-624. [PMID: 31603696 PMCID: PMC6921246 DOI: 10.1089/bio.2018.0136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Community engagement (CE) is an ethical imperative in research, but the knowledge base for what constitutes effective and ethically sound CE is limited. Ubuntu, as a component of responsive communitarianism where communal welfare is valued together with individual autonomy, is useful in furthering our understanding of effective CE and how it could best be achieved. Similarly, a relative solidarity model serves as a compromise between extreme individualism and extreme communalism and is more appropriate in a heterogenous African context. Approaching CE from an Ubuntu philosophical perspective in southern Africa is particularly important in genomic biobanking, given the implications for individuals, families, and communities. Discussion: CE is often implemented in a tokenistic manner as an ancillary component of research. Understanding consent information is challenging where genomic biobanking is concerned due to scientific complexity. We started a process of CE around genomic biobanking and conducted empirical research in an attempt to develop a model to promote effective and ethically sound CE, using relative solidarity to create a nuanced application of Ubuntu. The TRUCE model is an eight-step model that uses social mapping to identify potential communities, establishes the scope of CE, and requires that communities are approached early. Co-creation strategies for CE are encouraged and co-ownership of knowledge production is emphasized. Recruiting and engaging communities at each stage of research is necessary. Evaluation and adaptation of CE strategies are included. Discussion and dissemination of results after the research is completed are encouraged. Conclusions: There is a significant gap between the theory of CE and its authentic application to research in Africa. This Ubuntu-inspired model facilitates bridging that gap and is particularly suited to genomic biobanking. The CE model enhances and complements the consent process and should be integrated into research as a funding and regulatory requirement where applicable.
Collapse
Affiliation(s)
- Keymanthri Moodley
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
- Address correspondence to: Keymanthri Moodley, MBChB, MFamMed, MPhil, FCFP (SA), Executive MBA, DPhil, Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, P.O. Box 241, Cape Town 7505, South Africa
| | - Chad Beyer
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
30
|
Abstract
Individuals approached to participate in human subjects research, irrespective of age, must be completely apprised of the study, and researchers must ensure that the information is understood to the fullest extent possible, prior to decision making. However, evolving regulatory and institutional requirements have led to permission/assent/consent (PAC) forms that are unnecessarily complex, serving only to exacerbate the challenges associated with communicating this important information to prospective participants. At greatest risk are children and other individuals with low literacy, limited English proficiency, and diminished mental capacity, populations all too often neglected in clinical research. This paper examines various strategies that have been evaluated to facilitate informed PAC, drawing on experiences across a broad array of populations whose needs overlap with those of children. These strategies range from simplifying PAC forms for readability and creating multimedia PAC delivery tools to actively engaging participants on their understanding of PAC elements by leveraging testing, rewards, and third-party communications. Notably, the findings from strategies that have been explored in more than one setting are uniformly mixed with respect to their ability to improve comprehension, underscoring the challenges that persist in designing, implementing, and objectively examining strategies intended to facilitate informed PAC. However, these studies do serve to highlight efforts that may reduce anxiety around, and increase the satisfaction of participants with, the PAC process. Ultimately, accommodating a diverse participant pool will require the consideration, and continual refinement, of various PAC strategies along with the engagement of team members who are intimately familiar with these populations.
Collapse
Affiliation(s)
- Susan M Abdel-Rahman
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy, 2401 Gillham Rd., POB 2.M02.47, Kansas City, MO, 64108, USA. .,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
| |
Collapse
|
31
|
Lensink MA, Boers SN, Jongsma KR, Bredenoord AL. Understanding (in) Consent for Governance. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:43-45. [PMID: 31090523 DOI: 10.1080/15265161.2019.1587033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
32
|
Abstract
Residual dried blood spots from millions of newborns are being stored and used for research. The state of Michigan proactively developed a broad consent process for research use of newborns' blood spots. However, the extent to which mothers make informed choices about this research is unclear. A descriptive, qualitative study was conducted examining this issue. Twenty-nine observations of the consent process and 20 semistructured interviews were conducted with mothers on the postpartum unit of a large, academic hospital in Michigan. Content analysis of the transcripts was conducted. While most mothers agreed to donate the blood spots (n = 14/20; 70%), findings indicated that most decisions were uninformed (n = 16/20; 80%), as mothers lacked knowledge of biobanking research. Misunderstandings about anonymity, the consenter's credentials, and entity conducting the research seemed to influence decision making. Suggestions for improving the consent process include (1) changing the venue of blood spot education and consent from the postpartum period to the perinatal period, (2) strengthening the depth of information and delivery of information provided about the topic, including ethical and values clarification, and (3) increasing consenter education and training. Implementation may help increase the proportion of informed decisions.
Collapse
|
33
|
Prictor M, Teare HJA, Kaye J. Equitable Participation in Biobanks: The Risks and Benefits of a "Dynamic Consent" Approach. Front Public Health 2018; 6:253. [PMID: 30234093 PMCID: PMC6133951 DOI: 10.3389/fpubh.2018.00253] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/15/2018] [Indexed: 01/28/2023] Open
Abstract
Participation in biobanks tends to favor certain groups—white, middle-class, more highly-educated—often to the exclusion of others, such as indigenous people, the socially-disadvantaged and the culturally and linguistically diverse. Barriers to participation, which include age, location, cultural sensitivities around human tissue, and issues of literacy and language, can influence the diversity of samples found in biobanks. This has implications for the generalizability of research findings from biobanks being able to be translated into the clinic. Dynamic Consent, which is a digital decision-support tool, could improve participants' recruitment to, and engagement with, biobanks over time and help to overcome some of the barriers to participation. However, there are also risks that it may deepen the “digital divide” by favoring those with knowledge and access to digital technologies, with the potential to decrease participant engagement in research. When applying a Dynamic Consent approach in biobanking, researchers should give particular attention to adaptations that can improve participant inclusivity, and evaluate the tool empirically, with a focus on equity-relevant outcome measures. This may help biobanks to fulfill their promise of enabling translational research that is relevant to all.
Collapse
Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia
| | - Harriet J A Teare
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia.,Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Melbourne Law School, The University of Melbourne, Carlton, VIC, Australia.,Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|