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Roberts MC, Holt KE, Del Fiol G, Baccarelli AA, Allen CG. Precision public health in the era of genomics and big data. Nat Med 2024; 30:1865-1873. [PMID: 38992127 DOI: 10.1038/s41591-024-03098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024]
Abstract
Precision public health (PPH) considers the interplay between genetics, lifestyle and the environment to improve disease prevention, diagnosis and treatment on a population level-thereby delivering the right interventions to the right populations at the right time. In this Review, we explore the concept of PPH as the next generation of public health. We discuss the historical context of using individual-level data in public health interventions and examine recent advancements in how data from human and pathogen genomics and social, behavioral and environmental research, as well as artificial intelligence, have transformed public health. Real-world examples of PPH are discussed, emphasizing how these approaches are becoming a mainstay in public health, as well as outstanding challenges in their development, implementation and sustainability. Data sciences, ethical, legal and social implications research, capacity building, equity research and implementation science will have a crucial role in realizing the potential for 'precision' to enhance traditional public health approaches.
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Affiliation(s)
- Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
| | - Kathryn E Holt
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Guilherme Del Fiol
- Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andrea A Baccarelli
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Caitlin G Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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2
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Walshe J, Elphinstone B, Nicol D, Taylor M. A systematic literature review of the 'commercialisation effect' on public attitudes towards biobank and genomic data repositories. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2024; 33:548-567. [PMID: 38389329 DOI: 10.1177/09636625241230864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Initiatives that collect and share genomic data to advance health research are widespread and accelerating. Commercial interests in these efforts, while vital, may erode public trust and willingness to provide personal genomic data, upon which these initiatives depend. Understanding public attitudes towards providing genomic data for health research in the context of commercial involvement is critical. A PRISMA-guided search of six online academic databases identified 113 quantitative and qualitative studies using primary data pertaining to public attitudes towards commercial actors in the management, collection, access, and use of biobank and genomic data. The presence of commercial interests yields interrelated public concerns around consent, privacy and data security, trust in science and scientists, benefit sharing, and the ownership and control of health data. Carefully considered regulatory and data governance and access policies are therefore required to maintain public trust and support for genomic health initiatives.
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3
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Tai K, Zhao R, Rameau A. Patient-Centered Equitable and Safe Artificial Intelligence in Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2024. [PMID: 38943446 DOI: 10.1002/ohn.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 07/01/2024]
Affiliation(s)
- Katherine Tai
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice at Weill Cornell Medicine, New York City, New York, USA
| | - Robin Zhao
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice at Weill Cornell Medicine, New York City, New York, USA
| | - Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice at Weill Cornell Medicine, New York City, New York, USA
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Dortenzio V, Rhodes R, Merkelson A, Naik H. Research biobank participants attitudes towards genetic exceptionalism and health record confidentiality. J Community Genet 2024; 15:267-280. [PMID: 38441842 PMCID: PMC11217258 DOI: 10.1007/s12687-024-00704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 07/02/2024] Open
Abstract
Understanding attitudes towards genetic exceptionalism and confidentiality is important in guiding policies regarding special protections for genetic/genomic information stored in electronic health records (EHR). The goals of this study were to determine biobank participants' attitudes towards genetic exceptionalism and confidentiality and whether those attitudes are related to their preference for return of genetic results. An online questionnaire was distributed to patients with an EHR and email address who had previously enrolled in the BioMe Biobank program. Most participants responded with similar levels of concern in scenarios involving the use of genetic information and other types of health information, suggesting that participants want similar protections for genetic data as other types of sensitive health information, particularly mental health and family history records. Of the 829 respondents, the majority had genetic exceptionalist views when directly asked, even though their concerns about confidentiality were similar for their genetic information and other health information. There were no differences in genetic exceptionalist views between those who had a documented preference to have genetic results returned and those who did not. Notably, for many participants, their recall of preference did not align with their documented preference. The majority of biobank participants were most anxious about the loss of confidentiality for genetic, mental health, and family history information, indicating that certain types of health information are considered more "sensitive" than others. These findings suggest the importance of assuring people participating in biobank research that the confidentiality of their "sensitive" health information is secured.
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Affiliation(s)
- Victoria Dortenzio
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rosamond Rhodes
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amanda Merkelson
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hetanshi Naik
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetics, Stanford University School of Medicine, 483 Quarry Road, 450E, Stanford, CA, 94304, USA.
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Thomas M, Mackes N, Preuss-Dodhy A, Wieland T, Bundschus M. Assessing Privacy Vulnerabilities in Genetic Data Sets: Scoping Review. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2024; 5:e54332. [PMID: 38935957 PMCID: PMC11165293 DOI: 10.2196/54332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Genetic data are widely considered inherently identifiable. However, genetic data sets come in many shapes and sizes, and the feasibility of privacy attacks depends on their specific content. Assessing the reidentification risk of genetic data is complex, yet there is a lack of guidelines or recommendations that support data processors in performing such an evaluation. OBJECTIVE This study aims to gain a comprehensive understanding of the privacy vulnerabilities of genetic data and create a summary that can guide data processors in assessing the privacy risk of genetic data sets. METHODS We conducted a 2-step search, in which we first identified 21 reviews published between 2017 and 2023 on the topic of genomic privacy and then analyzed all references cited in the reviews (n=1645) to identify 42 unique original research studies that demonstrate a privacy attack on genetic data. We then evaluated the type and components of genetic data exploited for these attacks as well as the effort and resources needed for their implementation and their probability of success. RESULTS From our literature review, we derived 9 nonmutually exclusive features of genetic data that are both inherent to any genetic data set and informative about privacy risk: biological modality, experimental assay, data format or level of processing, germline versus somatic variation content, content of single nucleotide polymorphisms, short tandem repeats, aggregated sample measures, structural variants, and rare single nucleotide variants. CONCLUSIONS On the basis of our literature review, the evaluation of these 9 features covers the great majority of privacy-critical aspects of genetic data and thus provides a foundation and guidance for assessing genetic data risk.
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Dahlquist J, Robinson JO, Daoud A, Bash-Brooks W, McGuire AL, Guerrini CJ, Fullerton SM. Public Perspectives on Investigative Genetic Genealogy: Findings from a National Focus Group Study. AJOB Empir Bioeth 2024:1-11. [PMID: 38588389 DOI: 10.1080/23294515.2024.2336904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Investigative genetic genealogy (IGG) is a technique that involves uploading genotypes developed from perpetrator DNA left at a crime scene, or DNA from unidentified remains, to public genetic genealogy databases to identify genetic relatives and, through the creation of a family tree, the individual who was the source of the DNA. As policymakers demonstrate interest in regulating IGG, it is important to understand public perspectives on IGG to determine whether proposed policies are aligned with public attitudes. METHODS We conducted eight focus groups with members of the public (N = 72), sampled from four geographically diverse US regions, to explore general attitudes and perspectives regarding aspects of IGG practices, applications, and policies. Five major topics were explored in each focus group: when IGG should be used; who should perform IGG; how to approach consent for genetic database users; what systems of oversight should govern IGG practitioners; and whether to notify database users if their data are involved in law enforcement (LE) matching. RESULTS Participants were supportive of IGG in most scenarios, especially for cold and violent cases. The favorable attitudes toward IGG were, however, tempered by distrust of law enforcement among some participants. All participants agreed that databases must inform users if IGG is allowed, but they did not agree on how individual database users should be allowed to opt out or whether to notify them if their data are involved in specific investigations. All participants agreed that IGG should be subject to some prescriptive guidelines, regulations, or accountability mechanisms. CONCLUSIONS These findings suggest broad public support for IGG, and interest in developing systems of accountability for its practice. Our study provides useful insight for policy makers, genomic database stewards, law enforcement, and other stakeholders in IGG's practice, and suggests multiple directions for future research.
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Affiliation(s)
- Jacklyn Dahlquist
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jill O Robinson
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, USA
| | - Amira Daoud
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, USA
| | - Whitney Bash-Brooks
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, USA
| | - Amy L McGuire
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, USA
| | - Christi J Guerrini
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, USA
| | - Stephanie M Fullerton
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA
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Callahan KP, Clayton EW, Lemke AA, Chaudhari BP, Wenger TL, Lyle ANJ, Brothers KB. Ethical and Legal Issues Surrounding Genetic Testing in the NICU. Neoreviews 2024; 25:e127-e138. [PMID: 38425196 PMCID: PMC10998684 DOI: 10.1542/neo.25-3-e127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Clinicians practicing in a modern NICU are noticing an increase in the proportion of patients who undergo genetic testing as well as changes in the types of genetic testing patients receive. These trends are not surprising given the increasing recognition of the genetic causes of neonatal illness and recent advances in genetic technology. Yet, the expansion of genetic testing in the NICU also raises a number of ethical questions. In this article, we will review the ethical issues raised by genetic testing, with a focus on the practical implications for neonatologists. First, we outline the complexities of measuring benefit, or utility, for neonatal genetic testing. Next, we discuss potential harms such as inequity, unexpected findings, disability biases, and legal risks. Finally, we conclude with a discussion of ethical issues related to consent for genetic testing. Throughout this article, we highlight solutions to challenges toward the ultimate goal of minimizing harms and maximizing the substantial potential benefits of genetic medicine in the NICU.
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Affiliation(s)
- Katharine P. Callahan
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania; Philadelphia, Pennsylvania
| | - Ellen W. Clayton
- Center for Biomedical Ethics and Society, Department of Pediatrics, Vanderbilt University Medical Center, and School of Law, Vanderbilt University, Nashville, Tennessee
| | - Amy A. Lemke
- Norton Children’s Research Institute Affiliated with the University of Louisville School of Medicine, Louisville, Kentucky
| | - Bimal P. Chaudhari
- Divisions of Neonatology, Genetics and Genomic Medicine, Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Tara L. Wenger
- Division of Medical Genetics, University of Washington, Seattle, Washington
| | - Allison N. J. Lyle
- Division of Neonatology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Kyle B. Brothers
- Norton Children’s Research Institute Affiliated with the University of Louisville School of Medicine, Louisville, Kentucky
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Aspell N, Goldsteen A, Renwick R. Dicing with data: the risks, benefits, tensions and tech of health data in the iToBoS project. Front Digit Health 2024; 6:1272709. [PMID: 38357640 PMCID: PMC10864635 DOI: 10.3389/fdgth.2024.1272709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
This paper will discuss the European funded iToBoS project, tasked by the European Commission to develop an AI diagnostic platform for the early detection of skin melanoma. The paper will outline the project, provide an overview of the data being processed, describe the impact assessment processes, and explain the AI privacy risk mitigation methods being deployed. Following this, the paper will offer a brief discussion of some of the more complex aspects: (1) the relatively low population clinical trial study cohort, which poses risks associated with data distinguishability and the masking ability of the applied anonymisation tools, (2) the project's ability to obtain informed consent from the study cohort given the complexity of the technologies, (3) the project's commitment to an open research data strategy and the additional privacy risk mitigations required to protect the multi-modal study data, and (4) the ability of the project to adequately explain the outputs of the algorithmic components to a broad range of stakeholders. The paper will discuss how the complexities have caused tension which are reflective of wider tensions in the health domain. A project level solution includes collaboration with a melanoma patient network, as an avenue for fair and representative qualification of risks and benefits with the patient stakeholder group. However, it is unclear how scalable this process is given the relentless pursuit of innovation within the health domain, accentuated by the continued proliferation of artificial intelligence, open data strategies, and the integration of multi-modal data sets inclusive of genomics.
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Affiliation(s)
- Niamh Aspell
- Innovation & Research, Trilateral Research Ltd., Waterford, Ireland
| | | | - Robin Renwick
- Innovation & Research, Trilateral Research Ltd., Waterford, Ireland
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Lorenzo D, Esquerda M, Bofarull M, Cusi V, Roig H, Bertran J, Carrera J, Torralba F, Cambra FJ, Vila M, Garriga M, Palau F. The reuse of genetic information in research and informed consent. Eur J Hum Genet 2023; 31:1393-1397. [PMID: 37699995 PMCID: PMC10689789 DOI: 10.1038/s41431-023-01457-y] [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: 12/05/2022] [Revised: 05/28/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Important advances in genetics research have been made in recent years. Such advances have facilitated the availability of huge amounts of genetic information that could potentially be reused beyond the original purpose for which such information was obtained. Any such reuse must meet certain ethical criteria to ensure that the dignity, integrity, and autonomy of the individual from whom that information was obtained are protected. The aim of this paper is to reflect on these criteria through a critical analysis of the literature. To guarantee these values, ethical criteria need to be established in several respects. For instance, the question must be posed whether the information requires special attention and protection (so-called genetic exceptionalism). Another aspect to bear in mind is the most appropriate type of consent to be given by the person involved, on the one hand favouring research and the reuse of genetic information while on the other protecting the autonomy of that person. Finally, there is a need to determine what protection such reuse should have in order to avoid detrimental consequences and protect the rights of the individual. The main conclusions are that genetic information requires special care and protection (genetic exceptionalism) and that broad consent is the most practical and trustworthy type of consent for the reuse of genetic information.
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Affiliation(s)
- David Lorenzo
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
- EUI San Joan de Deu, Barcelona, Spain
| | - Montse Esquerda
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain.
- Sant Joan de Deu Terres de Lleida, Lleida, Spain.
| | | | - Victoria Cusi
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Helena Roig
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Joan Bertran
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Joan Carrera
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francesc Torralba
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francisco José Cambra
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
- Hospital Universitari Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Martí Vila
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Martina Garriga
- Institut Borja de Bioetica, Universitat Ramon Llull, Barcelona, Spain
| | - Francesc Palau
- Department of Genetic Medicine and Pediatric Institut of Rare Diseases, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER de Enfermedades Raras, ISCIII, Madrid, Spain
- Division of Pediatrics, University of Barcelona School of Medicine and Health Sciences, Barcelona, Spain
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10
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Sánchez MC, Hernández Clemente JC, García López FJ. Public and Patients' Perspectives Towards Data and Sample Sharing for Research: An Overview of Empirical Findings. J Empir Res Hum Res Ethics 2023; 18:319-345. [PMID: 37936410 DOI: 10.1177/15562646231212644] [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] [Indexed: 11/09/2023]
Abstract
We aimed to review the attitudes and perspectives of the public and patients towards the sharing of data and biospecimens for research and to identify common dimensions, regardless of setting. Our review included systematic, scoping or thematic reviews of empirical studies retrieved from Medline (PubMed interface), Web of Science, Scopus, ProQuest and Cochrane Reviews. The main themes identified and synthesised across the 14 reviews were readiness and motivations; potential risks and safeguards; trust, transparency and accountability; autonomy and preferred type of consent; and factors influencing data and biospecimen sharing and consent. Sociodemographic factors and research and individual context remain relevant influencing factors in all settings, while preferences for types of consent are highly heterogeneous. Trusted environments and adapted consent options with participant engagement are relevant to improve research participation.
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Zee TW, Abdul Aziz MFB, Wei PC. Ethical challenges of conducting and reviewing human genomics research in Malaysia: An exploratory study. Dev World Bioeth 2023:10.1111/dewb.12435. [PMID: 37997006 PMCID: PMC11111594 DOI: 10.1111/dewb.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023]
Abstract
Even though there is a significant amount of scholarly work examining the ethical issues surrounding human genomics research, little is known about its footing in Malaysia. This study aims to explore the experience of local researchers and research ethics committee (REC) members in developing it in Malaysia. In-depth interviews were conducted from April to May 2021, and the data were thematically analysed. In advancing this technology, both genomics researchers and REC members have concerns over how this research is being developed in the country especially the absence of a clear ethical and regulatory framework at the national level as a guidance. However, this study argues that it is not a salient issue as there are international guidelines in existence and both researchers and RECs will benefit from a training on the guidelines to ensure genomics research can be developed in an ethical manner.
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Aboujaoude E, Light J, Brown JE, Boscardin WJ, Hallgrímsson B, Klein OD. Privacy, bias and the clinical use of facial recognition technology: A survey of genetics professionals. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2023; 193:e32035. [PMID: 36751120 PMCID: PMC10578447 DOI: 10.1002/ajmg.c.32035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
Facial recognition technology (FRT) has been adopted as a precision medicine tool. The medical genetics field highlights both the clinical potential and privacy risks of this technology, putting the discipline at the forefront of a new digital privacy debate. Investigating how geneticists perceive the privacy concerns surrounding FRT can help shape the evolution and regulation of the field, and provide lessons for medicine and research more broadly. Five hundred and sixty-two genetics clinicians and researchers were approached to fill out a survey, 105 responded, and 80% of these completed. The survey consisted of 48 questions covering demographics, relationship to new technologies, views on privacy, views on FRT, and views on regulation. Genetics professionals generally placed a high value on privacy, although specific views differed, were context-specific, and covaried with demographic factors. Most respondents (88%) agreed that privacy is a basic human right, but only 37% placed greater weight on it than other values such as freedom of speech. Most respondents (80%) supported FRT use in genetics, but not necessarily for broader clinical use. A sizeable percentage (39%) were unaware of FRT's lower accuracy rates in marginalized communities and of the mental health effects of privacy violations (62%), but most (76% and 75%, respectively) expressed concern when informed. Overall, women and those who self-identified as politically progressive were more concerned about the lower accuracy rates in marginalized groups (88% vs. 64% and 83% vs. 63%, respectively). Younger geneticists were more wary than older geneticists about using FRT in genetics (28% compared to 56% "strongly" supported such use). There was an overall preference for more regulation, but respondents had low confidence in governments' or technology companies' ability to accomplish this. Privacy views are nuanced and context-dependent. Support for privacy was high but not absolute, and clear deficits existed in awareness of crucial FRT-related discrimination potential and mental health impacts. Education and professional guidelines may help to evolve views and practices within the field.
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Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Janice Light
- Department of Orofacial Sciences and Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA, USA
| | - Julia E.H. Brown
- Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA
| | - W. John Boscardin
- Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Benedikt Hallgrímsson
- Departments of Cell Biology & Anatomy, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, CANADA
| | - Ophir D. Klein
- Department of Orofacial Sciences and Program in Craniofacial Biology, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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13
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Briscoe F, Ajunwa I, Bourgoin A, Maxwell J. Racial Differences in Perceptions of Genetic Wellness Programs. Am J Health Promot 2023; 37:940-952. [PMID: 37439004 PMCID: PMC10469479 DOI: 10.1177/08901171231184360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE Genetic wellness programs (GWPs) are a highly innovative workforce wellness product. Recently marketed to U.S. employers by at least 16 vendors, GWPs take advantage of low-cost DNA sequencing to detect genetic risk factors for an increasing array of diseases. The purpose of this research is to understand perceptions, concerns, and barriers related to GWPs, among employees from Black, White, and Asian backgrounds and different income levels. APPROACH Qualitative study with 3 focus groups (FGs). SETTING Employees of large high-technology companies (deemed likely early GWP adopters). RESPONDENTS 21 individuals recruited online through User Interviews. METHOD FG guide developed via literature review and landscape analysis, and pre-tested. FGs led by a trained moderator and audio-recorded. Transcripts content analyzed for key themes. RESULTS Nearly all respondents saw potential benefits to GWP participation for themselves or their families. However, there were profound differences in perceptions of risks to GWP participation between Black and White/Asian respondents. These differences surfaced in three broad areas: privacy and discrimination risks; family impact risks; and feelings about the employer. Willingness to participate in a GWP also varied between Black employee respondents and White and Asian employee respondents (including low-income White employees). Only 27% of Black employees would participate in GWP, compared to 90% of the other employees. CONCLUSION Most employees appear likely to support employer adoption of GWPs. However, Black employees report significant concerns regarding participation. Addressing these concerns through program design would benefit all employees, and could increase trust and uptake of GWPs.
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Affiliation(s)
- Forrest Briscoe
- Smeal College of Business, The Pennsylvania State University, University Park, PA, USA
| | - Ifeoma Ajunwa
- University of North Carolina School of Law, Chapel Hill, NC, USA
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14
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Esmonde K, Roth SM, Walker A. A Social and Ethical Framework for Providing Health Information Obtained from Combining Genetics and Fitness Tracking Data. TECHNOLOGY IN SOCIETY 2023; 74:102297. [PMID: 37521714 PMCID: PMC10373508 DOI: 10.1016/j.techsoc.2023.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
In this paper we explore a new technological intersection in the "big data revolution": the integration of two forms of data, genetic data and fitness tracking data. For example, a small number of direct-to-consumer (DTC) genetic testing companies have recently begun offering customers the ability to link their fitness tracking data with their genetic profile to get personalized diet and exercise recommendations. In this paper we put forward four ethical considerations that should inform potential uses of this health information. Those considerations are: the heightened risks to privacy resulting from combining sensitive data sets; the poor quality of health information that is possible at present in the realm of precision DTC genomics; the limited usefulness of the recommendations; and finally, the cultural assumptions about health and personal responsibility that are embedded within fitness genetic testing and fitness tracking. To conclude, we offer some guidance on how the benefits and risks of returning this type of health information can be weighed.
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Affiliation(s)
- Katelyn Esmonde
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD, USA, 21205
| | - Stephen M Roth
- School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, USA, 20742
| | - Alexis Walker
- Department of Medical Humanities and Ethics, Columbia University, 630 West 168 Street, New York, NY, USA, 10032
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Deruelle T, Kalouguina V, Trein P, Wagner J. Is there a "pandemic effect" on individuals' willingness to take genetic tests? Eur J Hum Genet 2023; 31:360-362. [PMID: 36352012 PMCID: PMC9646467 DOI: 10.1038/s41431-022-01223-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
In this cross-sectional, semi-longitudinal and quasi-experimental study, our goal was to determine the effect of data storage conditions on willingness to take a genetic test. We compared individuals' preferences regarding how they want to store health data collected from genetic tests through two survey experiments fielded in Switzerland in March 2020 and January 2022. We tested for differences whether genetic data are presented as private goods or public goods. Results confirm our initial research expectation: more control over storage increases willingness, so does framing genetic data as private good. However, they also show that the willingness to take a genetic test has noticeably increased between 2020 and 2022. Our results point toward a "pandemic effect" which would have increased willingness take a genetic test, nevertheless, more data are needed to understand this putative effect.
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Affiliation(s)
| | | | | | - Joël Wagner
- University of Lausanne, Lausanne, Switzerland
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16
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Dron HA, Bucio D, Young JL, Tabor HK, Cho MK. Latinx attitudes, barriers, and experiences with genetic counseling and testing: A systematic review. J Genet Couns 2023; 32:166-181. [PMID: 36301246 PMCID: PMC10091969 DOI: 10.1002/jgc4.1632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/05/2022]
Abstract
As genetics is increasingly used across clinical settings, there is a need to understand the impact and experiences of diverse patients. This review systematically examined research literature on Latinx experiences with genetic counseling and genetic testing (GC/GT) in the United States, synthesizing key themes and knowledge gaps pertaining to both patient experience and hypothetical scenarios. Findings were based on a systematic search, inclusion, and thematic analysis of 81 empirical peer-reviewed articles published from January 1990 to July 2019 pertaining to Latinx populations and GC/GT. Studies most commonly addressed Latinas' perspectives on GC/GT in prenatal settings or for hereditary breast and ovarian cancer (HBOC). Costs, referrals, and communication were significant barriers to accessing genetic services for many Latinx patients, particularly those with low English proficiency (LEP). Studies highlighted difficulties accessing and communicating in healthcare settings, and how medical context and prior experience with healthcare workers and institutions influenced GC/GT decision-making. Providers' implicit biases about Latinx patients negatively impacted their care and impeded communication. Despite low awareness of cancer GT, Latinx patients often reported interest in learning more about GC/GT or unmet needs for GT discussion and provider involvement. This systematic review identified areas where providers can take action to improve Latinx experiences with GC/GT. Clinicians should elicit and respond to patient preferences about shared decision-making. For patients with low numeracy or LEP, providers should consider tailored educational and communication techniques. Most studies focused on HBOC and prenatal testing, and Latinx patients are heterogeneous, leaving many research questions about Latinx experience with GT/GC in other clinical areas.
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Affiliation(s)
- Heather A Dron
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,University of Michigan, Ann Arbor, Michigan, USA
| | - Daiana Bucio
- Providence St. Joseph Health, Burbank, California, USA
| | - Jennifer L Young
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,Center for Genetic Medicine, Northwestern University, Chicago, Illinois, USA
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,Departments of Medicine, and by courtesy, Epidemiology, Stanford University, Stanford, California, USA
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics (SCBE), Stanford University, Stanford, California, USA.,Department of Pediatrics, Stanford University, Stanford, California, USA
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17
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Kalouguina V, Wagner J. On the determinants and the role of the payers in the uptake of genetic testing and data sharing in personalized health. Front Public Health 2023; 11:920286. [PMID: 36935717 PMCID: PMC10017738 DOI: 10.3389/fpubh.2023.920286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background New health technologies and data offer tailored prevention and spot-on treatments, which can considerably reduce healthcare costs. In healthy individuals, insurers can participate in the creation of health capital through data and preventing the occurrence of a disease. In the onset of a disease, sequencing an individual's genome can provide information leading to the use of more efficient treatments. Both improvements are at the core of the "personalized health" paradigm. As a positive side effect, a reduction in healthcare costs is expected. However, the integration of personalized health in insurance schemes starts with a closer understanding of the demand drivers. Methods Using novel data from a survey carried out in Switzerland, we determine the factors influencing the uptake and sharing of data from genetic tests. In our regression analyses, we use five sets of socioeconomic, lifestyle, health insurance, sentiment, and political beliefs variables. Furthermore, two framings assess the willingness to undertake a test and the readiness to share results with an insurer when the costs of the test are borne by the insurer or the individual. Results We find that socioeconomic, lifestyle, or political belief variables have very little influence on the uptake of tests and the sharing of data. On the contrary, our results indicate that sentiment and insurance factors play a strong role. More precisely, if genetic tests are perceived as a mean to perform health prevention, this pushes individuals to take them. Furthermore, using the insurer's smartphone app leads to an increase of the likelihood to undergo a test and doubles the probability to share related data. Regarding insurance plans and deductible levels, there is no strong correlation neither with the willingness to take a test nor to share the data. Finally, individuals with complementary health insurance plans are less likely to share results. From the framings for the payment of genetic tests, our results indicate a positive effect of the insurer as a payer on the willingness to undertake tests as well as on data sharing. Conclusion Our results lay the ground for a deeper understanding of the role of payers on health decisions and sharing of health-related data. In particular, we find that it is relevant for health insurers to engage with their clients.
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Affiliation(s)
- Veronika Kalouguina
- Department of Actuarial Science, Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
| | - Joël Wagner
- Department of Actuarial Science, Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
- Swiss Finance Institute, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Joël Wagner
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18
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Butler T, Brown J, Jacobson PA, Stenehjem D. Perceptions of pharmacogenetic exceptionalism and the implications for clinical management within an electronic health record. Clin Transl Sci 2022; 15:2265-2274. [PMID: 35833242 PMCID: PMC9468565 DOI: 10.1111/cts.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 06/12/2022] [Indexed: 01/25/2023] Open
Abstract
Genetic exceptionalism refers to a concept that genetic information is distinct from other health data and therefore should have additional safety guards in place. The objective of this study was to establish perceptions of pharmacogenetic (PGx) exceptionalism and genetic information privacy and management within the electronic health record (EHR) from individuals who attended a PGx-focused conference. A 47-question survey was distributed to 370 attendees at a PGx conference in September 2020. The survey assessed demographics, professional characteristics, perceptions of PGx exceptionalism, knowledge of genetic laws and regulations, and EHR management of PGx information. Of the 370 participants invited to take the survey, 30% (n = 110) responded. Most respondents were pharmacists with postgraduate training (76.2%, n = 48). When asked whether PGx information was exceptional, 44% of respondents agreed while 32% disagreed. Agreement with PGx exceptionalism was associated most with respondents' lack of familiarity or knowledge with PGx. Over two-thirds (67%) felt that all members of the healthcare team should be able to access their patients' PGx information without restriction in the EHR. This study identified a lack of unanimity in the perception of PGx exceptionalism and the management of PGx information within the EHR across attendees of a PGx conference. Describing the perception of accessibility of PGx information within the EHR is important to ascertain for designing privacy-related technology, institutional management policies, and legal regulations as this area in genetics is increasingly being implemented into clinical care and clinical standards of care need to be established.
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Affiliation(s)
- Tiana Butler
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
| | - Jacob Brown
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
| | - Pamala A. Jacobson
- Department of Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
| | - David Stenehjem
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of PharmacyUniversity of MinnesotaDuluthMinnesotaUSA
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19
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Lehmann LS, Snyder Sulmasy L, Burke W. Ethical Considerations in Precision Medicine and Genetic Testing in Internal Medicine Practice: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1322-1323. [PMID: 35878403 DOI: 10.7326/m22-0743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This American College of Physicians position paper aims to inform ethical decision making for the integration of precision medicine and genetic testing into clinical care. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and can also inform how health care systems, professional schools, and residency programs integrate genomics into educational and clinical settings. Addressing the challenges of precision medicine and genetic testing will guide ethical and responsible implementation to improve health outcomes.
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Affiliation(s)
- Lisa Soleymani Lehmann
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Google Health, Mountain View, California (L.S.L.)
| | | | - Wylie Burke
- University of Washington, Seattle, Washington (W.B.)
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20
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Hanson CK, Liu K. Think about your friends and family: The disparate impacts of relationship-centered messages on privacy concerns, protective health behavior, and vaccination against Covid-19. PLoS One 2022; 17:e0270279. [PMID: 35862307 PMCID: PMC9302763 DOI: 10.1371/journal.pone.0270279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
To understand which factors affect how willing people are to share their personal information to combat the Covid-19 pandemic, and compare them to factors that affect other public health behaviors.
Method
We analyze data from three pre-registered online experiments conducted over eight months during the Covid-19 pandemic in the United States (April 3 2020 –November 25, 2020). Our primary analysis tests whether support for data sharing and intention to practice protective behavior increase in response to relationship-centered messages about prosociality, disease spread, and financial hardship. We then conduct a secondary correlational analysis to compare the demographic and attitudinal factors associated with willingness to share data, protective behavior, and intent to get vaccinated. Our sample (N = 650) is representative to socio-demographic characteristics of the U.S. population.
Results
We find the altruistic condition increased respondents’ willingness to share data. In our correlational analysis, we find interactive effects of political ID and socio-demographic traits on likelihood to share data. In contrast, we found health behavior was most strongly associated with political ID, and intent to vaccinate was more associated with socio-demographic traits.
Conclusions
Our findings suggest that some public health messaging, even when it is not about data sharing or privacy, may increase public willingness to share data. We also find the role of socio-demographic factors in moderating the effect of political party ID varies by public health behavior.
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Affiliation(s)
- Clara K. Hanson
- Department of Sociology, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail: (KL); (CKH)
| | - Kayuet Liu
- Department of Sociology, University of California, Los Angeles, Los Angeles, California, United States of America
- California Center for Population Research, University of California, Los Angeles, Los Angeles, California, United States of America
- Riken Center for Brain Science, Wako, Japan
- * E-mail: (KL); (CKH)
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21
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Amorim M, Silva S, Machado H, Teles EL, Baptista MJ, Maia T, Nwebonyi N, de Freitas C. Benefits and Risks of Sharing Genomic Data for Research: Comparing the Views of Rare Disease Patients, Informal Carers and Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148788. [PMID: 35886636 PMCID: PMC9319916 DOI: 10.3390/ijerph19148788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 01/25/2023]
Abstract
Assessing public and patients’ expectations and concerns about genomic data sharing is essential to promote adequate data governance and engagement in rare diseases genomics research. This cross-sectional study compared the views of 159 rare disease patients, 478 informal carers and 63 healthcare professionals in Northern Portugal about the benefits and risks of sharing genomic data for research, and its associated factors. The three participant groups expressed significantly different views. The majority of patients (84.3%) and informal carers (87.4%) selected the discovery of a cure for untreatable diseases as the most important benefit. In contrast, most healthcare professionals revealed a preference for the development of new drugs and treatments (71.4%), which was the second most selected benefit by carers (48.3%), especially by the more educated (OR (95% CI): 1.58 (1.07–2.34)). Lack of security and control over information access and the extraction of information exceeding research objectives were the two most often selected risks by patients (72.6% and 50.3%, respectively) and carers (60.0% and 60.6%, respectively). Conversely, professionals were concerned with genomic data being used to discriminate citizens (68.3%), followed by the extraction of information exceeding research objectives (54.0%). The latter risk was more frequently expressed by more educated carers (OR (95% CI): 1.60 (1.06–2.41)) and less by those with blue-collar (OR (95% CI): 0.44 (0.25–0.77) and other occupations (OR (95% CI): 0.44 (0.26–0.74)). Developing communication strategies and consent approaches tailored to participants’ expectations and needs can benefit the inclusiveness of genomics research that is key for patient-centred care.
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Affiliation(s)
- Mariana Amorim
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
| | - Susana Silva
- Centro em Rede de Investigação em Antropologia, Universidade do Minho, 4710-057 Braga, Portugal;
- Instituto de Ciências Sociais, Universidade do Minho, 4710-057 Braga, Portugal;
| | - Helena Machado
- Instituto de Ciências Sociais, Universidade do Minho, 4710-057 Braga, Portugal;
| | - Elisa Leão Teles
- Centro de Referência de Doenças Hereditárias do Metabolismo, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
| | - Maria João Baptista
- Centro de Referência de Cardiopatias Congénitas, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
- Departamento de Ginecologia, Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Tiago Maia
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
| | - Ngozi Nwebonyi
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
| | - Cláudia de Freitas
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal; (M.A.); (T.M.); (N.N.)
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- Correspondence:
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22
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Liu Y, Yin Z, Wan Z, Yan C, Xia W, Ni C, Clayton EW, Vorobeychik Y, Kantarcioglu M, Malin BA. Implicit Incentives Among Reddit Users to Prioritize Attention Over Privacy and Reveal Their Faces When Discussing Direct-to-Consumer Genetic Test Results: Topic and Attention Analysis. JMIR INFODEMIOLOGY 2022; 2:e35702. [PMID: 37113452 PMCID: PMC9987181 DOI: 10.2196/35702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 06/22/2022] [Indexed: 04/29/2023]
Abstract
Background As direct-to-consumer genetic testing services have grown in popularity, the public has increasingly relied upon online forums to discuss and share their test results. Initially, users did so anonymously, but more recently, they have included face images when discussing their results. Various studies have shown that sharing images on social media tends to elicit more replies. However, users who do this forgo their privacy. When these images truthfully represent a user, they have the potential to disclose that user's identity. Objective This study investigates the face image sharing behavior of direct-to-consumer genetic testing users in an online environment to determine if there exists an association between face image sharing and the attention received from other users. Methods This study focused on r/23andme, a subreddit dedicated to discussing direct-to-consumer genetic testing results and their implications. We applied natural language processing to infer the themes associated with posts that included a face image. We applied a regression analysis to characterize the association between the attention that a post received, in terms of the number of comments, the karma score (defined as the number of upvotes minus the number of downvotes), and whether the post contained a face image. Results We collected over 15,000 posts from the r/23andme subreddit, published between 2012 and 2020. Face image posting began in late 2019 and grew rapidly, with over 800 individuals revealing their faces by early 2020. The topics in posts including a face were primarily about sharing, discussing ancestry composition, or sharing family reunion photos with relatives discovered via direct-to-consumer genetic testing. On average, posts including a face image received 60% (5/8) more comments and had karma scores 2.4 times higher than other posts. Conclusions Direct-to-consumer genetic testing consumers in the r/23andme subreddit are increasingly posting face images and testing reports on social platforms. The association between face image posting and a greater level of attention suggests that people are forgoing their privacy in exchange for attention from others. To mitigate this risk, platform organizers and moderators could inform users about the risk of posting face images in a direct, explicit manner to make it clear that their privacy may be compromised if personal images are shared.
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Affiliation(s)
- Yongtai Liu
- Department of Computer Science Vanderbilt University Nashville, TN United States
| | - Zhijun Yin
- Department of Computer Science Vanderbilt University Nashville, TN United States
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Zhiyu Wan
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Chao Yan
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Weiyi Xia
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
| | - Congning Ni
- Department of Computer Science Vanderbilt University Nashville, TN United States
| | - Ellen Wright Clayton
- School of Law, Vanderbilt University Nashville, TN United States
- Department of Pediatrics, Vanderbilt University Medical Center Nashville, TN United States
- Department of Health Policy Vanderbilt University Medical Center Nashville, TN United States
| | - Yevgeniy Vorobeychik
- Department of Computer Science and Engineering, Washington University in St. Louis St. Louis, MO United States
| | - Murat Kantarcioglu
- Department of Computer Science, University of Texas at Dallas Richardson, TX United States
| | - Bradley A Malin
- Department of Computer Science Vanderbilt University Nashville, TN United States
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville, TN United States
- Department of Biostatistics Vanderbilt University Medical Center Nashville, TN United States
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23
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Madrid SD, Blum-Barnett E, Lemke AA, Pan V, Paolino V, McGlynn EA, Burnett-Hartman AN. "A Gift to My Family for Their Future": Attitudes about Genetic Research Participation. Public Health Genomics 2022; 25:1-10. [PMID: 35545013 DOI: 10.1159/000524462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Broad participation in genetic research is needed to promote equitable advances in disease treatment and prevention. OBJECTIVES The objective of the study was to assess motivations for, and concerns about, genetic research participation. METHODS The Genetics in Research and Health Care Survey was sent in winter 2017-2018 to 57,331 adult Kaiser Permanente (KP) members from 7 US regions to assess attitudes about genetic testing in health care and research. The survey included an open-ended question on why members would or would not participate in genetic research. Open text responses to this question were coded in the qualitative analysis software Dedoose and analyzed using a thematic analysis approach. Code summaries were organized by major themes, subthemes, and exemplary quotes. RESULTS Of the 10,369 participants who completed the survey, 2,645 (25%) provided a comment describing reasons they would or would not participate in research involving genetic testing. Respondents who provided a text comment were 64% female, 49% non-Hispanic (NH) White, 17% Asian/Pacific Islander, 20% Hispanic, and 14% NH Black. The primary themes identified were (1) altruism; (2) decision-making and planning; (3) data use; and (4) data security. These major themes were consistent across each race and ethnic group. CONCLUSIONS To promote broad participation in genetic research, it is important that recruitment materials address the primary motivators for genetic research participation, including altruism and the potential use of results for personal decision-making. Study materials should also address concerns about possible misuse of genetic information and fears over potential data breaches.
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Affiliation(s)
- Sarah D Madrid
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Amy A Lemke
- NorthShore University HealthSystem, Evanston, Illinois, USA
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Vivian Pan
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Valerie Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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24
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Cohen S, Zultan R. Genomic privacy, identity and dignity. JOURNAL OF MEDICAL ETHICS 2022; 48:317-322. [PMID: 33910975 DOI: 10.1136/medethics-2020-106979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/10/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
Significant advancements towards a future of big data genomic medicine, associated with large-scale public dataset repositories, intensify dilemmas of genomic privacy. To resolve dilemmas adequately, we need to understand the relative force of the competing considerations that make them up. Attitudes towards genomic privacy are complex and not well understood; understanding is further complicated by the vague claim of 'genetic exceptionalism'. In this paper, we distinguish between consequentialist and non-consequentialist privacy interests: while the former are concerned with harms secondary to exposure, the latter represent the interest in a private sphere for its own sake, as an essential component of human dignity. Empirical studies of attitudes towards genomic privacy have almost never targeted specifically this important dignitary component of the privacy interest. In this paper we first articulate the question of a non-consequentialist genomic privacy interest, and then present results of an empirical study that probed people's attitudes towards that interest. This was done via comparison to other non-consequentialist privacy interests, which are more tangible and can be more easily assessed. Our results indicate that the non-consequentialist genomic privacy interest is rather weak. This insight can assist in adjudicating dilemmas involving genomic privacy.
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Affiliation(s)
- Shlomo Cohen
- Department of Philosophy, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ro'i Zultan
- Department of Economics, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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25
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What ethical approaches are used by scientists when sharing health data? An interview study. BMC Med Ethics 2022; 23:41. [PMID: 35410285 PMCID: PMC9004072 DOI: 10.1186/s12910-022-00779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 04/01/2022] [Indexed: 11/27/2022] Open
Abstract
Background Health data-driven activities have become central in diverse fields (research, AI development, wearables, etc.), and new ethical challenges have arisen with regards to privacy, integrity, and appropriateness of use. To ensure the protection of individuals’ fundamental rights and freedoms in a changing environment, including their right to the protection of personal data, we aim to identify the ethical approaches adopted by scientists during intensive data exploitation when collecting, using, or sharing peoples’ health data. Methods Twelve scientists who were collecting, using, or sharing health data in different contexts in Sweden, were interviewed. We used systematic expert interviews to access these scientists’ specialist knowledge, and analysed the interviews with thematic analysis. Phrases, sentences, or paragraphs through which ethical values and norms were expressed, were identified and coded. Codes that reflected similar concepts were grouped, subcategories were formulated, and categories were connected to traditional ethical approaches. Results Through several examples, the respondents expressed four different ethical approaches, which formed the main conceptual categories: consideration of consequences, respect for rights, procedural compliance, and being professional. Conclusions To a large extent, the scientists’ ethical approaches were consistent with ethical and legal principles. Data sharing was considered important and worth pursuing, even though it is difficult. An awareness of the complex issues involved in data sharing was reflected from different perspectives, and the respondents commonly perceived a general lack of practical procedures that would by default ensure ethical and legally compliant data collection and sharing. We suggest that it is an opportune time to move on from policy discussions to practical technological ethics-by-design solutions that integrate these principles into practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00779-8.
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26
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McCormick JB, Hopkins M, Lehman EB, Green MJ. Mining the Data: Exploring Rural Patients' Attitudes about the Use of Their Personal Information in Research. AJOB Empir Bioeth 2022; 13:89-106. [PMID: 35271430 PMCID: PMC10038193 DOI: 10.1080/23294515.2022.2040644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study examines rural patients' perceived importance of knowing or being consulted about researchers' access and use of their personal data (identifiable and de-identified health information, and identifiable and de-identified non-health information) across five scenarios. This study also examines their views on stewardship or governance of their personal information by researchers in their healthcare systems. METHODS We conducted a survey by mail. Data were analyzed using descriptive statistics. Multivariable regression analyses were conducted across each scenario and type of personal data with the same variables included in each model. RESULTS The majority of participants said it was "very important/absolutely essential" to know the purpose of the study, to be asked every time, and to know the policies governing researcher access and use of their identifiable health information. Just over two-thirds of respondents thought it "very important/absolutely essential" to know who serves on the data governance committee and to have a community member serve. Distrust in healthcare organizations was positively correlated with the scenarios while willingness to give permission to donate leftover biological specimens was negatively correlated. CONCLUSION Our study findings indicate that the type of personal information being accessed and used generally matters to 1,407 patients living in rural Pennsylvania. We also demonstrate that knowing their healthcare organizations' governance policies and practices for managing their personal data is important to many rural Pennsylvania patients. Biomedical researchers need to recognize and attend to those differences as much as possible in order to expand opportunities for and participation in research by residents of these rural communities. Supplemental data for this article is available online at.
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Affiliation(s)
- Jennifer B McCormick
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Margaret Hopkins
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Parobek CM, Thorsen MM, Has P, Lorenzi P, Clark MA, Russo ML, Lewkowitz AK. Video education about genetic privacy and patient perspectives about sharing prenatal genetic data: a randomized trial. Am J Obstet Gynecol 2022; 227:87.e1-87.e13. [PMID: 35351406 DOI: 10.1016/j.ajog.2022.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Laboratories offering cell-free DNA often reserve the right to share prenatal genetic data for research or even commercial purposes, and obtain this permission on the patient consent form. Although it is known that nonpregnant patients are often reluctant to share their genetic data for research, pregnant patients' knowledge of, and opinions about, genetic data privacy are unknown. OBJECTIVE We investigated whether pregnant patients who had already undergone cell-free DNA screening were aware that genetic data derived from cell-free DNA may be shared for research. Furthermore, we examined whether pregnant patients exposed to video education about the Genetic Information Nondiscrimination Act-a federal law that mandates workplace and health insurance protections against genetic discrimination-were more willing to share cell-free DNA-related genetic data for research than pregnant patients who were unexposed. STUDY DESIGN In this randomized controlled trial (ClinicalTrials.gov Identifier: NCT04420858), English-speaking patients with singleton pregnancies who underwent cell-free DNA and subsequently presented at 17 0/7 to 23 6/7 weeks of gestation for a detailed anatomy scan were randomized 1:1 to a control or intervention group. Both groups viewed an infographic about cell-free DNA. In addition, the intervention group viewed an educational video about the Genetic Information Nondiscrimination Act. The primary outcomes were knowledge about, and willingness to share, prenatal genetic data from cell-free DNA by commercial laboratories for nonclinical purposes, such as research. The secondary outcomes included knowledge about existing genetic privacy laws, knowledge about the potential for reidentification of anonymized genetic data, and acceptability of various use and sharing scenarios for prenatal genetic data. Eighty-one participants per group were required for 80% power to detect an increase in willingness to share data from 60% to 80% (α=0.05). RESULTS A total of 747 pregnant patients were screened, and 213 patients were deemed eligible and approached for potential study participation. Of these patients, 163 (76.5%) consented and were randomized; one participant discontinued the intervention, and two participants were excluded from analysis after the intervention when it was discovered that they did not fulfill all eligibility criteria. Overall, 160 (75.1%) of those approached were included in the final analysis. Most patients in the control group (72 [90.0%]) and intervention (76 [97.4%]) group were either unsure about or incorrectly thought that cell-free DNA companies could not share prenatal genetic data for research. Participants in the intervention group were more likely to incorrectly believe that their prenatal genetic data would not be shared for nonclinical purposes than participants in the control group (28.8% in the control group vs 46.2% in the intervention; P=.03). However, video education did not increase participant willingness to share genetic data in multiple scenarios. Non-White participants were less willing than White participants to allow sharing of genetic data specifically for academic research (P<.001). CONCLUSION Most participants were unaware that their prenatal genetic data may be used for nonclinical purposes. Pregnant patients who were educated about the Genetic Information Nondiscrimination Act were not more willing to share genetic data than those who did not receive this education. Surprisingly, video education about the Genetic Information Nondiscrimination Act led patients to falsely believe that their data would not be shared for research, and participants who identified as racial minorities were less willing to share genetic data. New strategies are needed to improve pregnant patients' understanding of genetic privacy.
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Wan Z, Hazel JW, Clayton EW, Vorobeychik Y, Kantarcioglu M, Malin BA. Sociotechnical safeguards for genomic data privacy. Nat Rev Genet 2022; 23:429-445. [PMID: 35246669 PMCID: PMC8896074 DOI: 10.1038/s41576-022-00455-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 12/21/2022]
Abstract
Recent developments in a variety of sectors, including health care, research and the direct-to-consumer industry, have led to a dramatic increase in the amount of genomic data that are collected, used and shared. This state of affairs raises new and challenging concerns for personal privacy, both legally and technically. This Review appraises existing and emerging threats to genomic data privacy and discusses how well current legal frameworks and technical safeguards mitigate these concerns. It concludes with a discussion of remaining and emerging challenges and illustrates possible solutions that can balance protecting privacy and realizing the benefits that result from the sharing of genetic information. In this Review, the authors describe technical and legal protection mechanisms for mitigating vulnerabilities in genomic data privacy. They also discuss how these protections are dependent on the context of data use such as in research, health care, direct-to-consumer testing or forensic investigations.
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Affiliation(s)
- Zhiyu Wan
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Computer Science, Vanderbilt University, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James W Hazel
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Ellen Wright Clayton
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA.,Vanderbilt University Law School, Nashville, TN, USA
| | - Yevgeniy Vorobeychik
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Murat Kantarcioglu
- Department of Computer Science, University of Texas at Dallas, Richardson, TX, USA
| | - Bradley A Malin
- Center for Genetic Privacy and Identity in Community Settings, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Computer Science, Vanderbilt University, Nashville, TN, USA. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Warne N, Rook S, Bevan Jones R, Brown R, Bates L, Hopkins-Jones L, Evans A, Hall J, Langley K, Thapar A, Walters J, Murphy S, Moore G, Rice F, Collishaw S. Collecting genetic samples and linked mental health data from adolescents in schools: protocol coproduction and a mixed-methods pilot of feasibility and acceptability. BMJ Open 2022; 12:e049283. [PMID: 35105567 PMCID: PMC8808403 DOI: 10.1136/bmjopen-2021-049283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To coproduce a school-based protocol and examine acceptability and feasibility of collecting saliva samples for genetic studies from secondary/high school students for the purpose of mental health research. DESIGN Protocol coproduction and mixed-methods feasibility pilot. SETTING Secondary schools in Wales, UK. PARTICIPANTS Students aged 11-13 years. PRIMARY AND SECONDARY OUTCOME MEASURES Coproduced research protocol including an interactive science workshop delivered in schools; school, parental and student recruitment rates; adherence to protocol and adverse events; ability to extract and genotype saliva samples; student enjoyment of the science workshop and qualitative analysis of teacher focus groups on acceptability and feasibility. RESULTS Five secondary schools participated in the coproduction phase, and three of these took part in the research study (eligible sample n=868 students). Four further schools were subsequently approached, but none participated. Parental opt-in consent was received from 98 parents (11.3% eligible sample), three parents (0.3%) actively refused and responses were not received for 767 (88.4%) parents. We obtained saliva samples plus consent for data linkage for 79 students. Only one sample was of insufficient quality to be genotyped. The science workshop received positive feedback from students. Feedback from teachers showed that undertaking research like this in schools is viewed as acceptable in principle, potentially feasible, but that there are important procedural barriers to be overcome. Key recommendations include establishing close working relationships between the research team and school classroom staff, together with improved methods for communicating with and engaging parents. CONCLUSIONS There are major challenges to undertaking large-scale genetic mental health research in secondary schools. Such research may be acceptable in principle, and in practice DNA collected from saliva in classrooms is of sufficient quality. However, key challenges that must be overcome include ensuring representative recruitment of schools and sufficient parental engagement where opt-in parental consent is required.
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Affiliation(s)
- Naomi Warne
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Sarah Rook
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Rhys Bevan Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Rachel Brown
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lesley Bates
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lucinda Hopkins-Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Alexandra Evans
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Jeremy Hall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Kate Langley
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - James Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Frances Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Stephan Collishaw
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Alrefaei AF, Hawsawi YM, Almaleki D, Alafif T, Alzahrani FA, Bakhrebah MA. Genetic data sharing and artificial intelligence in the era of personalized medicine based on a cross-sectional analysis of the Saudi human genome program. Sci Rep 2022; 12:1405. [PMID: 35082362 PMCID: PMC8791994 DOI: 10.1038/s41598-022-05296-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/07/2022] [Indexed: 12/21/2022] Open
Abstract
The success of the Saudi Human Genome Program (SHGP), one of the top ten genomic programs worldwide, is highly dependent on the Saudi population embracing the concept of participating in genetic testing. However, genetic data sharing and artificial intelligence (AI) in genomics are critical public issues in medical care and scientific research. The present study was aimed to examine the awareness, knowledge, and attitude of the Saudi society towards the SHGP, the sharing and privacy of genetic data resulting from the SHGP, and the role of AI in genetic data analysis and regulations. Results of a questionnaire survey with 804 respondents revealed moderate awareness and attitude towards the SHGP and minimal knowledge regarding its benefits and applications. Respondents demonstrated a low level of knowledge regarding the privacy of genetic data. A generally positive attitude was found towards the outcomes of the SHGP and genetic data sharing for medical and scientific research. The highest level of knowledge was detected regarding AI use in genetic data analysis and privacy regulation. We recommend that the SHGP’s regulators launch awareness campaigns and educational programs to increase and improve public awareness and knowledge regarding the SHGP’s benefits and applications. Furthermore, we propose a strategy for genetic data sharing which will facilitate genetic data sharing between institutions and advance Personalized Medicine in genetic diseases’ diagnosis and treatment.
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Affiliation(s)
- Abdulmajeed F Alrefaei
- Department of Biology, Genetic and Molecular Biology Central Lab, Jamoum University College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia.
| | - Yousef M Hawsawi
- Research Centre, King Faisal Specialist Hospital and Research Centre, P.O. Box 40047, Jeddah, 21499, Saudi Arabia.,MBC: J04/ College of Medicine, Al-Faisal University, P.O. Box 50927, Riyadh, 11533, Kingdom of Saudi Arabia
| | - Deyab Almaleki
- Department of Evaluation, Measurement, and Research, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Tarik Alafif
- Computer Science Department, Jamoum University College, Umm Al-Qura University, Jamoum, 25375, Saudi Arabia
| | - Faisal A Alzahrani
- Department of Biochemistry, Faculty of Science, Embryonic Stem Cells Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Muhammed A Bakhrebah
- King Abdulaziz City for Science and Technology (KACST), Life Science and Environment Research Institute, P.O. Box 6086, Riyadh, 11442, Saudi Arabia
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Clasen K, Gani C, Schroeder C, Riess O, Zips D, Schöffski O, Clasen S. The patients view on genetics and functional imaging for precision medicine: a willingness-to-pay analysis. Per Med 2022; 19:103-112. [PMID: 34984920 DOI: 10.2217/pme-2021-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose: Willingness-to-pay (WTP) analyses can support allocation processes considering the patients preferences in personalized medicine. However, genetic testing especially might imply ethical concerns that have to be considered. Methods: A WTP questionnaire was designed to compare preferences for imaging and genetic testing in cancer patients and to evaluate potential ethical concerns. Results: Comparing the options of imaging and genetics showed comparable WTP values. Ethical concerns about genetic testing seemed to be minor. Treatment success was the top priority irrespective of the diagnostic modality. In general, the majority of patients considered personalized medicine to be beneficial. Conclusion: Most patients valued personalized approaches and rated the benefits of precision medicine of overriding importance irrespective of modality or ethical concerns.
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Affiliation(s)
- Kerstin Clasen
- Department of Radiation Oncology, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Cihan Gani
- Department of Radiation Oncology, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics & Applied Genomics, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Calwerstraße 7, Tübingen, 72076, Germany
| | - Olaf Riess
- Institute of Medical Genetics & Applied Genomics, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Calwerstraße 7, Tübingen, 72076, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Lange Gasse 20, Nuremberg, 90403, Germany
| | - Stephan Clasen
- Department of Diagnostic & Interventional Radiology, District Hospital Reutlingen, Steinenbergstraße 31, Reutlingen, 72764, Germany
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Martucci J, Prado Y, Rope AF, Weinmann S, White L, Zepp J, Henrikson NB, Feigelson HS, Hunter JE, Lee SSJ. An Examination of the Ethical and Legal Limits in Implementing "Traceback Testing" for Deceased Patients. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:818-832. [PMID: 36883408 PMCID: PMC10009393 DOI: 10.1017/jme.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This paper examines the legal and ethical aspects of traceback testing, a process in which patients who have been previously diagnosed with ovarian cancer are identified and offered genetic testing so that their family members can be informed of their genetic risk and can also choose to undergo testing. Specifically, this analysis examines the ethical and legal limits in implementing traceback testing in cases when the patient is deceased and can no longer consent to genetic testing.
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Affiliation(s)
- Jessica Martucci
- HISTORY AND SOCIOLOGY OF SCIENCE DEPARTMENT, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, USA
| | - Yolanda Prado
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
| | - Alan F Rope
- CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST; PORTLAND, OR AND GENOME MEDICAL; SOUTH SAN FRANCISCO, CA, USA
| | - Sheila Weinmann
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
| | - Larissa White
- INSTITUTE FOR HEALTH RESEARCH, KAISER PERMANENTE, DENVERCO, USA
| | - Jamilyn Zepp
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
| | - Nora B Henrikson
- KAISER PERMANENTE WASHINGTON HEALTH RESEARCH INSTITUTE, SEATTLEWA, USA
| | | | - Jessica Ezzell Hunter
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
- GENOMICS, ETHICS, AND TRANSLATIONAL RESEARCH PROGRAM, RTI INTERNATIONAL, RESEARCH TRIANGLE PARK, NC, USA
| | - Sandra Soo-Jin Lee
- DIVISION OF ETHICS, DEPARTMENT OF MEDICAL HUMANITIES AND ETHICS, COLUMBIA UNIVERSITY, NEW YORK, NY, USA
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Wan Z, Vorobeychik Y, Xia W, Liu Y, Wooders M, Guo J, Yin Z, Clayton EW, Kantarcioglu M, Malin BA. Using game theory to thwart multistage privacy intrusions when sharing data. SCIENCE ADVANCES 2021; 7:eabe9986. [PMID: 34890225 PMCID: PMC8664254 DOI: 10.1126/sciadv.abe9986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
Person-specific biomedical data are now widely collected, but its sharing raises privacy concerns, specifically about the re-identification of seemingly anonymous records. Formal re-identification risk assessment frameworks can inform decisions about whether and how to share data; current techniques, however, focus on scenarios where the data recipients use only one resource for re-identification purposes. This is a concern because recent attacks show that adversaries can access multiple resources, combining them in a stage-wise manner, to enhance the chance of an attack’s success. In this work, we represent a re-identification game using a two-player Stackelberg game of perfect information, which can be applied to assess risk, and suggest an optimal data sharing strategy based on a privacy-utility tradeoff. We report on experiments with large-scale genomic datasets to show that, using game theoretic models accounting for adversarial capabilities to launch multistage attacks, most data can be effectively shared with low re-identification risk.
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Affiliation(s)
- Zhiyu Wan
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37212, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Yevgeniy Vorobeychik
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Weiyi Xia
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Yongtai Liu
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37212, USA
| | - Myrna Wooders
- Department of Economics, Vanderbilt University, Nashville, TN 37235, USA
| | - Jia Guo
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37212, USA
| | - Zhijun Yin
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37212, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- School of Law, Vanderbilt University, Nashville, TN 37203, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Murat Kantarcioglu
- Department of Computer Science, University of Texas at Dallas, Richardson, TX 75080, USA
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA 02138, USA
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Bradley A. Malin
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37212, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37203, USA
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Hazel JW, Hammack-Aviran C, Brelsford KM, Malin BA, Beskow LM, Clayton EW. Direct-to-consumer genetic testing: Prospective users' attitudes toward information about ancestry and biological relationships. PLoS One 2021; 16:e0260340. [PMID: 34843533 PMCID: PMC8629298 DOI: 10.1371/journal.pone.0260340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Direct-to-consumer genetic testing is marketed as a tool to uncover ancestry and kin. Recent studies of actual and potential users have demonstrated that individuals’ responses to the use of these tests for these purposes are complex, with privacy, disruptive consequences, potential for misuse, and secondary use by law enforcement cited as potential concerns. We conducted six focus groups with a diverse sample of participants (n = 62) who were aware of but had not used direct-to-consumer genetic tests, in an effort to understand more about what people considering these tests think about the potential value, risks, and benefits of such testing, taking into account use by third parties, such as potential kin and law enforcement. Participants differed widely in the perceived value of direct-to-consumer genetic tests for ancestry and kinship information for their own lives, including the desirability of contact with previously unknown relatives. Some perceived ancestry testing as mere curiosity or entertainment, while others, particularly those who had gaps in their family history, few living relatives, or who were adopted, saw greater value. Concerns about intrusion into one’s life by purported kin and control of data were widespread, with many participants expressing concern about secondary uses of data that could harm users or their families. The use of direct-to-consumer genetic tests data for forensic genealogy elicited a particularly wide array of reactions, both spontaneously and in response to specific discussion prompts, mirroring the current public debate about law enforcement access to such data. The themes uncovered through our investigation warrant specific attention in the continued development of the science, policy, and practice of commercial direct-to-consumer genetic testing.
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Affiliation(s)
- James W. Hazel
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Catherine Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kathleen M. Brelsford
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bradley A. Malin
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe), Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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Wale JL, Di Pietro L, Renton H, Sahhar M, Walker C, Williams P, Meehan K, Lynch E, Martyn M, Bell J, Winship I, Gaff CL. Making community voices heard in a research-health service alliance, the evolving role of the Community Advisory Group: a case study from the members' perspective. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:84. [PMID: 34838131 PMCID: PMC8627002 DOI: 10.1186/s40900-021-00326-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Melbourne Genomics Health Alliance (the Alliance) is a collaboration of leading hospitals, research and academic organisations, supported by its member organisations and the Victorian Government. The Alliance was set up by its members in 2013 to steer the translation of genomics, making it an integral part of health care in Victoria, Australia. The Community Advisory Group (CAG) was formed soon after, to give input and advice across the program. This was to ensure consideration of community values, perspectives and priorities, and knowledge translation for patient care. The CAG was charged with providing a strong community voice for the duration of the program. Appointed members were experienced consumer advocates with developed connections to the community. MAIN BODY The Alliance progressed from an initial Demonstration Project (2013-2015) to a multifaceted program (2016-2020). The CAG worked strategically to help address complex issues, for example, communication, privacy, informed consent, ethics, patient experience, measurement and evaluation standards and policies, data storage and re-use of genomic data. Many aspects of translating genomics into routine care have been tackled, such as communicating with patients invited to have genomic testing, or their caregivers, and obtaining informed consent, clinical questions across 16 areas of health care, training and education of health and laboratory professionals, genomic data management and data-sharing. Evidence generated around clinical utility and cost-effectiveness led to government funding of testing for complex genetic conditions in children. CONCLUSION The CAG activities, recorded in a CAG-inspired Activity register, span the full spectrum of information sharing and consultation to co-design and partnership. The CAG were involved at multiple levels of participation and in all tiers of activity including governance, development of policies and procedures, program planning and evaluation. Working relationships were built up and a level of trust instilled to advance the Alliance work program in ensuring an effective patient-care model of delivery of genomics. CAG input into project deliverables has been tangible. Less tangible contributions included presentations at external meetings and conferences, direct interactions at meetings with Alliance members, interactions with visitors and external experts, taking part in consultations with experts, state and federal government.
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Affiliation(s)
| | - Louisa Di Pietro
- Genetic Support Network of Victoria, 50 Flemington Road, Parkville, VIC 3052 Australia
| | - Heather Renton
- Syndromes Without A Name (SWAN) – Australia, PO Box 390, Fairfield, VIC 3078 Australia
| | | | | | | | - Karen Meehan
- Melbourne Genomics Health Alliance, 1G Royal Parade, Parkville, VIC 3052 Australia
| | - Elly Lynch
- Melbourne Genomics Health Alliance, 1G Royal Parade, Parkville, VIC 3052 Australia
| | - Melissa Martyn
- Melbourne Genomics Health Alliance, 1G Royal Parade, Parkville, VIC 3052 Australia
- Department of Paediatrics (Royal Children’s Hospital), Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | | | - Ingrid Winship
- The Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3052 Australia
| | - Clara L. Gaff
- Melbourne Genomics Health Alliance, 1G Royal Parade, Parkville, VIC 3052 Australia
- Department of Paediatrics (Royal Children’s Hospital), Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
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Kasperbauer TJ, Halverson C, Garcia A, Schwartz PH. Biobank Participants' Attitudes Toward Data Sharing and Privacy: The Role of Trust in Reducing Perceived Risks. J Empir Res Hum Res Ethics 2021; 17:167-176. [PMID: 34779299 DOI: 10.1177/15562646211055282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Biobank participants are often unaware of possible uses of their genetic and health information, despite explicit descriptions of those uses in consent forms. To explore why this misunderstanding persists, we conducted semi-structured interviews and knowledge tests with 22 participants who had recently enrolled in a research biobank. Results indicated that participants lacked understanding of privacy and data-sharing topics but were mostly unconcerned about associated risks. Participants described their answers on the knowledge test as largely driven by their trust in the healthcare system, not by a close reading of the information presented to them. This finding may help explain the difficulties in increasing participant understanding of privacy-related topics, even when such information is clearly presented in biobank consent forms.
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Affiliation(s)
- T J Kasperbauer
- Indiana University Center for Bioethics, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Colin Halverson
- Indiana University Center for Bioethics, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abby Garcia
- Indiana University Center for Bioethics, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter H Schwartz
- Indiana University Center for Bioethics, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Philosophy, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
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Gille F, Brall C. Limits of data anonymity: lack of public awareness risks trust in health system activities. LIFE SCIENCES, SOCIETY AND POLICY 2021; 17:7. [PMID: 34304736 PMCID: PMC8310702 DOI: 10.1186/s40504-021-00115-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
Public trust is paramount for the well functioning of data driven healthcare activities such as digital health interventions, contact tracing or the build-up of electronic health records. As the use of personal data is the common denominator for these healthcare activities, healthcare actors have an interest to ensure privacy and anonymity of the personal data they depend on. Maintaining privacy and anonymity of personal data contribute to the trustworthiness of these healthcare activities and are associated with the public willingness to trust these activities with their personal data. An analysis of online news readership comments about the failed care.data programme in England revealed that parts of the public have a false understanding of anonymity in the context of privacy protection of personal data as used for healthcare management and medical research. Some of those commenting demanded complete anonymity of their data to be willing to trust the process of data collection and analysis. As this demand is impossible to fulfil and trust is built on a false understanding of anonymity, the inability to meet this demand risks undermining public trust. Since public concerns about anonymity and privacy of personal data appear to be increasing, a large-scale information campaign about the limits and possibilities of anonymity with respect to the various uses of personal health data is urgently needed to help the public to make better informed choices about providing personal data.
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Affiliation(s)
- Felix Gille
- Department of Health Sciences and Technology, Ethics and Policy Lab, ETH Zürich, Zürich, Switzerland.
| | - Caroline Brall
- Department of Health Sciences and Technology, Ethics and Policy Lab, ETH Zürich, Zürich, Switzerland
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Ratcliff CL, Wong B, Jensen JD, Kaphingst KA. The Impact of Communicating Uncertainty on Public Responses to Precision Medicine Research. Ann Behav Med 2021; 55:1048-1061. [PMID: 34297059 DOI: 10.1093/abm/kaab050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Precision medicine research depends upon recruiting large and diverse participant cohorts to provide genetic, environmental, and lifestyle data. How prospective participants react to information about this research, including depictions of uncertainty, is not well understood. PURPOSE The current study examined public responses to precision medicine research, focusing on reactions toward (a) uncertainty about the scientific impact of sharing data for research, and (b) uncertainty about the privacy, security, or intended uses of participant data. METHODS U.S. adults (N = 674; 51.9% male; 50% non-Hispanic white; Mage = 42.23) participated in an online experimental survey. Participants read a manipulated news article about precision medicine research that conveyed either certainty or uncertainty of each type (scientific, data). Participants then rated their attitudes toward the research, trust in the researchers, and willingness to join a cohort. We tested direct and mediated paths between message condition and outcomes and examined individual characteristics as moderators. RESULTS Overall attitudes were positive and a majority of participants (65%) reported being somewhat or very likely to participate in precision medicine research if invited. Conveying uncertainty of either type had no overall main effect on outcomes. Instead, those who reported perceiving greater uncertainty had lower attitudes, trust, and willingness to join, while those with more tolerance for uncertainty, support for science, and scientific understanding responded favorably to the scientific uncertainty disclosure. CONCLUSIONS Findings suggest responses to precision medicine research uncertainty are nuanced and that successful cohort enrollment may be well-supported by a transparent approach to communicating with prospective participants.
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Affiliation(s)
- Chelsea L Ratcliff
- Department of Communication Studies, University of Georgia, Athens, GA, USA
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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39
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Milne R, Morley KI, Almarri MA, Anwer S, Atutornu J, Baranova EE, Bevan P, Cerezo M, Cong Y, Costa A, Critchley C, Fernow J, Goodhand P, Hasan Q, Hibino A, Houeland G, Howard HC, Hussain SZ, Malmgren CI, Izhevskaya VL, Jędrzejak A, Jinhong C, Kimura M, Kleiderman E, Leach B, Liu K, Mascalzoni D, Mendes Á, Minari J, Nicol D, Niemiec E, Patch C, Pollard J, Prainsack B, Rivière M, Robarts L, Roberts J, Romano V, Sheerah HA, Smith J, Soulier A, Steed C, Stefànsdóttir V, Tandre C, Thorogood A, Voigt TH, Wang N, West AV, Yoshizawa G, Middleton A. Demonstrating trustworthiness when collecting and sharing genomic data: public views across 22 countries. Genome Med 2021; 13:92. [PMID: 34034801 PMCID: PMC8147072 DOI: 10.1186/s13073-021-00903-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/04/2021] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Public trust is central to the collection of genomic and health data and the sustainability of genomic research. To merit trust, those involved in collecting and sharing data need to demonstrate they are trustworthy. However, it is unclear what measures are most likely to demonstrate this. METHODS We analyse the 'Your DNA, Your Say' online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle- and high-income countries, gathered in 15 languages. We examine how participants perceived the relative value of measures to demonstrate the trustworthiness of those using donated DNA and/or medical information. We examine between-country variation and present a consolidated ranking of measures. RESULTS Providing transparent information about who will benefit from data access was the most important measure to increase trust, endorsed by more than 50% of participants across 20 of 22 countries. It was followed by the option to withdraw data and transparency about who is using data and why. Variation was found for the importance of measures, notably information about sanctions for misuse of data-endorsed by 5% in India but almost 60% in Japan. A clustering analysis suggests alignment between some countries in the assessment of specific measures, such as the UK and Canada, Spain and Mexico and Portugal and Brazil. China and Russia are less closely aligned with other countries in terms of the value of the measures presented. CONCLUSIONS Our findings highlight the importance of transparency about data use and about the goals and potential benefits associated with data sharing, including to whom such benefits accrue. They show that members of the public value knowing what benefits accrue from the use of data. The study highlights the importance of locally sensitive measures to increase trust as genomic data sharing continues globally.
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Affiliation(s)
- Richard Milne
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK.
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK.
| | - Katherine I Morley
- RAND Europe, Cambridge, CB4 1YG, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
- Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, 3010, Australia
| | - Mohamed A Almarri
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
- Department of Forensic Science and Criminology, Dubai Police GHQ, Dubai, United Arab Emirates
| | | | - Jerome Atutornu
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Elena E Baranova
- Russian Medical Academy of Continuous Professional Education, Moscow, 119049, Russia
| | - Paul Bevan
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
| | - Maria Cerezo
- EMBL-EBI, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Yali Cong
- Medical Ethics Program, Peking University Health Science Center, Beijing, 100191, China
| | - Alessia Costa
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Christine Critchley
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, 3122, Australia
- Centre for Law and Genetics, University of Tasmania, Hobart, 7001, Australia
| | - Josepine Fernow
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Peter Goodhand
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, M5G 0A3, Canada
| | - Qurratulain Hasan
- Department of Genetics & Molecular Medicine, Kamineni Hospitals, Hyderabad, 500 068, India
- SAAZ Genetics, Hyderabad, 500033, India
| | - Aiko Hibino
- Faculty of Humanities and Social Sciences, Hirosaki University, Hirosaki, 036-8560, Japan
| | - Gry Houeland
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Heidi C Howard
- Medical Ethics, Lund Universitet, Sölvegatan, 19, Lund, Sweden
| | | | - Charlotta Ingvoldstad Malmgren
- Department of Public Health and Caring Scienec, Uppsala University, 751 22, Uppsala, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Solna, Sweden
| | | | | | - Cao Jinhong
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Megumi Kimura
- Institute of Innovation Research, Hitotsubashi University, Tokyo, 186-8603, Japan
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, H3A 0G1, Canada
| | | | - Keying Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
- School of Public Health, Peking University Health Science Center, Beijing, 100191, China
| | - Deborah Mascalzoni
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
- EURAC, Institute of Biomedicine, 39100, Bolzano, Italy
| | - Álvaro Mendes
- UnIGENe and CGPP - Centre for Predictive and Preventive Genetics, IBMC - Institute for Molecular and Cell Biology, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal
| | - Jusaku Minari
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, 606-8507, Japan
| | - Dianne Nicol
- Centre for Law and Genetics, University of Tasmania, Hobart, 7001, Australia
| | - Emilia Niemiec
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Christine Patch
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
- Genomics England, Queen Mary University of London, London, EC1M 6BQ, UK
| | | | - Barbara Prainsack
- Department of Political Science, University of Vienna, 1010, Vienna, Austria
- Department of Global Health & Social Medicine, King's College London, London, WC2R 2LS, UK
| | | | - Lauren Robarts
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Jonathan Roberts
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
| | - Virginia Romano
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
- EURAC, Institute of Biomedicine, 39100, Bolzano, Italy
| | - Haytham A Sheerah
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - James Smith
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
| | - Alexandra Soulier
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Claire Steed
- Wellcome Sanger Institute, Cambridge, CB10 1SA, UK
| | - Vigdis Stefànsdóttir
- Landspitali, the National University Hospital of Iceland, 101, Reykjavík, Iceland
| | - Cornelia Tandre
- Centre for Research Ethics & Bioethics (CRB), Uppsala University, SE-751 22, Uppsala, Sweden
| | - Adrian Thorogood
- Centre of Genomics and Policy, McGill University, Montreal, H3A 0G1, Canada
| | - Torsten H Voigt
- Institute of Sociology, RWTH Aachen University, 52062, Aachen, Germany
| | - Nan Wang
- Medical Ethics Program, Peking University Health Science Center, Beijing, 100191, China
| | - Anne V West
- Indiana University Maurer School of Law, Bloomington, 47405, USA
| | - Go Yoshizawa
- Work Research Institute (AFI), Oslo Metropolitan University, 0130, Oslo, Norway
| | - Anna Middleton
- Society and Ethics Research Group, Wellcome Connecting Science, Wellcome Genome Campus, Cambridge, CB10 1SA, UK
- Faculty of Education, University of Cambridge, Cambridge, CB2 8PQ, UK
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Speechly C, Stenhouse R, Berman Y, Barlow-Stewart K, Fleming J, Petrie D, Culling B. Genetic counselors, patients', and carers' views on an Australian clinical genetics service information system. J Genet Couns 2021; 30:1440-1451. [PMID: 33866647 DOI: 10.1002/jgc4.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/07/2022]
Abstract
The Genetic Information System (GIS) is an Australian database of family genetic information. This health information technology system has been used by all 31 publicly operated clinical genetics services across New South Wales (NSW) and the Australian Capital Territory (ACT) for over a decade. As these services are separated geographically, the linkage engendered by the GIS facilitates the services to operate as a virtual state-wide service. This study aimed to explore the views of genetic counselors, patients, and carers on the use and storage of family genetic information in the GIS. Data were collected using audio-recorded semi-structured telephone interviews with genetic counselors experienced with using the GIS and focus groups with past patients/carers of the services. Using thematic analysis, four themes were identified from genetic counselor participant interviews (n = 12): (a) Shared information is valuable; (b) inconsistent data entry provides a challenge; (c) perceived need for the GIS to be current and integrated with other health systems; and (d) future challenges and strategies for the GIS. Three themes were identified following three focus groups with consumer participants (n = 14): (a) access to family genetic information provides a 'clearer picture'; (b) support, but caution, concerning use of information for relatives' health care; and (c) stewardship of family information. Genetic counselors and consumers identified similar advantages and privacy concerns regarding the sharing of family genetic information and all participants wanted patients/carers to be better informed about the GIS early in the genetic counseling process. Consumers were reassured by genetics health professionals' stewardship of their information, but surprised the GIS was not available nationally or for private geneticists or certain non-genetic specialists. These findings may inform further development of the GIS and other clinical genetic databases and lead to increased patient/carer knowledge through education and resource development.
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Affiliation(s)
- Catherine Speechly
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
| | - Rachael Stenhouse
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
| | - Yemima Berman
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia.,Department of Clinical Genetics, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Kristine Barlow-Stewart
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
| | - Jane Fleming
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
| | | | - Bronwyn Culling
- Clinical Applications Support, Service Delivery, eHealth NSW, Chatswood, NSW, Australia
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41
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Viberg Johansson J, Bentzen HB, Shah N, Haraldsdóttir E, Jónsdóttir GA, Kaye J, Mascalzoni D, Veldwijk J. Publics’ preferences for sharing health data: a discrete choice experiment (Preprint). JMIR Med Inform 2021; 9:e29614. [PMID: 36260402 PMCID: PMC8406119 DOI: 10.2196/29614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
Background Digital technological development in the last 20 years has led to significant growth in digital collection, use, and sharing of health data. To maintain public trust in the digital society and to enable acceptable policy-making in the future, it is important to investigate people’s preferences for sharing digital health data. Objective The aim of this study is to elicit the preferences of the public in different Northern European countries (the United Kingdom, Norway, Iceland, and Sweden) for sharing health information in different contexts. Methods Respondents in this discrete choice experiment completed several choice tasks, in which they were asked if data sharing in the described hypothetical situation was acceptable to them. Latent class logistic regression models were used to determine attribute-level estimates and heterogeneity in preferences. We calculated the relative importance of the attributes and the predicted acceptability for different contexts in which the data were shared from the estimates. Results In the final analysis, we used 37.83% (1967/5199) questionnaires. All attributes influenced the respondents’ willingness to share health information (P<.001). The most important attribute was whether the respondents were informed about their data being shared. The possibility of opting out from sharing data was preferred over the opportunity to consent (opt-in). Four classes were identified in the latent class model, and the average probabilities of belonging were 27% for class 1, 32% for class 2, 23% for class 3, and 18% for class 4. The uptake probability varied between 14% and 85%, depending on the least to most preferred combination of levels. Conclusions Respondents from different countries have different preferences for sharing their health data regarding the value of a review process and the reason for their new use. Offering respondents information about the use of their data and the possibility to opt out is the most preferred governance mechanism.
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Affiliation(s)
- Jennifer Viberg Johansson
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Heidi Beate Bentzen
- Norwegian Research Center for Computers and Law, Faculty of Law, University of Oslo, Oslo, Norway
| | - Nisha Shah
- Centre for Health, Law, and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, United Kingdom
| | - Eik Haraldsdóttir
- Social Science Research Institute, University of Iceland, Reykjavik, Iceland
| | | | - Jane Kaye
- Centre for Health, Law, and Emerging Technologies, Faculty of Law, University of Oxford, Oxford, United Kingdom
- Centre for Health, Law and Emerging Technologies, Melbourne Law School, University of Melbourne, Melbourne, Australia
| | - Deborah Mascalzoni
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
- Institute for Biomedicine, Bolzano, Italy
| | - Jorien Veldwijk
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
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Abstract
PURPOSE OF REVIEW Polygenic scores (PGS) are used to quantify the genetic predisposition for heritable traits, with hypothesized utility for personalized risk assessments. Lipid PGS are primed for clinical translation, but evidence-based practice changes will require rigorous PGS standards to ensure reproducibility and generalizability. Here we review applicable reporting and technical standards for dyslipidemia PGS translation along phases of the ACCE (Analytical validity, Clinical validity, Clinical utility, Ethical considerations) framework for evaluating genetic tests. RECENT FINDINGS New guidance suggests existing standards for study designs incorporating the ACCE framework are applicable to PGS and should be adopted. One recent example is the Clinical Genomics Resource (ClinGen) and Polygenic Score Catalog's PRS reporting standards, which define minimal requirements for describing rationale for score development, study population definitions and data parameters, risk model development and application, risk model evaluation, and translational considerations, such as generalizability beyond the target population studied. SUMMARY Lipid PGS are likely to be integrated into clinical practice in the future. Clinicians will need to be prepared to determine if and when lipid PGS is useful and valid. This decision-making will depend on the quality of evidence for the clinical use of PGS. Establishing reporting standards for PGS will help facilitate data sharing and transparency for critical evaluation, ultimately benefiting the efficiency of evidence-based practice.
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Affiliation(s)
| | - Joshua W. Knowles
- Division of Cardiovascular Medicine
- Cardiovascular Institute
- Stanford Diabetes Research Center
- Stanford Prevention Research Center, Stanford University, Stanford
- The FH Foundation, Pasadena, California, USA
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43
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Brall C, Berlin C, Zwahlen M, Ormond KE, Egger M, Vayena E. Public willingness to participate in personalized health research and biobanking: A large-scale Swiss survey. PLoS One 2021; 16:e0249141. [PMID: 33793624 PMCID: PMC8016315 DOI: 10.1371/journal.pone.0249141] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
This paper reports survey findings on the Swiss public's willingness, attitudes, and concerns regarding personalized health research participation by providing health information and biological material. The survey reached a sample of 15,106 Swiss residents, from which we received 5,156 responses (34.1% response rate). The majority of respondents were aware of research using human biological samples (71.0%) and held a positive opinion towards this type of research (62.4%). Of all respondents, 53.6% indicated that they would be willing to participate in a personalized health research project. Willingness to participate was higher in younger, higher educated, non-religious respondents with a background in the health sector. Respondents were more willing to provide 'traditional' types of health data, such as health questionnaires, blood or biological samples, as opposed to social media or app-related data. All respondents valued the return of individual research results, including risk for diseases for which no treatment is available. Our findings highlight that alongside general positive attitudes towards personalized health research using data and samples, respondents have concerns about data privacy and re-use. Concerns included potential discrimination, confidentiality breaches, and misuse of data for commercial or marketing purposes. The findings of this large-scale survey can inform Swiss research institutions and assist policymakers with adjusting practices and developing policies to better meet the needs and preferences of the public. Efforts in this direction could focus on research initiatives engaging in transparent communication, education, and engagement activities, to increase public understanding and insight into data sharing activities, and ultimately strengthen personalized health research efforts.
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Affiliation(s)
- Caroline Brall
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Claudia Berlin
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marcel Zwahlen
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kelly E Ormond
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Matthias Egger
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Effy Vayena
- Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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44
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Sanghavi K, Feero WG, Mathews DJH, Prince AER, Price LL, Liu ET, Brothers KB, Roberts JS, Lee C. Employees' Views and Ethical, Legal, and Social Implications Assessment of Voluntary Workplace Genomic Testing. Front Genet 2021; 12:643304. [PMID: 33815477 PMCID: PMC8010177 DOI: 10.3389/fgene.2021.643304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Employers have begun to offer voluntary workplace genomic testing (wGT) as part of employee wellness benefit programs, but few empirical studies have examined the ethical, legal, and social implications (ELSI) of wGT. To better understand employee perspectives on wGT, employees were surveyed at a large biomedical research institution. Survey respondents were presented with three hypothetical scenarios for accessing health-related genomic testing: via (1) their doctor; (2) their workplace; and 3) a commercial direct-to-consumer (DTC) genetic testing company. Overall, 594 employees (28%) responded to the survey. Respondents indicated a preference for genomic testing in the workplace setting (70%; 95% CI 66-74%), followed by doctor's office (54%; 95% CI 50-58%), and DTC testing (20%; 95% CI 17-24%). Prior to participating in wGT, respondents wanted to know about confidentiality of test results (79%), existence of relevant laws and policies (70%), and privacy protection (64%). Across scenarios, 92% of respondents preferred to view the test results with a genetic counselor. These preliminary results suggest that many employees are interested and even prefer genetic testing in the workplace and would prefer testing with support from genetic health professionals. Confirmation in more diverse employer settings will be needed to generalize such findings.
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Affiliation(s)
- Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
| | - W Gregory Feero
- Maine-Dartmouth Family Medicine Residency, Augusta, ME, United States
| | - Debra J H Mathews
- Berman Institute of Bioethics, Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Anya E R Prince
- College of Law, University of Iowa College of Law, Iowa City, IA, United States
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States.,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, United States
| | - Edison T Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - J Scott Roberts
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Charles Lee
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States.,Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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45
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Zhang S, Johnson RA, Novembre J, Freeland E, Conley D. Public attitudes toward genetic risk scoring in medicine and beyond. Soc Sci Med 2021; 274:113796. [PMID: 33684700 DOI: 10.1016/j.socscimed.2021.113796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/26/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
Advances in genomics research have led to the development of polygenic risk scores, which numerically summarize genetic predispositions for a wide array of human outcomes. Initially developed to characterize disease risk, polygenic risk scores can now be calculated for many non-disease traits and social outcomes, with the potential to be used not only in health care but also other institutional domains. In this study, we draw on a nationally-representative survey of U.S. adults to examine three sets of lay attitudes toward the deployment of genetic risk scores in a variety of medical and non-medical domains: 1. abstract belief about whether people should be judged on the basis of genetic predispositions; 2. concrete attitudes about whether various institutions should be permitted to use genetic information; and 3. personal willingness to provide genetic information to various institutions. Results demonstrate two striking differences across these three sets of attitudes. First, despite almost universal agreement that people should not be judged based on genetics, there is support, albeit varied, for institutions being permitted to use genetic information, with support highest for disease outcomes and in reproductive decision-making. We further find significant variation in personal willingness to provide such information, with a majority of respondents expressing willingness to provide information to health care providers and relative finder services, but less than a quarter expressing willingness to do so for an array of other institutions and services. Second, while there are no demographic differences in respondents' abstract beliefs about judging based on genetics, demographic differences emerge in permissibility ratings and personal willingness. Our results should inform debates about the deployment of polygenic scores in domains within and beyond medicine.
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Affiliation(s)
- Simone Zhang
- Princeton University, Department of Sociology, 107 Wallace Hall, Princeton, NJ, 08544, USA.
| | - Rebecca A Johnson
- Dartmouth College, Quantitative Social Science and affiliate, Sociology, 301E Blunt Hall, Hanover, NH, 03755, USA.
| | - John Novembre
- University of Chicago, Department of Human Genetics, 920 E 58th Street, Chicago, IL, 60616, USA.
| | - Edward Freeland
- Princeton University, Survey Research Center, 169 Nassau Street, Princeton, NJ, 08542, USA.
| | - Dalton Conley
- Princeton University, Department of Sociology and Office of Population Research, 157 Wallace Hall, Princeton, NJ, 08544, USA; National Bureau of Economic Research, Cambridge, MA, 02138, USA.
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The FamilyTalk randomized controlled trial: patient-reported outcomes in clinical genetic sequencing for colorectal cancer. Cancer Causes Control 2021; 32:483-492. [PMID: 33591484 DOI: 10.1007/s10552-021-01398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
As genetics gains favor in clinical oncology, it is important to address patient concerns around confidentiality, privacy, and security of genetic information that might otherwise limit its utilization. We designed a randomized controlled trial to assess the social impact of an online educational tool (FamilyTalk) to increase family communication about colorectal cancer (CRC) risk and screening. Of 208 randomized participants, 149 (71.6%) returned six-month surveys. Overall, there was no difference in CRC screening between the study arms. Privacy and confidentiality concerns about medical and genetic information, reactions to genetic test results, and lifestyle changes did not differ between arms. Participants with pathogenic or likely pathogenic (P/LP) and variant of uncertain significance (VUS) results were more likely than those with negative results to report that the results accurately predicted their disease risks (OR 5.37, p = 0.02 and OR 3.13, p = 0.02, respectively). This trial demonstrated no evidence that FamilyTalk impacted patient-reported outcomes. Low power, due to the limited number of participants with P/LP results in the overall sample, as well as the short follow-up period, could have contributed to the null findings.
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Bak MAR, Veeken R, Blom MT, Tan HL, Willems DL. Health data research on sudden cardiac arrest: perspectives of survivors and their next-of-kin. BMC Med Ethics 2021; 22:7. [PMID: 33509184 PMCID: PMC7844916 DOI: 10.1186/s12910-021-00576-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/17/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Consent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and health-related data for observational research. METHODS We conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues. RESULTS Sudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients' data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives. CONCLUSIONS Sudden cardiac arrest patients' donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants' data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well.
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Affiliation(s)
- Marieke A R Bak
- Section of Medical Ethics, Department of General Practice, Amsterdam, UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Rens Veeken
- Faculty of Medicine, Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Center, Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Amsterdam, UMC, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Dick L Willems
- Section of Medical Ethics, Department of General Practice, Amsterdam, UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Participant mothers' attitudes toward genetic analysis in a birth cohort study. J Hum Genet 2021; 66:671-679. [PMID: 33495570 PMCID: PMC8225506 DOI: 10.1038/s10038-020-00894-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 01/21/2023]
Abstract
To conduct a long-term birth cohort study that includes genetic analysis, it is crucial to understand the attitudes of participants to genetic analysis and then take appropriate approaches for addressing their ambiguous and negative attitudes. This study aimed to explore participants’ attitudes toward genetic analysis and associated background factors among mothers who were enrolled in a large Japanese birth cohort. A questionnaire was sent to participants’ households, and the responses of 1762 mothers (34.0%) were used for the study. The majority of mothers recognized genetic analysis for themselves and their children and sharing of genetic data as beneficial. A low knowledge level of genomic terminology was associated with ambiguous attitudes toward genetic analysis and data sharing. Education level was positively associated with the recognition of the benefits of genetic analysis. Concern about handling genetic information was associated with the unacceptability of data sharing. Trust was associated with the approval of genetic analysis. Most mothers preferred that genetic analysis results be returned. These findings suggest the need for multiple efforts to maximize participants’ acceptance of genetic analysis, such as utilizing an educational approach to encourage familiarity with genetics/genomics, optimizing explanations for different educational levels, and explicitly disclosing the handling policy for genetic information.
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Gibbons E, Stovall I, Clayton J. Genetics in Film and TV, 1912-2020. JOURNAL OF LITERATURE AND SCIENCE 2021; 14:1-22. [PMID: 35765351 PMCID: PMC9236223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Hamann-Rose P. What We Talk About When We Talk About Cloning: A Literature and Bioethics Perspective on Genetic Privacy, Consent and the Family. JOURNAL OF LITERATURE AND SCIENCE 2021; 14:57-77. [PMID: 36589478 PMCID: PMC9802648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Paul Hamann-Rose
- Institut für England- und Amerikastudien, Goethe-Universität Frankfurt
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