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De Sutter E, Barbier L, Borry P, Geerts D, Ioannidis JP, Huys I. Personalized and longitudinal electronic informed consent in clinical trials: How to move the needle? Digit Health 2024; 10:20552076231222361. [PMID: 38269372 PMCID: PMC10807334 DOI: 10.1177/20552076231222361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/26/2024] Open
Abstract
Changes in the clinical trials landscape have been driven by advancements in digital technology. The use of electronic informed consent to inform research participants and to obtain their consent electronically has the potential to improve participant-researcher interactions over time, facilitate clinical trial participation, and increase efficiency in clinical trial conduct. A personalized electronic informed consent platform that enables long-term interactions with the research team could function as a tool to empower participant engagement in clinical trials. However, significant challenges persist impeding successful and widespread implementation. This Perspective provides insights into the opportunities and challenges for the implementation of electronic informed consent in clinical trials. It sets out key recommendations to promote the implementation of this innovative approach to the informed consent process, including the creation of uniform electronic informed consent platforms at regional and national level.
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Liese Barbier
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - David Geerts
- KU Leuven Digital Society Institute, KU Leuven, Leuven, Belgium
| | - John P.A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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2
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Haas MA, Madelli EO, Brown R, Prictor M, Boughtwood T. Evaluation of CTRL: a web application for dynamic consent and engagement with individuals involved in a cardiovascular genetic disorders cohort. Eur J Hum Genet 2024; 32:61-68. [PMID: 37709947 PMCID: PMC10772119 DOI: 10.1038/s41431-023-01454-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
There has been keen interest in whether dynamic consent should be used in health research but few real-world studies have evaluated its use. Australian Genomics piloted and evaluated CTRL ('control'), a digital consent tool incorporating granular, dynamic decision-making and communication for genomic research. Individuals from a Cardiovascular Genetic Disorders Flagship were invited in person (prospective cohort) or by email (retrospective cohort) to register for CTRL after initial study recruitment. Demographics, consent choices, experience surveys and website analytics were analysed using descriptive statistics. Ninety-one individuals registered to CTRL (15.5% of the prospective cohort and 11.8% of the retrospective cohort). Significantly more males than females registered when invited retrospectively, but there was no difference in age, gender, or education level between those who did and did not use CTRL. Variation in individual consent choices about secondary data use and return of results supports the desirability of providing granular consent options. Robust conclusions were not drawn from satisfaction, trust, decision regret and knowledge outcome measures: differences between CTRL and non-CTRL cohorts did not emerge. Analytics indicate CTRL is acceptable, although underutilised. This is one of the first studies evaluating uptake and decision making using online consent tools and will inform refinement of future designs.
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Affiliation(s)
- Matilda A Haas
- Australian Genomics, Parkville, VIC, 3052, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.
| | - Evanthia O Madelli
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Rosie Brown
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Tiffany Boughtwood
- Australian Genomics, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
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3
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Lee AR, Koo D, Kim IK, Lee E, Kim HH, Yoo S, Kim JH, Choi EK, Lee HY. Identifying facilitators of and barriers to the adoption of dynamic consent in digital health ecosystems: a scoping review. BMC Med Ethics 2023; 24:107. [PMID: 38041034 PMCID: PMC10693132 DOI: 10.1186/s12910-023-00988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Conventional consent practices face ethical challenges in continuously evolving digital health environments due to their static, one-time nature. Dynamic consent offers a promising solution, providing adaptability and flexibility to address these ethical concerns. However, due to the immaturity of the concept and accompanying technology, dynamic consent has not yet been widely used in practice. This study aims to identify the facilitators of and barriers to adopting dynamic consent in real-world scenarios. METHODS This scoping review, conducted in December 2022, adhered to the PRISMA Extension for Scoping Reviews guidelines, focusing on dynamic consent within the health domain. A comprehensive search across Web of Science, PubMed, and Scopus yielded 22 selected articles based on predefined inclusion and exclusion criteria. RESULTS The facilitators for the adoption of dynamic consent in digital health ecosystems were the provision of multiple consent modalities, personalized alternatives, continuous communication, and the dissemination of up-to-date information. Nevertheless, several barriers, such as consent fatigue, the digital divide, complexities in system implementation, and privacy and security concerns, needed to be addressed. This study also investigated current technological advancements and suggested considerations for further research aimed at resolving the remaining challenges surrounding dynamic consent. CONCLUSIONS Dynamic consent emerges as an ethically advantageous method for digital health ecosystems, driven by its adaptability and support for continuous, two-way communication between data subjects and consumers. Ethical implementation in real-world settings requires the development of a robust technical framework capable of accommodating the diverse needs of stakeholders, thereby ensuring ethical integrity and data privacy in the evolving digital health landscape.
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Affiliation(s)
- Ah Ra Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dongjun Koo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Il Kon Kim
- School of Computer Science & Engineering, College of IT Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Eunjoo Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Ho Kim
- Department of Pediatrics, Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute of Clinical Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Public Health Medical Services, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Eun Kyung Choi
- Department of Medical Humanities and Medical Education, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Ho-Young Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Muller SHA, van Thiel GJMW, Mostert M, van Delden JJM. Dynamic consent, communication and return of results in large-scale health data reuse: Survey of public preferences. Digit Health 2023; 9:20552076231190997. [PMID: 37599899 PMCID: PMC10434987 DOI: 10.1177/20552076231190997] [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: 02/02/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Dynamic consent forms a comprehensive, tailored approach for interacting with research participants. We conducted a survey study to inquire how research participants evaluate the elements of consent, information provision, communication and return of results within dynamic consent in a hypothetical health data reuse scenario. We distributed a digital questionnaire among a purposive sample of patient panel members. Data were analysed using descriptive and nonparametric inferential statistics. Respondents favoured the potential to manage changing consent preferences over time. There was much agreement between people favouring closer and more specific control over data reuse approval and those in favour of broader approval, facilitated by an opt-out system or an independent data reuse committee. People want to receive more information about reuse, outcomes and return of results. Respondents supported an interactive model of research participation, welcoming regular, diverse and interactive forms of communication, like a digital communication platform. Approval for reuse and providing meaningful information, including meaningful return of results, are intricately related to facilitating better communication. Respondents favoured return of actionable research results. These findings emphasize the potential of dynamic consent for enabling participants to maintain control over how their data are being used for which purposes by whom. Allowing different options to shape a dynamic consent interface in health data reuse in a personalized manner is pivotal to accommodate plurality in a flexible though robust manner. Interaction via dynamic consent enables participants to tailor the elements of participation they deem relevant to their own preferences, engaging diverse perspectives, interests and preferences.
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Affiliation(s)
- Sam HA Muller
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ghislaine JMW van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno Mostert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes JM van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Mascalzoni D, Melotti R, Pattaro C, Pramstaller PP, Gögele M, De Grandi A, Biasiotto R. Ten years of dynamic consent in the CHRIS study: informed consent as a dynamic process. Eur J Hum Genet 2022; 30:1391-1397. [PMID: 36064788 PMCID: PMC9441838 DOI: 10.1038/s41431-022-01160-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/13/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
The Cooperative Health Research in South Tyrol (CHRIS) is a longitudinal study in Northern Italy, using dynamic consent since its inception in 2011. The CHRIS study collects health data and biosamples for research, and foresees regular follow-ups over time. We describe the experience with the CHRIS study dynamic consent, providing an overview of its conceptualization and implementation, and of the participant-centered strategies used to assess and improve the process, directly linked to participation and communication. In order to comply with high ethical standards and to allow broadness in the areas of research, CHRIS dynamic consent was conceived as an interactive process: based on a strong governance and an ongoing tailored communication with participants, it aims to promote autonomy and to develop a trust-based engaged relationship with participants, also relevant for retention. Built within an online platform, the consent allows granular choices, which can be changed over time. In a process of co-production, participants views have been investigated and kept into account in policy development. Participants showed a high degree of participation, thus enabling the consolidation of the CHRIS resources. Even though a low change rate was reported in the baseline, participants valued the possibility of changing their informed consent choices. Communication (language-tailored, ongoing, multimedia) was important for participants, and for participation and retention. In our experience, dynamic consent was proven to be a flexible consent model, which allowed to meet ethical and legal standards for participation in research, and to accommodate participants' and researchers' needs.
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Affiliation(s)
- Deborah Mascalzoni
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy ,grid.8993.b0000 0004 1936 9457Center for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Roberto Melotti
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Cristian Pattaro
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Peter Paul Pramstaller
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Martin Gögele
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Alessandro De Grandi
- grid.511439.bInstitute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy
| | - Roberta Biasiotto
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy. .,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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6
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Nwebonyi N, Silva S, de Freitas C. Public Views About Involvement in Decision-Making on Health Data Sharing, Access, Use and Reuse: The Importance of Trust in Science and Other Institutions. Front Public Health 2022; 10:852971. [PMID: 35619806 PMCID: PMC9127133 DOI: 10.3389/fpubh.2022.852971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Data-intensive and needs-driven research can deliver substantial health benefits. However, concerns with privacy loss, undisclosed surveillance, and discrimination are on the rise due to mounting data breaches. This can undermine the trustworthiness of data processing institutions and reduce people's willingness to share their data. Involving the public in health data governance can help to address this problem by imbuing data processing frameworks with societal values. This study assesses public views about involvement in individual-level decisions concerned with health data and their association with trust in science and other institutions. Methods Cross-sectional study with 162 patients and 489 informal carers followed at two reference centers for rare diseases in an academic hospital in Portugal (June 2019–March 2020). Participants rated the importance of involvement in decision-making concerning health data sharing, access, use, and reuse from “not important” to “very important”. Its association with sociodemographic characteristics, interpersonal trust, trust in national and international institutions, and the importance of trust in research teams and host institutions was tested. Results Most participants perceived involvement in decision-making about data sharing (85.1%), access (87.1%), use (85%) and reuse (79.9%) to be important or very important. Participants who ascribed a high degree of importance to trust in research host institutions were significantly more likely to value involvement in such decisions. A similar position was expressed by participants who valued trust in research teams for data sharing, access, and use. Participants with low levels of trust in national and international institutions and with lower levels of education attributed less importance to being involved in decisions about data use. Conclusion The high value attributed by participants to involvement in individual-level data governance stresses the need to broaden opportunities for public participation in health data decision-making, namely by introducing a meta consent approach. The important role played by trust in science and in other institutions in shaping participants' views about involvement highlights the relevance of pairing such a meta consent approach with the provision of transparent information about the implications of data sharing, the resources needed to make informed choices and the development of harm mitigation tools and redress.
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Affiliation(s)
- Ngozi Nwebonyi
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - Susana Silva
- Departamento de Sociologia, Instituto de Ciências Sociais, Universidade do Minho, Braga, Portugal.,Centro em Rede de Investigação em Antropologia, Universidade do Minho, Braga, Portugal
| | - Cláudia de Freitas
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Centre for Research and Studies in Sociology, University Institute of Lisbon (ISCTE-IUL), Lisbon, Portugal
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7
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Sovereign Digital Consent through Privacy Impact Quantification and Dynamic Consent. TECHNOLOGIES 2022. [DOI: 10.3390/technologies10010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Digitization is becoming more and more important in the medical sector. Through electronic health records and the growing amount of digital data of patients available, big data research finds an increasing amount of use cases. The rising amount of data and the imposing privacy risks can be overwhelming for patients, so they can have the feeling of being out of control of their data. Several previous studies on digital consent have tried to solve this problem and empower the patient. However, there are no complete solution for the arising questions yet. This paper presents the concept of Sovereign Digital Consent by the combination of a consent privacy impact quantification and a technology for proactive sovereign consent. The privacy impact quantification supports the patient to comprehend the potential risk when sharing the data and considers the personal preferences regarding acceptance for a research project. The proactive dynamic consent implementation provides an implementation for fine granular digital consent, using medical data categorization terminology. This gives patients the ability to control their consent decisions dynamically and is research friendly through the automatic enforcement of the patients’ consent decision. Both technologies are evaluated and implemented in a prototypical application. With the combination of those technologies, a promising step towards patient empowerment through Sovereign Digital Consent can be made.
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Merlec MM, Lee YK, Hong SP, In HP. A Smart Contract-Based Dynamic Consent Management System for Personal Data Usage under GDPR. SENSORS (BASEL, SWITZERLAND) 2021; 21:7994. [PMID: 34883997 PMCID: PMC8659597 DOI: 10.3390/s21237994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/25/2022]
Abstract
A massive amount of sensitive personal data is being collected and used by scientists, businesses, and governments. This has led to unprecedented threats to privacy rights and the security of personal data. There are few solutions that empower individuals to provide systematic consent agreements on distinct personal information and control who can collect, access, and use their data for specific purposes and periods. Individuals should be able to delegate consent rights, access consent-related information, and withdraw their given consent at any time. We propose a smart-contract-based dynamic consent management system, backed by blockchain technology, targeting personal data usage under the general data protection regulation. Our user-centric dynamic consent management system allows users to control their personal data collection and consent to its usage throughout the data lifecycle. Transaction history and logs are recorded in a blockchain that provides trusted tamper-proof data provenance, accountability, and traceability. A prototype of our system was designed and implemented to demonstrate its feasibility. The acceptability and reliability of the system were assessed by experimental testing and validation processes. We also analyzed the security and privacy of the system and evaluated its performance.
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Affiliation(s)
- Mpyana Mwamba Merlec
- Department of Computer Science and Engineering, Korea University, Seoul 02841, Korea;
| | - Youn Kyu Lee
- Department of Computer Engineering, Hongik University, Seoul 04066, Korea
| | - Seng-Phil Hong
- Management Support Division, Hancom WITH, Inc., Pangyo 13493, Korea;
| | - Hoh Peter In
- Department of Computer Science and Engineering, Korea University, Seoul 02841, Korea;
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9
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Greenwood J, Crowden A. Thinking about the idea of consent in data science genomics: How 'informed' is it? Nurs Philos 2021; 22:e12347. [PMID: 33979474 DOI: 10.1111/nup.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
In this paper we argue that 'informed' consent in Big Data genomic biobanking is frequently less than optimally informative. This is due to the particular features of genomic biobanking research which render it ethically problematic. We discuss these features together with details of consent models aimed to address them. Using insights from consent theory, we provide a detailed analysis of the essential components of informed consent which includes recommendations to improve consent performance. In addition, and using insights from philosophy of mind and language and psycholinguistics we support our analyses by identifying the nature and function of concepts (ideas) operational in human cognition and language together with an implicit coding/decoding model of human communication. We identify this model as the source of patients/participants poor understanding. We suggest an alternative, explicit model of human communication, namely, that of relevance-theoretic inference which obviates the limitations of the code model. We suggest practical strategies to assist health service professionals to ensure that the specific information they provide concerning the proposed treatment or research is used to inform participants' decision to consent. We do not prescribe a standard, formal approach to decision-making where boxes are ticked; rather, we aim to focus attention towards the sorts of considerations and questions that might usefully be borne in mind in any consent situation. We hope that our theorising will be of real practical benefit to nurses and midwives working on the clinical and research front-line of genomic science.
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Affiliation(s)
- Jennifer Greenwood
- School of Historical and Philosophical Inquiry, University of Queensland, St Lucia, QLD, Australia
| | - Andrew Crowden
- School of Historical and Philosophical Inquiry, University of Queensland, St Lucia, QLD, Australia
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10
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Taylor CO, Manov NF, Crew KD, Weng C, Connolly JJ, Chute CG, Ford DE, Lehmann H, Rahm AK, Kullo IJ, Caraballo PJ, Holm IA, Mathews D. Preferences for Updates on General Research Results: A Survey of Participants in Genomic Research from Two Institutions. J Pers Med 2021; 11:399. [PMID: 34065005 PMCID: PMC8151672 DOI: 10.3390/jpm11050399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 01/11/2023] Open
Abstract
There is a need for multimodal strategies to keep research participants informed about study results. Our aim was to characterize preferences of genomic research participants from two institutions along four dimensions of general research result updates: content, timing, mechanism, and frequency. METHODS We conducted a web-based cross-sectional survey that was administered from 25 June 2018 to 5 December 2018. RESULTS 397 participants completed the survey, most of whom (96%) expressed a desire to receive research updates. Preferences with high endorsement included: update content (brief descriptions of major findings, descriptions of purpose and goals, and educational material); update timing (when the research is completed, when findings are reviewed, when findings are published, and when the study status changes); update mechanism (email with updates, and email newsletter); and update frequency (every three months). Hierarchical cluster analyses based on the four update preferences identified four profiles of participants with similar preference patterns. Very few participants in the largest profile were comfortable with budgeting less money for research activities so that researchers have money to set up services to send research result updates to study participants. CONCLUSION Future studies may benefit from exploring preferences for research result updates, as we have in our study. In addition, this work provides evidence of a need for funders to incentivize researchers to communicate results to participants.
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Affiliation(s)
- Casey Overby Taylor
- Department of Medicine, Department of Biomedical Engineering, and The Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Natalie Flaks Manov
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (N.F.M.); (D.E.F.)
| | - Katherine D. Crew
- Department of Medicine and Epidemiology, Columbia University, New York, NY 10032, USA;
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA;
| | - John J. Connolly
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Christopher G. Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Daniel E. Ford
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (N.F.M.); (D.E.F.)
| | - Harold Lehmann
- Department of Medicine, Division of Health Sciences Informatics, Johns Hopkins University, Baltimore, MD 21205, USA;
| | | | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | | | - Ingrid A. Holm
- Division of Genetics and Genomics, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA;
| | - Debra Mathews
- Johns Hopkins University Berman Institute of Bioethics, Baltimore, MD 21205, USA;
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Lensink MA, Boers SN, M Gulmans VA, Jongsma KR, Bredenoord AL. Mini-gut feelings: perspectives of people with cystic fibrosis on the ethics and governance of organoid biobanking. Per Med 2021; 18:241-254. [PMID: 33825546 DOI: 10.2217/pme-2020-0161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim: Organoid technology has enormous potential for precision medicine, such as has recently been demonstrated in the field of cystic fibrosis. However, storage and use of organoids has been associated with ethical challenges and there is currently a lack of harmony in regulation and guidelines to govern the rapid emergence of 'organoid medicine'. Developing sound governance demands incorporation of the perspectives of patients as key stakeholders. Materials & methods: We conducted 17 semi-structured interviews with people with cystic fibrosis to explore their perspectives on the ethics and governance of organoid biobanking. Results: We identified three themes: prioritization of research and trust, ambivalent views on commercial involvement and transparency and control. Conclusion: Our study offers important insights for ethically robust governance of 'organoid medicine'.
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Affiliation(s)
- Michael A Lensink
- Julius Center for Health Sciences & Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Internal post Str. 6.131, P.O. Box 85500, GA Utrecht 3508, The Netherlands
| | - Sarah N Boers
- Julius Center for Health Sciences & Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Internal post Str. 6.131, P.O. Box 85500, GA Utrecht 3508, The Netherlands
| | - Vincent A M Gulmans
- Dutch Cystic Fibrosis Foundation (NCFS), Dr. A. Schweitzerweg 3A, MG Baarn 3744, The Netherlands
| | - Karin R Jongsma
- Julius Center for Health Sciences & Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Internal post Str. 6.131, P.O. Box 85500, GA Utrecht 3508, The Netherlands
| | - Annelien L Bredenoord
- Julius Center for Health Sciences & Primary Care, Department of Medical Humanities, University Medical Center Utrecht, Internal post Str. 6.131, P.O. Box 85500, GA Utrecht 3508, The Netherlands
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12
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Jacquier E, Laurent-Puig P, Badoual C, Burgun A, Mamzer MF. Facing new challenges to informed consent processes in the context of translational research: the case in CARPEM consortium. BMC Med Ethics 2021; 22:21. [PMID: 33653311 PMCID: PMC7927247 DOI: 10.1186/s12910-021-00592-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the context of translational research, researchers have increasingly been using biological samples and data in fundamental research phases. To explore informed consent practices, we conducted a retrospective study on informed consent documents that were used for CARPEM's translational research programs. This review focused on detailing their form, their informational content, and the adequacy of these documents with the international ethical principles and participants' rights. METHODS Informed consent forms (ICFs) were collected from CARPEM investigators. A content analysis focused on information related to biological samples and data treatment (context of sampling and collect, aims, reuse, consent renewal), including the type of consent. An automatic assessment of the readability of the ICFs were performed with the IT program "Flesch Score". RESULTS 29 ICFs from 25 of 49 studies were analyzed after selection criteria were applied. Three types of consent were identified: 11 broad consents, six specific consents, and two opt-out consents. The Flesch Scores showed that most of the documents were too complex to be fully understood by most of the potential research participants. Most of the biological samples were collected during the healthcare routine, but the information content about secondary use of biological samples varied between ICFs. All documents mentioned personal data treatment but information about their reuse was not standardized in the ICFs. CONCLUSIONS Our review of current IC procedures of CARPEM showed that practices could be improved considering new translational research methods. "Old fashion written ICFs" should be adapted to the translational research approach, to better respect individual rights and international research ethics principles. In this context, theoretically, a digital tool allowing dynamic information and consent of participants, through an electronic interactive platform may be a good way to promote more active participation in research. Nevertheless, its feasibility in the complex environment of biological samples and data research remains to prove. The way of a combination of a broad consent followed by dynamic information may be alternatively tested.
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Affiliation(s)
- Elise Jacquier
- Centre de Recherche Des Cordeliers (UMRS 1138), INSERM, Sorbonne Université, Université de Paris, Team ETREs, 75006 Paris, France
| | - Pierre Laurent-Puig
- Centre de Recherche Des Cordeliers (UMRS 1138), Team Personalized Medicine, INSERM, Sorbonne Université, Université de Paris, Pharmacogenomics and Therapeutic Optimization, 75006 Paris, France
- Pharmacogénétique Et Oncologie Moléculaire, Hôpital Européen Georges Pompidou, Assistance publique – Hôpitaux de Paris, Paris, France
| | - Cécile Badoual
- Centre de Ressources Biologiques, Service d’anatomo-pathologie, Hôpital Européen Georges Pompidou, Assistance publique – Hôpitaux de Paris, Paris, France
| | - Anita Burgun
- Département D’informatique Médicale, de Biostatistique Et de Santé Publique, Hôpital Européen Georges Pompidou, Assistance publique – Hôpitaux de Paris, Paris, France
- UMR-S 1138, Centre de Recherche Des Cordeliers, Paris, France
- Faculté de Médecine, Université Paris Descartes, Sorbonne Universités, Paris, France
| | - Marie-France Mamzer
- Centre de Recherche Des Cordeliers (UMRS 1138), INSERM, Sorbonne Université, Université de Paris, Team ETREs, 75006 Paris, France
- Unité Fonctionnelle D’éthique Et Médecine Légale, Hôpital Necker-Enfants Maladies, Paris, France
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Haas MA, Teare H, Prictor M, Ceregra G, Vidgen ME, Bunker D, Kaye J, Boughtwood T. 'CTRL': an online, Dynamic Consent and participant engagement platform working towards solving the complexities of consent in genomic research. Eur J Hum Genet 2021; 29:687-698. [PMID: 33408362 PMCID: PMC8115139 DOI: 10.1038/s41431-020-00782-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
The complexities of the informed consent process for participating in research in genomic medicine are well-documented. Inspired by the potential for Dynamic Consent to increase participant choice and autonomy in decision-making, as well as the opportunities for ongoing participant engagement it affords, we wanted to trial Dynamic Consent and to do so developed our own web-based application (web app) called CTRL (control). This paper documents the design and development of CTRL, for use in the Australian Genomics study: a health services research project building evidence to inform the integration of genomic medicine into mainstream healthcare. Australian Genomics brought together a multi-disciplinary team to develop CTRL. The design and development process considered user experience; security and privacy; the application of international standards in data sharing; IT, operational and ethical issues. The CTRL tool is now being offered to participants in the study, who can use CTRL to keep personal and contact details up to date; make consent choices (including indicate preferences for return of results and future research use of biological samples, genomic and health data); follow their progress through the study; complete surveys, contact the researchers and access study news and information. While there are remaining challenges to implementing Dynamic Consent in genomic research, this study demonstrates the feasibility of building such a tool, and its ongoing use will provide evidence about the value of Dynamic Consent in large-scale genomic research programs.
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Affiliation(s)
- Matilda A Haas
- Australian Genomics Health Alliance, Parkville, VIC, Australia. .,Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Harriet Teare
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK
| | - Megan Prictor
- Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | | | - Miranda E Vidgen
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - David Bunker
- Queensland Genomics Health Alliance, Herston, QLD, Australia
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, UK.,Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Carlton, VIC, Australia
| | - Tiffany Boughtwood
- Australian Genomics Health Alliance, Parkville, VIC, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
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14
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Reflections on dynamic consent in biomedical research: the story so far. Eur J Hum Genet 2020; 29:649-656. [PMID: 33249421 PMCID: PMC7695991 DOI: 10.1038/s41431-020-00771-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022] Open
Abstract
Dynamic consent (DC) was originally developed in response to challenges to the informed consent process presented by participants agreeing to ‘future research’ in biobanking. In the past 12 years, it has been trialled in a number of different projects, and examined as a new approach for consent and to support patient engagement over time. There have been significant societal shifts during this time, namely in our reliance on digital tools and the use of social media, as well as a greater appreciation of the integral role of patients in biomedical research. This paper reflects on the development of DC to understand its importance in an age where digital health is becoming the norm and patients require greater oversight and control of how their data may be used in a range of settings. As well as looking back, it looks forwards to consider how DC could be further utilised to enhance the patient experience and address some of the inequalities caused by the digital divide in society.
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15
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De Sutter E, Zaçe D, Boccia S, Di Pietro ML, Geerts D, Borry P, Huys I. Implementation of Electronic Informed Consent in Biomedical Research and Stakeholders' Perspectives: Systematic Review. J Med Internet Res 2020; 22:e19129. [PMID: 33030440 PMCID: PMC7582148 DOI: 10.2196/19129] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023] Open
Abstract
Background Informed consent is one of the key elements in biomedical research. The introduction of electronic informed consent can be a way to overcome many challenges related to paper-based informed consent; however, its novel opportunities remain largely unfulfilled due to several barriers. Objective We aimed to provide an overview of the ethical, legal, regulatory, and user interface perspectives of multiple stakeholder groups in order to assist responsible implementation of electronic informed consent in biomedical research. Methods We conducted a systematic literature search using Web of Science (Core collection), PubMed, EMBASE, ACM Digital Library, and PsycARTICLES. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for reporting this work. We included empirical full-text studies focusing on the concept of electronic informed consent in biomedical research covering the ethical, legal, regulatory, and user interface domains. Studies written in English and published from January 2010 onward were selected. We explored perspectives of different stakeholder groups, in particular researchers, research participants, health authorities, and ethics committees. We critically appraised literature included in the systematic review using the Newcastle-Ottawa scale for cohort and cross-sectional studies, Critical Appraisal Skills Programme for qualitative studies, Mixed Methods Appraisal Tool for mixed methods studies, and Jadad tool for randomized controlled trials. Results A total of 40 studies met our inclusion criteria. Overall, the studies were heterogeneous in the type of study design, population, intervention, research context, and the tools used. Most of the studies’ populations were research participants (ie, patients and healthy volunteers). The majority of studies addressed barriers to achieving adequate understanding when using electronic informed consent. Concerns shared by multiple stakeholder groups were related to the security and legal validity of an electronic informed consent platform and usability for specific groups of research participants. Conclusions Electronic informed consent has the potential to improve the informed consent process in biomedical research compared to the current paper-based consent. The ethical, legal, regulatory, and user interface perspectives outlined in this review might serve to enhance the future implementation of electronic informed consent. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020158979; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158979
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Affiliation(s)
- Evelien De Sutter
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Drieda Zaçe
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Maria Luisa Di Pietro
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy
| | - David Geerts
- Meaningful Interactions Lab, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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16
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Despotou G, Evans J, Nash W, Eavis A, Robbins T, Arvanitis TN. Evaluation of patient perception towards dynamic health data sharing using blockchain based digital consent with the Dovetail digital consent application: A cross sectional exploratory study. Digit Health 2020; 6:2055207620924949. [PMID: 32435503 PMCID: PMC7223864 DOI: 10.1177/2055207620924949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/16/2020] [Indexed: 11/29/2022] Open
Abstract
Background New patient-centric integrated care models are enabled by the capability to exchange the patient’s data amongst stakeholders, who each specialise in different aspects of the patient’s care. This requires a robust, trusted and flexible mechanism for patients to offer consent to share their data. Furthermore, new IT technologies make it easier to give patients more control over their data, including the right to revoke consent. These characteristics challenge the traditional paper-based, single-organisation-led consent process. The Dovetail digital consent application uses a mobile application and blockchain based infrastructure to offer this capability, as part of a pilot allowing patients to have their data shared amongst digital tools, empowering patients to manage their condition within an integrated care setting. Objective To evaluate patient perceptions towards existing consent processes, and the Dovetail blockchain based digital consent application as a means to manage data sharing in the context of diabetes care. Method Patients with diabetes at a General Practitioner practice were recruited. Data were collected using focus groups and questionnaires. Thematic analysis of the focus group transcripts and descriptive statistics of the questionnaires was performed. Results There was a lack of understanding of existing consent processes in place, and many patients did not have any recollection of having previously given consent. The digital consent application received favourable feedback, with patients recognising the value of the capability offered by the application. Patients overwhelmingly favoured the digital consent application over existing practice. Conclusions Digital consent was received favourably, with patients recognising that it addresses the main limitations of the current process. Feedback on potential improvements was received. Future work includes confirmation of results in a broader demographic sample and across multiple conditions.
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Affiliation(s)
- George Despotou
- Institute of Digital Healthcare, WMG, University of Warwick, UK
| | - Jill Evans
- Institute of Digital Healthcare, WMG, University of Warwick, UK
| | | | | | - Tim Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, UK
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17
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Prictor M, Huebner S, Teare HJA, Burchill L, Kaye J. Australian Aboriginal and Torres Strait Islander Collections of Genetic Heritage: The Legal, Ethical and Practical Considerations of a Dynamic Consent Approach to Decision Making. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:205-217. [PMID: 32342777 DOI: 10.1177/1073110520917012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dynamic Consent (DC) is both a model and a specific web-based tool that enables clear, granular communication and recording of participant consent choices over time. The DC model enables individuals to know and to decide how personal research information is being used and provides a way in which to exercise legal rights provided in privacy and data protection law. The DC tool is flexible and responsive, enabling legal and ethical requirements in research data sharing to be met and for online health information to be maintained. DC has been used in rare diseases and genomics, to enable people to control and express their preferences regarding their own data. However, DC has never been explored in relationship to historical collections of bioscientific and genetic heritage or to contexts involving Aboriginal and Torres Strait Islander people (First Peoples of Australia). In response to the growing interest by First Peoples throughout Australia in genetic and genomic research, and the increasing number of invitations from researchers to participate in community health and wellbeing projects, this article examines the legal and ethical attributes and challenges of DC in these contexts. It also explores opportunities for including First Peoples' cultural perspectives, governance, and leadership as a method for defining (or redefining) DC on cultural terms that engage best practice research and data analysis as well as respect for meaningful and longitudinal individual and family participation.
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Affiliation(s)
- Megan Prictor
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Sharon Huebner
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Harriet J A Teare
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Luke Burchill
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
| | - Jane Kaye
- Megan Prictor, Ph.D., is a Research Fellow in health, law and emerging technologies at Melbourne Law School, the University of Melbourne, Australia. Her interdisciplinary research focuses on informed consent approaches, electronic health records and data privacy. Sharon Huebner, Ph.D., is a Research Fellow at the University of Melbourne's Indigenous Studies Unit and an honorary Research Fellow at the Monash Indigenous Studies Centre, Monash University. She has worked with Aboriginal and Torres Strait Islander families for the past two decades protecting and preserving intergenerational rights to cultural heritage, including the digital return of material culture from archives, libraries and museums. Harriet J.A. Teare, D.Phil. (Chemistry), is a researcher in healthcare and policy, and Deputy Director of the Centre for Health, Law and Emerging Technologies (HeLEX), the University of Oxford. Over the past 6 years she has been developing dynamic consent approaches, working with different patient groups and organisations to learn directly from potential users about how such a tool could benefit their research experience. Luke Burchill, Ph.D., is an Associate Professor of Medicine at the University of Melbourne, where he leads the Aboriginal cardiovascular health disparities program. Clinically he works as an Adult Congenital Heart Disease Specialist at Royal Melbourne Hospital. Associate Professor Burchill is the first Aboriginal cardiologist in Australia. Jane Kaye, D.Phil., is the Director of the Centre for Health, Law, and Emerging Technologies (HeLEX) at the University of Oxford and has a part-time Professorship at the University of Melbourne, Australia, where she also leads the HeLEX@Melbourne research team. The focus of Professor Kaye's research is on governance with an emphasis on personalised medicine, biobanks, privacy, data-sharing frameworks, international governance and translational research
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18
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Prictor M, Lewis MA, Newson AJ, Haas M, Baba S, Kim H, Kokado M, Minari J, Molnár-Gábor F, Yamamoto B, Kaye J, Teare HJA. Dynamic Consent: An Evaluation and Reporting Framework. J Empir Res Hum Res Ethics 2019; 15:175-186. [DOI: 10.1177/1556264619887073] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Dynamic consent (DC) is an approach to consent that enables people, through an interactive digital interface, to make granular decisions about their ongoing participation. This approach has been explored within biomedical research, in fields such as biobanking and genomics, where ongoing contact is required with participants. It is posited that DC can enhance decisional autonomy and improve researcher–participant communication. Currently, there is a lack of evidence about the measurable effects of DC-based tools. This article outlines a framework for DC evaluation and reporting. The article draws upon the evidence for enhanced modes of informed consent for research as the basis for a logic model. It outlines how future evaluations of DC should be designed to maximize their quality, replicability, and relevance based on this framework. Finally, the article considers best-practice for reporting studies that assess DC, to enable future research and implementation to build upon the emerging evidence base.
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Affiliation(s)
- Megan Prictor
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
| | | | - Ainsley J. Newson
- Sydney Health Ethics, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matilda Haas
- Australian Genomics Health Alliance, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | | | - Hannah Kim
- Yonsei University, Seoul, Republic of Korea
| | | | - Jusaku Minari
- Uehiro Research Division for iPS Cell Ethics, CiRA, Kyoto University, Japan
| | | | | | - Jane Kaye
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
- University of Oxford, Oxford, United Kingdom
| | - Harriet J. A. Teare
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
- University of Oxford, Oxford, United Kingdom
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19
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Savatt J, Pisieczko CJ, Zhang Y, Lee MTM, Faucett WA, Williams JL. Biobanks in the Era of Genomic Data. CURRENT GENETIC MEDICINE REPORTS 2019. [DOI: 10.1007/s40142-019-00171-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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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.
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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
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21
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Whelan ME, Kingsnorth AP, Orme MW, Sherar LB, Esliger DW. Sensing interstitial glucose to nudge active lifestyles (SIGNAL): feasibility of combining novel self-monitoring technologies for persuasive behaviour change. BMJ Open 2017; 7:e018282. [PMID: 28993396 PMCID: PMC5640007 DOI: 10.1136/bmjopen-2017-018282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Increasing physical activity (PA) reduces the risk of developing diabetes, highlighting the role of preventive medicine approaches. Changing lifestyle behaviours is difficult and is often predicated on the assumption that individuals are willing to change their lifestyles today to reduce the risk of developing disease years or even decades later. The self-monitoring technologies tested in this study will present PA feedback in real time, parallel with acute physiological data. Presenting the immediate health benefits of being more physically active may help enact change by observing the immediate consequences of that behaviour. The present study aims to assess user engagement with the self-monitoring technologies in individuals at moderate-to-high risk of developing type 2 diabetes. METHODS AND ANALYSIS 45 individuals with a moderate-to-high risk, aged ≥40 years old and using a compatible smartphone, will be invited to take part in a 7-week protocol. Following 1 week of baseline measurements, participants will be randomised into one of three groups: group 1- glucose feedback followed by biobehavioural feedback (glucose plus PA); group 2-PA feedback followed by biobehavioural feedback; group 3-biobehavioural feedback. A PA monitor and a flash glucose monitor will be deployed during the intervention. Participants will wear both devices throughout the intervention but blinded to feedback depending on group allocation. The primary outcome is the level of participant engagement and will be assessed by device use and smartphone usage. Feasibility will be assessed by the practicality of the technology and screening for diabetes risk. Semistructured interviews will be conducted to explore participant experiences using the technologies. TRIAL REGISTRATION NUMBER ISRCTN17545949. Registered on 15/05/2017.
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Affiliation(s)
- Maxine E Whelan
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Andrew P Kingsnorth
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Mark W Orme
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, Glenfield Hospital, Leicester, Leicestershire, UK
| | - Lauren B Sherar
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
- NIHR Leicester Biomedical Research Centre-Lifestyle, Leicester, Leicestershire, UK
| | - Dale W Esliger
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, Leicestershire, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
- NIHR Leicester Biomedical Research Centre-Lifestyle, Leicester, Leicestershire, UK
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22
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Morrison M, Bell J, George C, Harmon S, Munsie M, Kaye J. The European General Data Protection Regulation: challenges and considerations for iPSC researchers and biobanks. Regen Med 2017; 12:693-703. [PMID: 28976812 PMCID: PMC5857917 DOI: 10.2217/rme-2017-0068] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/26/2017] [Indexed: 02/08/2023] Open
Abstract
Increasingly, human induced pluripotent stem cells (iPSC) and their associated genetic and clinical information are being used in a wide range of applications, with large biobanks being established to support and increase their scientific use. The new European General Data Protection Regulations, which comes into effect in 2018, will have implications for biobanks that generate, store and allow research access to iPSC. This paper describes some of the challenges that iPSC biobanks face and suggests some points for the development of appropriate governance structures to address these new requirements. These suggestions also have implications for iPSC research in general.
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Affiliation(s)
- Michael Morrison
- Nuffield Department of Population Health, HeLEX – Center for Health, Law & Emerging Technologies, University of Oxford, Ewert House, Ewert Place, Banbury Road, Oxford OX2 7DD, UK
| | - Jessica Bell
- Nuffield Department of Population Health, HeLEX – Center for Health, Law & Emerging Technologies, University of Oxford, Ewert House, Ewert Place, Banbury Road, Oxford OX2 7DD, UK
- Melbourne Law School, University of Melbourne, Parkville, VIC 3010, Australia
| | - Carol George
- School of Law, Kenyon Mason Institute for Medicine, Life Sciences & Law, University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YL, UK
| | - Shawn Harmon
- School of Law, Kenyon Mason Institute for Medicine, Life Sciences & Law, University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YL, UK
| | - Megan Munsie
- Department of Anatomy & Neuroscience, Stem Cells Center for Stem Cell Systems, University of Melbourne, Parkville, VIC 3010, Australia
| | - Jane Kaye
- Nuffield Department of Population Health, HeLEX – Center for Health, Law & Emerging Technologies, University of Oxford, Ewert House, Ewert Place, Banbury Road, Oxford OX2 7DD, UK
- Melbourne Law School, University of Melbourne, Parkville, VIC 3010, Australia
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23
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Budin-Ljøsne I, Teare HJA, Kaye J, Beck S, Bentzen HB, Caenazzo L, Collett C, D'Abramo F, Felzmann H, Finlay T, Javaid MK, Jones E, Katić V, Simpson A, Mascalzoni D. Dynamic Consent: a potential solution to some of the challenges of modern biomedical research. BMC Med Ethics 2017; 18:4. [PMID: 28122615 PMCID: PMC5264333 DOI: 10.1186/s12910-016-0162-9] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/26/2016] [Indexed: 01/04/2023] Open
Abstract
Background Innovations in technology have contributed to rapid changes in the way that modern biomedical research is carried out. Researchers are increasingly required to endorse adaptive and flexible approaches to accommodate these innovations and comply with ethical, legal and regulatory requirements. This paper explores how Dynamic Consent may provide solutions to address challenges encountered when researchers invite individuals to participate in research and follow them up over time in a continuously changing environment. Methods An interdisciplinary workshop jointly organised by the University of Oxford and the COST Action CHIP ME gathered clinicians, researchers, ethicists, lawyers, research participants and patient representatives to discuss experiences of using Dynamic Consent, and how such use may facilitate the conduct of specific research tasks. The data collected during the workshop were analysed using a content analysis approach. Results Dynamic Consent can provide practical, sustainable and future-proof solutions to challenges related to participant recruitment, the attainment of informed consent, participant retention and consent management, and may bring economic efficiencies. Conclusions Dynamic Consent offers opportunities for ongoing communication between researchers and research participants that can positively impact research. Dynamic Consent supports inter-sector, cross-border approaches and large scale data-sharing. Whilst it is relatively easy to set up and maintain, its implementation will require that researchers re-consider their relationship with research participants and adopt new procedures.
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Affiliation(s)
- Isabelle Budin-Ljøsne
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318, Oslo, Norway. .,Norwegian Cancer Genomics Consortium, cancergenomics.no, Oslo, Norway.
| | - Harriet J A Teare
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Stephan Beck
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Heidi Beate Bentzen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318, Oslo, Norway.,Norwegian Cancer Genomics Consortium, cancergenomics.no, Oslo, Norway.,Norwegian Research Center for Computers and Law, Faculty of Law, University of Oslo, Oslo, Norway
| | | | | | | | - Heike Felzmann
- Centre of Bioethical Research & Analysis, NUI Galway, Galway, Ireland
| | - Teresa Finlay
- Centre for Health, Law and Emerging Technologies (HeLEX), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Muhammad Kassim Javaid
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Erica Jones
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Višnja Katić
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Deborah Mascalzoni
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.,Centre for Biomedicine, EURAC, Bolzano, Italy
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24
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Coathup V, Teare HJA, Minari J, Yoshizawa G, Kaye J, Takahashi MP, Kato K. Using digital technologies to engage with medical research: views of myotonic dystrophy patients in Japan. BMC Med Ethics 2016; 17:51. [PMID: 27553007 PMCID: PMC4995774 DOI: 10.1186/s12910-016-0132-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 08/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background As in other countries, the traditional doctor-patient relationship in the Japanese healthcare system has often been characterised as being of a paternalistic nature. However, in recent years there has been a gradual shift towards a more participatory-patient model in Japan. With advances in technology, the possibility to use digital technologies to improve patient interactions is growing and is in line with changing attitudes in the medical profession and society within Japan and elsewhere. The implementation of an online patient engagement platform is being considered by the Myotonic Dystrophy Registry of Japan. The aim of this exploratory study was to understand patients’ views and attitudes to using digital tools in patient registries and engagement with medical research in Japan, prior to implementation of the digital platform. Methods We conducted an exploratory, cross-sectional, self-completed questionnaire with a sample of myotonic dystrophy (MD) patients attending an Open Day at Osaka University, Japan. Patients were eligible for inclusion if they were 18 years or older, and were diagnosed with MD. Results A total of 68 patients and family members attended the Open Day and were invited to participate in the survey. Of those, 59 % submitted a completed questionnaire (n = 40). The survey showed that the majority of patients felt that they were not receiving the information they wanted from their clinicians, which included recent medical research findings and opportunities to participate in clinical trials, and 88 % of patients indicated they would be willing to engage with digital technologies to receive relevant medical information. Patients also expressed an interest in having control over when and how they received this information, as well as being informed of how their data is used and shared with other researchers. Conclusion Overall, the findings from this study suggest that there is scope to develop a digital platform to engage with patients so that they can receive information about medical care and research opportunities. While this study group is a small, self-selecting population, who suffer from a particular condition, the results suggest that there are interested populations within Japan that would appreciate enhanced communication and interaction with healthcare teams. Electronic supplementary material The online version of this article (doi:10.1186/s12910-016-0132-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria Coathup
- Centre for Health, Law and Emerging Technology, Nuffield Department of Population Health, University of Oxford, Ewert House, Banbury Road, Oxford, OX2 7DD, UK
| | - Harriet J A Teare
- Centre for Health, Law and Emerging Technology, Nuffield Department of Population Health, University of Oxford, Ewert House, Banbury Road, Oxford, OX2 7DD, UK
| | - Jusaku Minari
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Go Yoshizawa
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Jane Kaye
- Centre for Health, Law and Emerging Technology, Nuffield Department of Population Health, University of Oxford, Ewert House, Banbury Road, Oxford, OX2 7DD, UK
| | - Masanori P Takahashi
- Department of Neurology and Functional Diagnostics Graduate School of Medicine, Osaka University, D-4, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan.
| | - Kazuto Kato
- Department of Biomedical Ethics and Public Policy, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan.
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25
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Cato KD, Bockting W, Larson E. Did I Tell You That? Ethical Issues Related to Using Computational Methods to Discover Non-Disclosed Patient Characteristics. J Empir Res Hum Res Ethics 2016; 11:214-9. [PMID: 27534587 PMCID: PMC4991620 DOI: 10.1177/1556264616661611] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Widespread availability of electronic health records coupled with sophisticated statistical methods offer great potential for a variety of applications for health and disease surveillance, developing predictive models and advancing decision support for clinicians. However, use of "big data" mining and discovery techniques has also raised ethical issues such as how to balance privacy and autonomy with the wider public benefits of data sharing. Furthermore, electronic data are being increasingly used to identify individual characteristics, which can be useful for clinical prediction and management, but were not previously disclosed to a clinician. This process in computer parlance is called electronic phenotyping, and has a number of ethical implications. Using the Belmont Report's principles of respect for persons, beneficence, and justice as a framework, we examined the ethical issues posed by electronic phenotyping. Ethical issues identified include the ability of the patient to consent for the use of their information, the ability to suppress pediatric information, ensuring that the potential benefits justify the risks of harm to patients, and acknowledging that the clinician's biases or stereotypes, conscious or unintended, may become a factor in the therapeutic interaction. We illustrate these issues with two vignettes, using the person characteristic of gender minority status (i.e., transgender identity) and health history characteristic of substance abuse. Data mining has the potential to uncover patient characteristics previously obscured, which can provide clinicians with beneficial clinical information. Hence, ethical guidelines must be updated to ensure that electronic phenotyping supports the principles of respect for persons, beneficence, and justice.
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Affiliation(s)
| | - Walter Bockting
- School of Nursing, Columbia University, New York, NY
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elaine Larson
- School of Nursing, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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26
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Woolley JP, McGowan ML, Teare HJA, Coathup V, Fishman JR, Settersten RA, Sterckx S, Kaye J, Juengst ET. Citizen science or scientific citizenship? Disentangling the uses of public engagement rhetoric in national research initiatives. BMC Med Ethics 2016; 17:33. [PMID: 27260081 PMCID: PMC4893207 DOI: 10.1186/s12910-016-0117-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/23/2016] [Indexed: 02/01/2023] Open
Abstract
Background The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. Originally, these labels were invoked by volunteer research efforts propelled by amateurs outside of traditional research institutions and aimed at appealing to those looking for more “democratic,” “patient-centric,” or “lay” alternatives to the professional science establishment. As mainstream translational biomedical research requires increasingly larger participant pools, however, corporate, academic and governmental research programs are embracing this populist rhetoric to encourage wider public participation. Discussion We examine the ethical and social implications of this recruitment strategy. We begin by surveying examples of “citizen science” outside of biomedicine, as paradigmatic of the aspirations this democratizing rhetoric was originally meant to embody. Next, we discuss the ways these aspirations become articulated in the biomedical context, with a view to drawing out the multiple and potentially conflicting meanings of “public engagement” when citizens are also the subjects of the science. We then illustrate two uses of public engagement rhetoric to gain public support for national biomedical research efforts: its post-hoc use in the “care.data” project of the National Health Service in England, and its proactive uses in the “Precision Medicine Initiative” of the United States White House. These examples will serve as the basis for a normative analysis, discussing the potential ethical and social ramifications of this rhetoric. Summary We pay particular attention to the implications of government strategies that cultivate the idea that members of the public have a civic duty to participate in government-sponsored research initiatives. We argue that such initiatives should draw from policy frameworks that support normative analysis of the role of citizenry. And, we conclude it is imperative to make visible and clear the full spectrum of meanings of “citizen science,” the contexts in which it is used, and its demands with respect to participation, engagement, and governance.
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Affiliation(s)
- J Patrick Woolley
- University of Oxford, Harris Manchester College, Mansfield Road, Oxford, OX1 3TD, UK
| | - Michelle L McGowan
- The Pennsylvania State University, 128B Willard Building, University Park, PA, 16802, USA
| | - Harriet J A Teare
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Ewert House, Ewert Place, Banbury Road, Oxford, OX2 7DD, UK
| | - Victoria Coathup
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Ewert House, Ewert Place, Banbury Road, Oxford, OX2 7DD, UK
| | - Jennifer R Fishman
- McGill University, Social Studies of Medicine, 3647 Peel, Room 207, Montreal, Quebec, H3A 1X1, Canada
| | - Richard A Settersten
- School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, Oregon, 123 Women's Building, Corvallis, OR, 97331-8577, USA
| | - Sigrid Sterckx
- Department of Philosophy & Moral Sciences Ghent University, Blandijnberg 2, 9000, Gent, Belgium
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Ewert House, Ewert Place, Banbury Road, Oxford, OX2 7DD, UK.
| | - Eric T Juengst
- 333 MacNider Hall, Campus Box 7240, University of North Carolina, Chapel Hill, 333S. Columbia Road, Chapel Hill, NC, 27599-7240, USA
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Spencer K, Sanders C, Whitley EA, Lund D, Kaye J, Dixon WG. Patient Perspectives on Sharing Anonymized Personal Health Data Using a Digital System for Dynamic Consent and Research Feedback: A Qualitative Study. J Med Internet Res 2016; 18:e66. [PMID: 27083521 PMCID: PMC4851723 DOI: 10.2196/jmir.5011] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Electronic health records are widely acknowledged to provide an important opportunity to anonymize patient-level health care data and collate across populations to support research. Nonetheless, in the wake of public and policy concerns about security and inappropriate use of data, conventional approaches toward data governance may no longer be sufficient to respect and protect individual privacy. One proposed solution to improve transparency and public trust is known as Dynamic Consent, which uses information technology to facilitate a more explicit and accessible opportunity to opt out. In this case, patients can tailor preferences about whom they share their data with and can change their preferences reliably at any time. Furthermore, electronic systems provide opportunities for informing patients about data recipients and the results of research to which their data have contributed. OBJECTIVE To explore patient perspectives on the use of anonymized health care data for research purposes. To evaluate patient perceptions of a Dynamic Consent model and electronic system to enable and implement ongoing communication and collaboration between patients and researchers. METHODS A total of 26 qualitative interviews and three focus groups were conducted that included a video presentation explaining the reuse of anonymized electronic patient records for research. Slides and tablet devices were used to introduce the Dynamic Consent system for discussion. A total of 35 patients with chronic rheumatic disease with varying levels of illness and social deprivation were recruited from a rheumatology outpatient clinic; 5 participants were recruited from a patient and public involvement health research network. RESULTS Patients were supportive of sharing their anonymized electronic patient record for research, but noted a lack of transparency and awareness around the use of data, making it difficult to secure public trust. While there were general concerns about detrimental consequences of data falling into the wrong hands, such as insurance companies, 39 out of 40 (98%) participants generally considered that the altruistic benefits of sharing health care data outweighed the risks. Views were mostly positive about the use of an electronic interface to enable greater control over consent choices, although some patients were happy to share their data without further engagement. Participants were particularly enthusiastic about the system as a means of enabling feedback regarding data recipients and associated research results, noting that this would improve trust and public engagement in research. This underlines the importance of patient and public involvement and engagement throughout the research process, including the reuse of anonymized health care data for research. More than half of patients found the touch screen interface easy to use, although a significant minority, especially those with limited access to technology, expressed some trepidation and felt they may need support to use the system. CONCLUSIONS Patients from a range of socioeconomic backgrounds viewed a digital system for Dynamic Consent positively, in particular, feedback about data recipients and research results. Implementation of a digital Dynamic Consent system would require careful interface design and would need to be located within a robust data infrastructure; it has the potential to improve trust and engagement in electronic medical record research.
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Affiliation(s)
- Karen Spencer
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom
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28
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Budin-Ljøsne I, Bentzen HB, Solbakk JH, Myklebost O. Genome sequencing in research requires a new approach to consent. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:2031-2. [PMID: 26627287 DOI: 10.4045/tidsskr.15.0944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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