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Watson S, Pacyna JE, Olson JE, Sharp RR. Assessing Decisional Regret Among Biobank Sample Donors. Biopreserv Biobank 2024. [PMID: 39073153 DOI: 10.1089/bio.2024.0053] [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: 07/30/2024] Open
Abstract
Background: Large biobanks that link biological specimens with specimen donors' health histories are a critical tool for precision medicine, and many health care institutions have invested significant resources in setting up and building up large collections for this purpose. As biobanks require consented participation from thousands of individual donors, much research has focused on the values and preferences of new and prospective donors who are actively contemplating an invitation to participate in the collection. Few studies, however, have focused on participants' opinions about their biobank participation in the months and years following enrollment. Methods: We conducted a survey in a large, established biobank and evaluated participants' levels of decisional regret regarding their decision to enroll in the biobank. Results: We found very low levels of decisional regret among established biobank participants. Multivariable regression analysis found that age, length of time in the biobank, lower educational attainment, inadequate health literacy, and previous invitations to research participation were all significant predictors of elevated regret. Discussion: Among those with elevated regret, several demographic factors may point to elevated likelihood of decisional regret. More research is needed to identify factors associated with long-term satisfaction with biobank participation and with elevated risk of regret and/or withdrawal from the collection.
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Affiliation(s)
- Sara Watson
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Joel E Pacyna
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Beusink M, Koetsveld F, van Scheijen S, Janssen T, Buiter M, Schmidt MK, Rebers S. Health Research with Data in a Time of Privacy: Which Information do Patients Want? J Empir Res Hum Res Ethics 2023; 18:304-316. [PMID: 37309128 PMCID: PMC10496423 DOI: 10.1177/15562646231181439] [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: 12/24/2022] [Revised: 04/12/2023] [Accepted: 05/05/2023] [Indexed: 06/14/2023]
Abstract
When hospitals ask broad consent for the secondary use of patient data for scientific research, it is unknown for which studies the data will be used. We investigated what patients at a cancer hospital consider to be an adequate level and most suitable method of information provision using questionnaires (n = 71) and interviews (n = 24). A part of the respondents indicated that they would feel sufficiently informed by either being notified about potential further use, or by receiving a general brochure before being asked for consent. Others stated that additional information would be interesting and appreciated. Yet, when discussing required resources needed to provide additional information, interviewees lowered the bar of what they considered minimally required, voicing the importance of spending resources on research.
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Affiliation(s)
- Miriam Beusink
- Department of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
- Health-RI, Utrecht, The Netherlands
| | - Folkert Koetsveld
- Department of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
- Department of Radiotherapy, The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Sonja van Scheijen
- Department of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Tomas Janssen
- Department of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
- Department of Radiotherapy, The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Maarten Buiter
- Department of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
- Department of Radiotherapy, The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Marjanka K Schmidt
- Department of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Susanne Rebers
- Department of Molecular Pathology, The Netherlands Cancer Institute – Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
- Health-RI, Utrecht, The Netherlands
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3
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Abtahi H, Gholamzadeh M, Baharii R. Iranian school-aged twin registry: preliminary reports and project progress. BMC Pediatr 2023; 23:71. [PMID: 36765320 PMCID: PMC9912495 DOI: 10.1186/s12887-023-03865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND National Persian school-aged twin registry was established to provide a platform for twin studies. In this report, we describe defining registry characteristics, database design, and preliminary results regarding gathered data in the first phase of the registry program. METHOD Through focus group discussions, the required data elements to design the database and data collection process were defined. First, a list of twins in school-aged groups was retrieved from the electronic database of the Ministry of Education. Tehran schools were selected for the first phase of our registry. Standard "Pea-in-Pods" questionnaire and twins' similarity questionnaires were filled out by the parents themselves in addition to demographic information. Data were analyzed using SPSS v.22. RESULTS The first national school-aged twin registry was established in 2018. Firstly, the required data sets and data collection process were defined using focus group discussions. At the country level, the initial information on 189,738 students was retrieved from the national database of the Ministry of Education. They were born between 2003 and 2017, of which 94,997 are boys (50.1%) and 94,741 are girls (49.9%). Of them, a total of 5,642 pairs of school-aged twins participated in the first phase of our program. Our sample size comprised 9772 twins, 906 triples, and 92 quadruplets. The analysis of the zygosity questionnaire showed that 14% of twin pairs were identified as monozygotic twins. CONCLUSION Recruiting school-aged twins through school health assistants leads to high enrollment and decreasing costs for the twin registry. The study showed a high rate of dizygotic twins that need to be verified by twin bio-sample in the next phase of studies.
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Affiliation(s)
- Hamidreza Abtahi
- Pulmonary and Critical Care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Marsa Gholamzadeh
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roza Baharii
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Isaacson S, Kuczynski K, Ormsby N, Peay HL, Rennie S, Cadigan RJ, Kroon E, Phanuphak N, Ananworanich J, Jupimai T, Prueksakaew P, Henderson GE. Decision making for invasive and non-invasive optional procedures within an acute HIV research cohort in Bangkok. Contemp Clin Trials Commun 2023; 31:101054. [PMID: 36636463 PMCID: PMC9829688 DOI: 10.1016/j.conctc.2022.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/16/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Clinical research regularly includes required, nontherapeutic procedures to answer research questions. Optional procedures usually offer minimal or no personal benefit and may involve harms and burdens. Members from the Bangkok SEARCH010/RV254 HIV research cohort of individuals acutely HIV-infected are recruited to six optional procedures varying in invasiveness: leukapheresis, genital secretions collection, lumbar puncture, brain MRI/MRS/DTI, colon biopsy, and lymph node biopsy. We surveyed cohort members about their first recruitment for each procedure to examine factors associated with decision making and attitudes about compensation. 406 members (68%) completed the survey. Reported procedure participation ranged from 71% (MRI) to 27% (lymph node biopsy). Respondents underwent 0-6 procedure types (median 3). Ordinal regression indicated that lower perceived HIV impact and HIV remission trial participation were associated with more procedures completed. Reports of decision difficulty varied, and feeling pressured by research staff was low overall. Notably, those who declined procedures and those who underwent more invasive procedures reported greater decision difficulty and perceived pressure. Most respondents felt compensation amounts were appropriate, although opinions differed by procedure, and for some procedures, between people who agreed and declined. There is limited literature regarding consent to and attitudes about optional research procedures. Researchers must consider how to best support voluntary decisions for procedures with little personal benefit, particularly in lower-income or marginalized populations. In this longitudinal research cohort, perceived pressure to participate may be a concern, although our finding of variation in participation rates corresponding to invasiveness is reassuring. Data from different research contexts would provide important comparators.
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Affiliation(s)
- Sinéad Isaacson
- Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristine Kuczynski
- Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nuchanart Ormsby
- Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Holly L. Peay
- RTI International, Research Triangle Park, Durham, NC, USA
| | - Stuart Rennie
- Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R. Jean Cadigan
- Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eugène Kroon
- SEARCH, Institute of HIV Research and Innovation, Bangkok, Thailand
| | | | - Jintanat Ananworanich
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, And Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Thidarat Jupimai
- Center of Excellence in Pediatric Infectious Diseases and Vaccines Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Gail E. Henderson
- Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Corresponding author.
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5
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Merz S, Jaehn P, Pischon T, Fischer B, Wirkner K, Rach S, Guenther K, Obi N, Holmberg C. Investigating people's attitudes towards participating in longitudinal health research: an intersectionality-informed perspective. Int J Equity Health 2023; 22:23. [PMID: 36721141 PMCID: PMC9887766 DOI: 10.1186/s12939-022-01807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Increasing evidence suggests that participation proportions in longitudinal health research vary according to sex/gender, age, social class, or migration status. Intersectionality scholarship purports that such social categories cannot be understood in isolation and makes visible the co-dependent nature of the social determinants of health and illness. This paper uses an intersectionality-informed approach in order to expand the understanding of why people participate in health research, and the impact of intersecting social structures and experiences on these attitudes. METHODS A sample of 80 respondents who had previously either accepted or declined an invitation to participate in the German National Cohort (NAKO) participated in our interview study. Interviews were semi-structured and contained both narrative elements and more structured probes. Data analysis proceeded in two steps: first, the entire data set was analysed thematically (separately for participants and non-participants); second, key themes were compared across self-reported sex/gender, age group and migration status to identify differences and commonalities. RESULTS Respondents' attitudes towards study participation can be categorised into four themes: wanting to make a contribution, seeking personalised health information, excitement and feeling chosen, and seeking social recognition. Besides citing logistical challenges, non-participants narrated adverse experiences with or attitudes towards science and the healthcare system that deterred them from participating. A range of social experiences and cultural value systems shaped such attitudes; in particular, this includes the cultural authority of science as an arbiter of social questions, transgressing social categories and experiences of marginalisation. Care responsibilities, predominantly borne by female respondents, also impacted upon the decision to take part in NAKO. DISCUSSION Our findings suggest that for participants, health research constitutes a site of distinction in the sense of making a difference and being distinct or distinguishable, whereas non-participants inhabited an orientation towards science that reflected their subjective marginalisation through science. No clear relationship can thereby be presumed between social location and a particular attitude towards study participation; rather, such attitudes transgress and challenge categorical boundaries. This challenges the understanding of particular populations as more or less disadvantaged, or as more or less inclined to participate in health research.
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Affiliation(s)
- Sibille Merz
- grid.473452.3Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Hochstr. 15, 14770 Brandenburg an der Havel, Germany
| | - Philipp Jaehn
- grid.473452.3Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Hochstr. 15, 14770 Brandenburg an der Havel, Germany ,grid.11348.3f0000 0001 0942 1117Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, Brandenburg Medical School, University of Potsdam, Fehrbelliner Str. 38, 16816 Neuruppin, Germany
| | - Tobias Pischon
- grid.419491.00000 0001 1014 0849Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Robert-Rössle-Straße 10, 13125 Berlin, Germany ,grid.419491.00000 0001 1014 0849Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Robert-Rössle-Straße 10, 13125 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Biobank, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany ,grid.6363.00000 0001 2218 4662Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitépl. 1, 10117 Berlin, Germany
| | - Beate Fischer
- grid.7727.50000 0001 2190 5763University of Regensburg, Department of Epidemiology and Preventive Medicine, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Kerstin Wirkner
- LIFE – Leipzig Research Centre for Civilization Diseases, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Stefan Rach
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Kathrin Guenther
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Nadia Obi
- grid.13648.380000 0001 2180 3484University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Christine Holmberg
- grid.473452.3Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Hochstr. 15, 14770 Brandenburg an der Havel, Germany ,grid.11348.3f0000 0001 0942 1117Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus – Senftenberg, Brandenburg Medical School, University of Potsdam, Fehrbelliner Str. 38, 16816 Neuruppin, Germany
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Köngeter A, Schickhardt C, Jungkunz M, Bergbold S, Mehlis K, Winkler EC. Patients’ willingness to provide their clinical data for research purposes and acceptance of different consent models: Findings from a representative survey of cancer patients in Germany (Preprint). J Med Internet Res 2022; 24:e37665. [PMID: 36006690 PMCID: PMC9459939 DOI: 10.2196/37665] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/27/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anja Köngeter
- Section for Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Schickhardt
- Section for Translational Medical Ethics, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Martin Jungkunz
- Section for Translational Medical Ethics, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Susanne Bergbold
- Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center, Heidelberg, Germany
| | - Katja Mehlis
- Section for Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva C Winkler
- Section for Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
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Samuel G, Broekstra R, Gille F, Lucassen A. Public Trust and Trustworthiness in Biobanking: The Need for More Reflexivity. Biopreserv Biobank 2022; 20:291-296. [PMID: 35172119 DOI: 10.1089/bio.2021.0109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Low levels of public trust in biobanks are perceived to be a deterrent to participation and a threat to their sustainability. Acting in a "trustworthy" manner is seen to be one approach to ensuring public trust in biobanks. Striving to improve public trust in biobanks and prioritizing the need for institutional trustworthiness are both vital endeavors. However, there has been little discussion in the context of biobanking about the meaning of these two concepts, and the relationship between them. In this article, we argue that it is important to examine this, to ensure clarity around their meaning, as well as their relationship with each other as they apply to biobanking. We conclude by making a series of recommendations for biobanks.
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Affiliation(s)
- Gabrielle Samuel
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Reinder Broekstra
- Clinical Ethics and Law Southampton (CELS), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Felix Gille
- Digital Society Initiative, University of Zurich, Zurich, Switzerland.,Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Anneke Lucassen
- The Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom.,Clinical Ethics and Law Southampton (CELS), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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8
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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.
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Affiliation(s)
| | - Kai Wang
- University of Iowa, Iowa City, IA, USA
| | | | | | | | | | - Rebecca Pentz
- School of Medicine, Emory University, Atlanta, GA, USA
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9
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Marques SCS, Doetsch J, Abate G, Brødsgaard A, Colombo G, Cuttini M, Pedersen P, Barros H. Understanding participation in European cohort studies of preterm children: the views of parents, healthcare professionals and researchers. BMC Med Res Methodol 2021; 21:19. [PMID: 33430773 PMCID: PMC7802270 DOI: 10.1186/s12874-020-01206-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retention of participants in cohort studies is a major challenge. A better understanding of all elements involved in participation and attrition phenomena in particular settings is needed to develop effective retention strategies. The study aimed to achieve an in-depth understanding of participant retention in longitudinal cohorts focusing on participants' and researcher's perspectives, across three diverse socio-geographic and cultural settings. METHODS This study used a triangulation of multi-situated methods to collect data on cohort studies of children born with less than 32 weeks of gestation in Denmark, Italy and Portugal. It included focus groups and individual semi-driven interviewing with involved key actors (i.e. parents, staff, healthcare professionals, researchers) and a collaborative visual methodology. A purposive sample of 48 key actors (n = 13 in Denmark; n = 13 in Italy; n = 22 in Portugal) was collected. A triangulation of phenomenological thematic analysis with discourse analysis was applied. Cross-contextual and context-specific situational elements involved in participation and attrition phenomena in these child cohorts were identified at various levels and stages. RESULTS Main findings included: situational challenges affecting potential and range of possibilities for implementation strategies (geopolitical environment, societal changes, research funding models); situational elements related to particular strategies acting as deterrents (postal questionnaires) and facilitators (multiple flexible strategies, reminders, regular interaction); main motivations to enrol and participate (altruism/solidarity and gratitude/sense of duty to reciprocate); main motivational deterrents to participate to follow-up waves (lack of bonding, insufficient feedback); entanglement of clinical and research follow-up as facilitator and deterrent. CONCLUSIONS The multi-situated approach used, addressing the interplay of the lived experience of individuals, was of most value to understand participation variability under different implemented strategies in-context. Cross-contextual and context-specific situational elements that have been influential factors towards participation and attrition in the cohorts were identified.
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Affiliation(s)
- Sandra C S Marques
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal.,Centro em Rede de Investigação em Antropologia, Instituto Universitário de Lisboa, Lisboa, Portugal
| | - Julia Doetsch
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal
| | - Georgia Abate
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anne Brødsgaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.,Department of Public Health, HEALTH, Aarhus University, Aarhus, Denmark
| | - Grazia Colombo
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pernille Pedersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
| | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal.
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10
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Nobile H, Borry P, Moldenhauer J, Bergmann MM. Return of Results in Population Studies: How Do Participants Perceive Them? Public Health Ethics 2020. [DOI: 10.1093/phe/phaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
As a cornerstone of public health, epidemiology has lately undergone substantial changes enabled by, among other factors, the use of biobank infrastructures. In biobank-related research, the return of results to participants constitutes an important and complex ethical question. In this study, we qualitatively investigated how individuals perceive the results returned following their participation in cohort studies with biobanks. In our semi-structured interviews with 31 participants of two such German studies, we observed that some participants overestimate the nature of the personal information they will receive from the study. Although this misestimation does not seem to jeopardize the validity of the consent provided at recruitment, it may still represent a threat for participants’ trust in research and thus their long-term commitment, crucial for such studies. We argue that such misestimation may have ethical consequences on the principles guiding the reflection on the return of results in biobank research, i.e. autonomy, beneficence, non-maleficence and reciprocity. We suggest that shifting from the idea of directly benefiting participants through the return of research results could help focusing on benefiting society as a whole, thereby increasing research trustworthiness of population-based studies using biobanks.
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Affiliation(s)
- Hélène Nobile
- Department of Epidemiology, German Institute for Human Nutrition, and Centre of Biomedical Ethics and Law, Department of Public Health, KU Leuven
| | - Pascal Borry
- Centre of Biomedical Ethics and Law, Department of Public Health, KU Leuven
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Abstract
From a legal perspective, before a physician engages in a serious medical intervention they must obtain informed consent. In this paper, we argue that there are serious deficits in our processes of obtaining informed consent; it is often seen as just a bureaucratic hurdle, and people agree to interventions without being in an appropriate epistemic state. We explore some possible reasons for this, including ignorance, trust in physicians' authority, and the minimal time physicians spend with patients. We trace many of these issues to one central cause, which is that in the United States obtaining informed consent is the purview of physicians. We argue that a simple shift in how we obtain informed consent can help to ameliorate these issues. Specifically, we argue that obtaining informed consent should be the responsibility of nurses rather than physicians. While there are several reasons for this, the central ideas are that (1) since nurses are the ones who know the patient, they will be in better position to tell when patients are genuinely informed, and (2) patients will be more comfortable asking questions and admitting ignorance to nurses rather than physicians. While we focus on US law, our conclusions are more broadly applicable.
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12
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Rach S, Günther K, Hadeler B. Participants who were difficult to recruit at baseline are less likely to complete a follow-up questionnaire - results from the German National Cohort. BMC Med Res Methodol 2020; 20:187. [PMID: 32646374 PMCID: PMC7346423 DOI: 10.1186/s12874-020-01073-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/01/2020] [Indexed: 12/23/2022] Open
Abstract
Background With declining response proportions in population-based research the importance of evaluating the effectiveness of measures aimed at improving response increases. We investigated whether an additional flyer with information about the study influences participation in a follow-up questionnaire and the time participants take to send back filled questionnaire. Methods In a trial embedded within the German National Cohort we compared responses to invitations for a follow-up questionnaire either including a flyer with information about the cohort study or not including it. Outcomes of interest were participation in the follow-up (yes vs. no) and time to response (in days). We analyzed paradata from baseline recruitment to account for differences in recruitment history between participants. Results Adding a flyer to invitations did neither influence the likelihood of participation in the follow-up (OR 0.94, 95% CI: 0.80, 1.11), nor the time it took participants to return completed questionnaires (β̂ = 1.71, 95% CI: − 1.01, 4.44). Subjects who, at baseline, needed to be reminded before eventually participating in examinations and subjects who scheduled three or more appointments until eventually completing baseline examinations were less likely to complete the follow-up questionnaire and, if they did, took more time to complete questionnaires. Conclusions Evaluating the effectiveness of measures aimed at increasing response can help to improve the allocation of usually limited resources. Characteristics of baseline recruitment can influence response to follow-up studies and therefore information about recruitment history (i.e., paradata) might prove useful to tailor follow-up recruitments to those who were difficult to recruit during baseline. To this end, however, it is necessary to routinely and meticulously collect paradata during recruitment.
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Affiliation(s)
- Stefan Rach
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany.
| | - Kathrin Günther
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
| | - Birte Hadeler
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359, Bremen, Germany
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13
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Broekstra R, Aris-Meijer J, Maeckelberghe E, Stolk R, Otten S. Trust in Centralized Large-Scale Data Repository: A Qualitative Analysis. J Empir Res Hum Res Ethics 2019; 15:365-378. [PMID: 31738093 PMCID: PMC7488827 DOI: 10.1177/1556264619888365] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Exponential increases in digital data and calls for participation in human research raise questions about when and why individuals voluntarily provide personal data. We conducted 36 in-depth interviews with ex-participants, participants, and nonparticipants in a biobank to identify key factors influencing trust in centralized large-scale data repository for human research. Our findings indicated that trust depends strongly on whether such data repository benefits the public, the interests of data collectors, the characteristics of the collected data, and application of informed consent for retaining control over personal data. Concerns about the aims and range of data repository appeared to influence withdrawal of participation. Our findings underscore ethical and practical issues relating to data collection and consent procedures in human research.
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Affiliation(s)
| | | | | | - Ronald Stolk
- University Medical Center Groningen, the Netherlands
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14
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Kongsholm NCH, Lassen J, Sandøe P. "I didn't have anything to decide, I wanted to help my kids"-An interview-based study of consent procedures for sampling human biological material for genetic research in rural Pakistan. AJOB Empir Bioeth 2018; 9:113-127. [PMID: 29722609 DOI: 10.1080/23294515.2018.1472148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Individual, comprehensive, and written informed consent is broadly considered an ethical obligation in research involving the sampling of human material. In developing countries, however, local conditions, such as widespread illiteracy, low levels of education, and hierarchical social structures, complicate compliance with these standards. As a result, researchers may modify the consent process to secure participation. To evaluate the ethical status of such modified consent strategies it is necessary to assess the extent to which local practices accord with the values underlying informed consent. METHODS Over a 2-week period in April 2014 we conducted semistructured interviews with researchers from a genetic research institute in rural Pakistan and families who had given blood samples for their research. Interviews with researchers focused on the institute's requirements for consent, and the researchers' strategies for and experiences with obtaining consent in the field. Interviews with donors focused on their motivation for donating samples, their experience of consent and donation, and what factors were central in their decisions to give consent. RESULTS Researchers often reported modifications to consent procedures suited to the local context, standardly employing oral and elder consent, and tailoring information to the social education level of donor families. Central themes in donors' accounts of their decision to consent were the hope of getting something out of their participation and their remarkably high levels of trust in the researchers. Several donor accounts indicated a degree of confusion about participation and diagnosis, resulting in misconceived expectations of therapeutic benefits. CONCLUSIONS We argue that while building and maintaining trusting relationships in research is important-not least in developing countries-strategies that serve this endeavor should be supplemented with efforts to ensure proper provision and understanding of relevant information, specifically about the nature of research and measures for individual consent and opt-out.
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Affiliation(s)
| | - Jesper Lassen
- b Section for Consumption, Bioethics, and Governance , University of Copenhagen
| | - Peter Sandøe
- b Section for Consumption, Bioethics, and Governance , University of Copenhagen
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15
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Berrios C, James CA, Raraigh K, Bollinger J, Murray B, Tichnell C, Applegate CD, Bergner AL. Enrolling Genomics Research Participants through a Clinical Setting: the Impact of Existing Clinical Relationships on Informed Consent and Expectations for Return of Research Results. J Genet Couns 2018; 27:263-273. [PMID: 28932961 PMCID: PMC7539290 DOI: 10.1007/s10897-017-0143-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
Genetic counselors working in a clinical setting may find themselves recruiting, enrolling, and returning results for genomic research, and existing clinical relationships with study participants may impact these research interactions. We present a qualitative study using semi-structured interviews of participants enrolled in a genome sequencing/exome sequencing (GS/ES) study at the same institution where they receive clinical care. Interviews were coded for motivations to participate and expectations of this research. The interviews revealed common motivations for participation, including altruism and hope for benefit for themselves, family members, and/or others with their condition. Additionally, themes emerged related to unintentional influence based on trust of the clinical provider that recruited them to the study. Participant trust in the enrolling provider at times appeared to extend to the study team to decide which research results to return and to do so in an appropriate format. Participants also based expectations for research results return on previous clinical genetic testing experiences, which may or may not be realistic depending on study design. It is imperative that genetic counselors enrolling patients into research studies be aware of the potential influence of their clinical relationship on potential subjects, be transparent about their role on the study team, and help set expectations about the study process, including results return.
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Affiliation(s)
- Courtney Berrios
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Karen Raraigh
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn D Applegate
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA
| | - Amanda L Bergner
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, 600 North Wolfe Street, Blalock 1008, Baltimore, MD, 21287, USA.
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16
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Timmons S, Vezyridis P. Market-driven production of biospecimens and the role of NHS hospital-led biobanks. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1242-1257. [PMID: 28555937 DOI: 10.1111/1467-9566.12584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio-ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital. There is extensive investment in a range of intellectual and commercial relationships and labour among stakeholders involved in the production of biospecimens. It is not only the boundaries of research, clinical care and commercialisation of biospecimens that blur but also those of volunteerism and citizenship. Hospital-led biobanks provide an opportunity to study the intertwining of biomedical innovation and healthcare.
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Affiliation(s)
- Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, UK
| | - Paraskevas Vezyridis
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, UK
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