1
|
Moving Beyond the Ableist Roots of Educational Psychology: Audit of the Field and a Path Forward. EDUCATIONAL PSYCHOLOGY REVIEW 2022. [DOI: 10.1007/s10648-022-09673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
2
|
Ross LF. Ethical Issues Raised by the Media Portrayal of Adolescent Transplant Refusals. Pediatrics 2020; 146:S33-S41. [PMID: 32737230 DOI: 10.1542/peds.2020-0818h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
Cases of adolescents in organ failure who refuse solid organ transplant are not common, but several have been discussed in the media in the United States and the United Kingdom. Using the framework developed by Buchanan and Brock for surrogate decision-making, I examine what role the adolescent should morally play when deciding about therapy for life-threatening conditions. I argue that the greater the efficacy of treatment, the less voice the adolescent (and the parent) should have. I then consider how refusals of highly effective transplant cases are similar to and different from refusals of other lifesaving therapies (eg, chemotherapy for leukemia), which is more commonly discussed in the media and medical literature. I examine whether organ scarcity and the need for lifelong immunosuppression justify differences in whether the state intervenes when an adolescent and his or her parents refuse a transplant. I argue that the state, as parens patriae, has an obligation to provide the social supports needed for a successful transplant and follow-up treatment plan, although family refusals may be permissible when the transplant is experimental or of low efficacy because of comorbidities or other factors. I conclude by discussing the need to limit media coverage of pediatric treatment refusals.
Collapse
Affiliation(s)
- Lainie Friedman Ross
- Departments of Pediatrics, Medicine, and Surgery, University of Chicago, Chicago, Illinois
| |
Collapse
|
3
|
Landers SE, Francis JKR, Morris MC, Mauro C, Rosenthal SL. Adolescent and Parent Perceptions about Participation in Biomedical Sexual Health Trials. Ethics Hum Res 2020; 42:2-11. [PMID: 32421948 DOI: 10.1002/eahr.500048] [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: 11/06/2022]
Abstract
Given the burden of HIV and other sexually transmitted infections among adolescents who are legal minors, it is critical that they be included in biomedical sexual health trials to ensure that new prevention and treatment interventions are safe, effective, and acceptable for their use. However, adolescents are often not well represented in clinical trials. We provide an overview of the available evidence regarding adolescent and parent willingness for adolescents to participate in biomedical sexual health trials, parental involvement in the permission-consent process, management of differences and discord among adolescents and parents, and parental involvement throughout the study period. We also outline recommendations for current practice and areas for future research.
Collapse
Affiliation(s)
- Sara E Landers
- Research coordinator in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Jenny K R Francis
- Assistant professor in the Department of Pediatrics at the University of Texas Southwestern Medical Center
| | - Marilyn C Morris
- Associate professor in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Christine Mauro
- Assistant professor in the Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center
| | - Susan L Rosenthal
- Professor of medical psychology in the Departments of Pediatrics and Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| |
Collapse
|
4
|
Knopf A, Ott MA, Draucker CB, Fortenberry JD, Reirden DH, Arrington-Sanders R, Schneider J, Straub D, Baker R, Bakoyannis G, Zimet GD. Innovative Approaches to Obtain Minors' Consent for Biomedical HIV Prevention Trials: Multi-Site Quasi-Experimental Study of Adolescent and Parent Perspectives. JMIR Res Protoc 2020; 9:e16509. [PMID: 32224493 PMCID: PMC7154935 DOI: 10.2196/16509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the high burden of new HIV infections in minor adolescents, they are often excluded from biomedical HIV prevention trials, largely owing to the ethical complexities of obtaining consent for enrollment. Researchers and ethics regulators have a duty to protect adolescents-as a special category of human subjects, they must have protection that extends beyond those afforded to all human subjects. Typically, additional protection includes parental consent for enrollment. However, parental consent can present a risk of harm for minor adolescents. Research involving minor adolescents indicate that they are unwilling to join biomedical trials for stigmatized health problems, such as HIV, when parental consent is required. This presents a significant barrier to progress in adolescent HIV prevention by creating delays in research and the translation of new scientific evidence generated in biomedical trials in adult populations. OBJECTIVE This protocol aims to examine how parental involvement in the consent process affects the acceptability of hypothetical participation in biomedical HIV prevention trials from the perspectives of minor adolescents and parents of minor adolescents. METHODS In this protocol, we use a quasi-experimental design that involves a simulated consent process for 2 different HIV prevention trials. The first trial is modeled after an open-label study of the use of tenofovir disoproxil fumarate and emtricitabine as preexposure prophylaxis for HIV. The second trial is modeled after a phase IIa trial of an injectable HIV integrase inhibitor. There are 2 groups in the study-minor adolescents aged 14 to 17 years, inclusive, and parents of minor adolescents in the same age range. The adolescent participants are randomized to 1 of 3 consent conditions with varying degrees of parental involvement. After undergoing a simulated consent process, they rate their willingness to participate (WTP) in each of the 2 trials if offered the opportunity. The primary outcome is WTP, given the consent condition. Parents undergo a similar process but are asked to rate the acceptability of each of the 3 consent conditions. The primary outcome is acceptability of the consent method for enrollment. The secondary outcomes include the following: capacity to consent among both participant groups, the prevalence of medical mistrust, and the effects of the study phase (eg, phase IIa vs the open-label study) and drug administration route (eg, oral vs injection) on WTP (adolescents) and acceptability (parents) of the consent method. RESULTS Enrollment began in April 2018 and ended mid-September 2019. Data are being analyzed and dissemination is expected in April 2020. CONCLUSIONS The study will provide the needed empirical data about minor adolescents' and parents' perspectives on consent methods for minors. The evidence generated can be used to guide investigators and ethics regulators in the design of consent processes for biomedical HIV prevention trials. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16509.
Collapse
Affiliation(s)
- Amelia Knopf
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Mary A Ott
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Claire Burke Draucker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - J Dennis Fortenberry
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Daniel H Reirden
- Children's Hospital Colorado, School of Medicine, The University of Colorado, Aurora, CO, United States
| | - Renata Arrington-Sanders
- Division of General Pediatrics & Adolescent Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - John Schneider
- Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Diane Straub
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Rebecca Baker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Giorgos Bakoyannis
- Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| |
Collapse
|
5
|
Miller MK, Chernick LS, Goyal MK, Reed JL, Ahmad FA, Hoehn EF, Pickett MS, Stukus K, Mollen CJ. A Research Agenda for Emergency Medicine-based Adolescent Sexual and Reproductive Health. Acad Emerg Med 2019; 26:1357-1368. [PMID: 31148339 DOI: 10.1111/acem.13809] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/29/2019] [Accepted: 05/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to identify key questions for emergency medicine (EM)-based adolescent sexual and reproductive health and to develop an evidence-based research agenda. METHODS We recruited national content experts to serve as advisory group members and used a modified Delphi technique to develop consensus around actionable research questions related to EM-based adolescent reproductive and sexual health care. Author subgroups conducted literature reviews and developed the initial list of research questions, which were iteratively refined with advisory members. External stakeholders then independently rated each item for its importance in expanding the evidence base (1 = not important to 5 = very important) via electronic survey. RESULTS Our final list of 24 research questions included items that intersected all sexual and reproductive health topics as well as questions specific to human immunodeficiency virus/sexually transmitted infections (HIV/STIs), pregnancy prevention, confidentiality/consent, public health, and barriers and facilitators to care. External stakeholders rated items related to HIV/STI, cost-effectiveness, brief intervention for sexual risk reduction, and implementation and dissemination as most important. CONCLUSIONS We identified critical questions to inform EM-based adolescent sexual and reproductive health research. Because evidence-based care has potential to improve health outcomes while reducing costs associated with HIV/STI and unintended pregnancy, funders and researchers should consider increasing attention to these key questions.
Collapse
Affiliation(s)
- Melissa K. Miller
- Department of Pediatrics Division of Emergency Medical Services Children's Mercy Hospitals and Clinics Kansas City MO
| | - Lauren S. Chernick
- Department of Emergency Medicine and Pediatrics Columbia University New York NY
| | - Monika K. Goyal
- Department of Pediatrics Children's National Medical Center The George Washington University Washington DC
| | - Jennifer L. Reed
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Fahd A. Ahmad
- Department of Pediatrics Washington University School of Medicine St. Louis MO
| | - Erin F. Hoehn
- Division of Emergency Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | | | - Kristin Stukus
- Department of Pediatrics Division of Emergency Medicine Nationwide Children's Hospital Columbus OH
| | - Cynthia J. Mollen
- Department of Pediatrics Division of Emergency Medicine Children's Hospital of Philadelphia Philadelphia PA
| |
Collapse
|
6
|
Gumede D, Ngwenya NB, Namukwaya S, Bernays S, Seeley J. A reflection on ethical and methodological challenges of using separate interviews with adolescent-older carer dyads in rural South Africa. BMC Med Ethics 2019; 20:47. [PMID: 31286952 PMCID: PMC6615300 DOI: 10.1186/s12910-019-0383-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background This article discusses our reflections on ethical and methodological challenges when conducting separate interviews with individuals in dyads in the uMkhanyakude district, South Africa. Our work is embedded in an ethnographic study exploring care relationships between adolescents and their older carers in the context of a large-donor funded HIV programme. We use these reflections to discuss some of the challenges and present possible management strategies that may be adopted in conducting dyadic health research in resource-poor settings. Methods Drawing from the relational agency, three rounds of separate interviews and participant observation were undertaken with dyads of adolescents aged between 13 and 19 and their older carers aged 50+ from October 2017 to September 2018. A reflexive journal was kept to record the interviewer's experiences of the whole research process. We identified methodological and ethical challenges from these data during the thematic analysis. Results A total of 36 separate interviews were conducted with six pairs of adolescent-older carer dyads (n = 12 participants). Five themes emerged: recruitment of dyads, consenting dyads, confidentiality, conducting separate interviews with adolescents and older carers, and interviewer-dyad interaction. We also illustrated how we dealt with these challenges. Conclusions Results from this study can guide the recruitment, consenting and collecting data for health studies that employ a similar form of enquiry in LMICs. However, ethical and methodological challenges should be recognised as features of the relationships between cross-generation dyads rather than weaknesses of the method.
Collapse
Affiliation(s)
- Dumile Gumede
- Africa Health Research Institute, Durban, South Africa. .,School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | | | - Stella Namukwaya
- Medical Research Council/ Uganda Virus Research Institute and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
| | - Sarah Bernays
- Sydney School of Public Health, The University of Sydney, 324, Edward Ford Building A27, Sydney, Australia.,Departsment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Janet Seeley
- Africa Health Research Institute, Durban, South Africa.,Medical Research Council/ Uganda Virus Research Institute and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.,Departsment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| |
Collapse
|
7
|
Pervola J, Myers MF, McGowan ML, Prows CA. Giving adolescents a voice: the types of genetic information adolescents choose to learn and why. Genet Med 2019; 21:965-971. [PMID: 30369597 PMCID: PMC10445294 DOI: 10.1038/s41436-018-0320-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/14/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The American College of Medical Genetics and Genomics supports parents' opting in or out of secondary analysis of 59 genes when their child has clinical exome/genome sequencing. We explored the reasons adolescents choose to learn certain types of results and the reasons they want to involve or not involve parents in decision-making. METHODS Adolescents recruited without clinical indication were offered independent, followed by joint choices with a parent to learn genomic results. After making independent choices, adolescent/parent dyads were interviewed to explore the reasons for their choices. Interviews were audio-recorded and transcribed. The constant comparative method was used to analyze 64 purposefully selected transcripts that included 31 from adolescents who excluded some or all potential results. RESULTS Three major themes informed adolescents' choices: (1) actionability of information, (2) knowledge seeking, and (3) psychological impact. Of adolescents who independently excluded some conditions (n=31), 58% changed their initial choices during the joint interview due to parental influence or improved understanding. Nearly all adolescents (98%) wanted to be involved in the decision-making process, and 53% wanted to make choices independently. CONCLUSIONS Our findings contribute empirical evidence to support the refinement of professional guidelines for adolescents' engagement and preferences in genetic testing decisions.
Collapse
Affiliation(s)
- Josie Pervola
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Melanie F Myers
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michelle L McGowan
- Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics & Women's, Gender & Sexuality Studies, University of Cincinnati, Cincinnati, OH, USA
| | - Cynthia A Prows
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Patient Services, Cincinnati Children's Hospital Medical Center Cincinnati, Cincinnati, OH, USA.
| |
Collapse
|
8
|
Francis JKR, de Roche AM, Mauro C, Landers SE, Chang J, Catallozzi M, Breitkopf CR, Rosenthal SL. Adolescent-Parent Dyadic Retention in an Interview Study and Changes in Willingness to Participate in a Hypothetical Microbicide Safety Study. J Pediatr Adolesc Gynecol 2018; 31:592-596. [PMID: 29906513 PMCID: PMC6218291 DOI: 10.1016/j.jpag.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/17/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE In this study we describe adolescent and parent retention and changes in willingness to participate (WTP) in research among adolescents, parents, and adolescent-parent dyads. DESIGN AND SETTING Adolescent-parent dyads were recruited to participate in a longitudinal study to assess research participation attitudes using simultaneous individual interviews of the adolescent and parent with a return visit 1 year later using the same interview. PARTICIPANTS Adolescents (14-17 years old) and their parents. INTERVENTIONS None. MAIN OUTCOME MEASURES The relationship between participant characteristics and dyad retention was assessed. WTP was measured on a Likert scale and dichotomized (willing/unwilling) to assess changes in WTP attitudes over time for adolescents, parents, and dyads. RESULTS Eighty-three percent of the 300 dyads were retained. Dyads in which there was successful contact with the parent before follow-up were more likely to be retained (odds ratio, 4.88; 95% confidence interval, 2.57-9.26). For adolescents at baseline, 59% were willing to participate and 55% were willing to participate at follow-up (McNemar S = 0.91; P = .34). For parents at baseline, 51% were willing to participate and 57% were willing to participate at follow-up (McNemar S = 5.12; P = .02). For dyads at baseline, 57% were concordant (in either direction) and 70% of dyads were concordant at follow-up (McNemar S = 10.56; P = .001). CONCLUSION Over 1 year, parent contact might positively influence successful adolescent retention. Parents become more willing to let their adolescents participate over time, with dyads becoming more concordant about research participation.
Collapse
Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Christine Mauro
- Department of Biostatistics, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | - Sara E Landers
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | | | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| |
Collapse
|
9
|
Tsevat RK, Breitkopf CR, Landers SE, de Roche AM, Mauro C, Ipp LS, Catallozzi M, Rosenthal SL. Adolescents' and Parents' Attitudes Toward Adolescent Clinical Trial Participation: Changes Over One Year. J Empir Res Hum Res Ethics 2018; 13:383-390. [PMID: 30103655 PMCID: PMC6146060 DOI: 10.1177/1556264618790889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about how adolescents' and parents' thoughts about participation in clinical trials change over time. In this study, adolescent (14-17 years)-parent dyads were asked about willingness to participate in a hypothetical reproductive health study. A year later, they were asked how their thoughts about the study had changed. Qualitative responses were coded and analyzed using framework analysis. Thirty-two percent of adolescents and 18% of parents reported changes in thoughts; reasons included general changes in perception, clearer understanding, new knowledge or experiences, increased maturity/age of adolescents, and changes in participants independent of the study. Adolescents and parents may benefit from learning about studies multiple times, and investigators should account for development and new experiences to optimize adolescent research enrollment.
Collapse
Affiliation(s)
- Rebecca K. Tsevat
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Sara E. Landers
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | - Ariel M. de Roche
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Lisa S. Ipp
- NewYork-Presbyterian Hospital (USA)
- Weill Cornell Medical College (USA)
| | - Marina Catallozzi
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- Columbia University Mailman School of Public Health (USA)
- NewYork-Presbyterian Hospital (USA)
| | - Susan L. Rosenthal
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- NewYork-Presbyterian Hospital (USA)
| |
Collapse
|