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Richmond J, Cunningham-Erves J, Givens B, Guide A, Barnes LK, Fair AM, Carpenter SM, Chen Q, Watson KS, Cohn EG, Wilkins CH. All of Us participant perspectives on the return of value in research. Genet Med 2024; 26:101163. [PMID: 38738530 PMCID: PMC11298296 DOI: 10.1016/j.gim.2024.101163] [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: 11/28/2023] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024] Open
Abstract
PURPOSE To understand participant preferences for receiving specific types of research information, whether information preferences vary across sociodemographic groups, and the types of health providers participants could access to understand returned information. METHODS All of Us Research Program participants completed a value of returning research information survey. Stratified sampling was implemented to enhance participant diversity and avoid noncoverage. We used weighted multivariable logistic regression to evaluate associations between the most valuable information types, access to providers, and sociodemographic variables. RESULTS Participants (N = 20,405) were diverse in their race/ethnicity (eg, 52% were White, 18% were Hispanic/Latino or Spanish, 3% were Asian, and 20% were Black or African American). Most participants (78.6%) valued information about their risk of serious genetic diseases with available treatment. Primary care physicians, specialists, and genetic counselors were the top providers that participants could access for help understanding returned information. Information preferences and provider access varied across sociodemographic groups. For example, as income levels increased, the odds of placing value on genetic results indicating risk of serious disease with available treatment increased when compared with the lowest income levels (P value < .001). CONCLUSION Although genetic information was most valuable to participants, preferences about specific information types varied across sociodemographic groups.
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Affiliation(s)
- Jennifer Richmond
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | - Andrew Guide
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Alecia Malin Fair
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Consuelo H Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
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Mangal S, Niño de Rivera S, Reading Turchioe M, Myers A, Benda N, Goyal P, Dugdale L, Masterson Creber R. Perceptions of patient-reported outcome data access and sharing among patients with heart failure: ethical implications for research. Eur J Cardiovasc Nurs 2024; 23:145-151. [PMID: 37172035 PMCID: PMC10640657 DOI: 10.1093/eurjcn/zvad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/14/2023]
Abstract
AIMS In the face of growing expectations for data transparency and patient engagement in care, we evaluated preferences for patient-reported outcome (PRO) data access and sharing among patients with heart failure (HF) using an ethical framework. METHODS AND RESULTS We conducted qualitative interviews with a purposive sample of patients with HF who participated in a larger 8-week study that involved the collection and return of PROs using a web-based interface. Guided by an ethical framework, patients were asked questions about their preferences for having PRO data returned to them and shared with other groups. Interview transcripts were coded by three study team members using directed content analysis. A total of 22 participants participated in semi-structured interviews. Participants were mostly male (73%), White (68%) with a mean age of 72. Themes were grouped into priorities, benefits, and barriers to data access and sharing. Priorities included ensuring anonymity when data are shared, transparency with intentions of data use, and having access to all collected data. Benefits included: using data as a communication prompt to discuss health with clinicians and using data to support self-management. Barriers included: challenges with interpreting returned results, and potential loss of benefits and anonymity when sharing data. CONCLUSION Our interviews with HF patients highlight opportunities for researchers to return and share data through an ethical lens, by ensuring privacy and transparency with intentions of data use, returning collected data in comprehensible formats, and meeting individual expectations for data sharing.
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Affiliation(s)
- Sabrina Mangal
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, Seattle, WA, USA
| | | | | | - Annie Myers
- Columbia University School of Nursing, New York, NY, USA
| | - Natalie Benda
- Columbia University School of Nursing, New York, NY, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lydia Dugdale
- Department of Medicine, Center for Clinical Medical Ethics, Columbia University, New York, NY, USA
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Wolf SM, Green RC. Return of Results in Genomic Research Using Large-Scale or Whole Genome Sequencing: Toward a New Normal. Annu Rev Genomics Hum Genet 2023; 24:393-414. [PMID: 36913714 PMCID: PMC10497726 DOI: 10.1146/annurev-genom-101122-103209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
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Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
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Angal J, Brockevelt B, Caraway SJ, Kenyon DB, Ziegler K, Elliott AJ. Return of Individual Research Results: Participant Perspectives in a Longitudinal Community-Based Sample. J Empir Res Hum Res Ethics 2023; 18:109-117. [PMID: 37192743 PMCID: PMC10468824 DOI: 10.1177/15562646231173745] [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: 05/18/2023]
Abstract
The last decade has witnessed growing calls for the return of individual research results. Prior work in genetic studies has shown that individual, contextual, and cultural factors influence participants' preferences for individual research results. There is a gap in knowledge about participants' views about other types of results, specifically those lacking clinical significance. This study investigates the perspectives of 1587 mothers enrolled in the Northern Plains Environmental Influences on Child Health Outcomes (ECHO) Program. Participants were presented with hypothetical scenarios to determine their perceived value of individual research results based on result type and the ability to interpret them within a normative context. Irrespective of the result type, participants attributed higher perceived value to results that were well understood than results of unknown significance.
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Affiliation(s)
- Jyoti Angal
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Barbara Brockevelt
- School of Health Sciences, The University of South Dakota, Vermillion, SD, USA
| | - S. Jean Caraway
- College of Arts and Sciences, The University of South Dakota, Vermillion, SD
| | - DenYelle B. Kenyon
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
- School of Health Sciences, The University of South Dakota, Vermillion, SD, USA
| | - Katherine Ziegler
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, USA
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Iltis AS, Rolf L, Yaeger L, Goodman MS, DuBois JM. Attitudes and beliefs regarding race-targeted genetic testing of Black people: A systematic review. J Genet Couns 2023; 32:435-461. [PMID: 36644818 PMCID: PMC10349658 DOI: 10.1002/jgc4.1653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 01/17/2023]
Abstract
Geographical ancestry has been associated with an increased risk of various genetic conditions. Race and ethnicity often have been used as proxies for geographical ancestry. Despite numerous problems associated with the crude reliance on race and ethnicity as proxies for geographical ancestry, some genetic testing in the clinical, research, and employment settings has been and continues to be race- or ethnicity-based. Race-based or race-targeted genetic testing refers to genetic testing offered only or primarily to people of particular racial or ethnic groups because of presumed differences among groups. One current example is APOL1 testing of Black kidney donors. Race-based genetic testing raises numerous ethical and policy questions. Given the ongoing reliance on the Black race in genetic testing, it is important to understand the views of people who identify as Black or are identified as Black (including African American, Afro-Caribbean, and Hispanic Black) regarding race-based genetic testing that targets Black people because of their race. We conducted a systematic review of studies and reports of stakeholder-engaged projects that examined how people who identify as or are identified as Black perceive genetic testing that specifically presumes genetic differences exist among racial groups or uses race as a surrogate for ancestral genetic variation and targets Black people. Our review identified 14 studies that explicitly studied this question and another 13 that implicitly or tacitly studied this matter. We found four main factors that contribute to a positive attitude toward race-targeted genetic testing (facilitators) and eight main factors that are associated with concerns regarding race-targeted genetic testing (barriers). This review fills an important gap. These findings should inform future genetic research and the policies and practices developed in clinical, research, public health, or other settings regarding genetic testing.
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Affiliation(s)
| | - Liz Rolf
- Washington University in St. Louis School of Medicine
| | - Lauren Yaeger
- Washington University in St. Louis School of Medicine
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Washington V, Franklin JB, Huang ES, Mega JL, Abernethy AP. Diversity, Equity, and Inclusion in Clinical Research: A Path Toward Precision Health for Everyone. Clin Pharmacol Ther 2023; 113:575-584. [PMID: 36423203 DOI: 10.1002/cpt.2804] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
Healthcare disparities are a persistent societal problem. One of the contributing factors to this status quo is the lack of diversity and representativeness of research efforts, which result in nongeneralizable evidence that, in turn, provides suboptimal means to enable the best possible outcomes at the individual level. There are several strategies that research teams can adopt to improve the diversity, equity, and inclusion (DEI) of their efforts; these strategies span the totality of the research path, from initial design to the shepherding of clinical data through a potential regulatory process. These strategies include more intentionality and DEI-based goal-setting, more diverse research and leadership teams, better community engagement to set study goals and approaches, better tailored outreach interventions, decentralization of study procedures and incorporation of innovative technology for more flexible data collection, and self-surveillance to identify and prevent biases. Within their remit of overlooking research efforts, regulatory authorities, as stakeholders, also have the potential for a positive effect on the DEI of emerging clinical evidence. All these are implementable tools and mechanisms that can make study participation more approachable to diverse communities, and ultimately generate evidence that is more generalizable and a conduit for better outcomes. The research community has an imperative to make DEI principles key foundational aspects in study conduct in order to pursue better personalized medicine for diverse patient populations.
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Affiliation(s)
| | | | - Erich S Huang
- Verily Life Sciences, South San Francisco, California, USA
| | - Jessica L Mega
- Verily Life Sciences, South San Francisco, California, USA
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Mangal S, Niño de Rivera S, Choi J, Reading Turchioe M, Benda N, Sharko M, Myers A, Goyal P, Dugdale L, Masterson Creber R. Returning study results to research participants: Data access, format, and sharing preferences. Int J Med Inform 2023; 170:104955. [PMID: 36565546 PMCID: PMC9869800 DOI: 10.1016/j.ijmedinf.2022.104955] [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: 05/25/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Research participants have a growing expectation for transparency with their collected information; however, there is little guidance on participant preferences for receiving health information and how researchers should return this information to participants. METHODS We conducted a cross-sectional online survey with a representative sample of 502 participants in the United States. Participants were asked about their preferences for receiving, sharing, and the formatting of health information collected for research purposes. RESULTS Most participants wanted their health information returned (84 %) to use it for their own knowledge and to manage their own health. Email was the most preferred format for receiving health data (67 %), followed by online website (44 %), and/or paper copy (32 %). Data format preferences varied by age, education, financial resources, subjective numeracy, and health literacy. Around one third of Generation Z (25 %), Millennials (30 %), and Generation X (29 %) participants preferred to receive their health information with a mobile app. In contrast, very few Baby Boomers (12 %) and none from the Silent Generation preferred the mobile app format. Having a paper copy of the data was preferred by 38 % of participants without a college degree compared to those with a college degree. Preferences were highest for sharing all health information with doctors and nurses (77 %), and some information with friends and family (66 %). CONCLUSION Study findings support returning research information to participants in multiple formats, including email, online websites, and paper copy. Preferences for whom to share information with varied by stakeholders and by sociodemographic characteristics. Researchers should offer multiple formats to participants and tailor data sharing options to participants' preferences. Future research should further explore combinations of individual characteristics that may further influence data sharing and format preferences.
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Affiliation(s)
- Sabrina Mangal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA, USA.
| | - Stephanie Niño de Rivera
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Columbia University School of Nursing, New York, NY, USA
| | - Jacky Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Meghan Reading Turchioe
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Columbia University School of Nursing, New York, NY, USA
| | - Natalie Benda
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Columbia University School of Nursing, New York, NY, USA
| | - Marianne Sharko
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Annie Myers
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Columbia University School of Nursing, New York, NY, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lydia Dugdale
- Department of Medicine, Columbia University, New York, NY, USA
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Columbia University School of Nursing, New York, NY, USA
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Owen Z, Saeb S, Short S, Ong N, Angi G, Ghoreyshi A, Sullivan SS. Lingering impacts on sleep following the Daylight Savings Time transition in the Project Baseline Health Study. SLEEP SCIENCE AND PRACTICE 2022. [DOI: 10.1186/s41606-022-00082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background
The “spring forward” change to Daylight Savings Time (DST) has been epidemiologically linked with numerous health and safety risks in the days following the transition, but direct measures of sleep are infrequently collected in free-living individuals.
Methods
The Project Baseline Health Study (PBHS), a prospective, multicenter, longitudinal representative U.S. cohort study that began in 2017 launched a Sleep Mission in March 2021 to characterize sleep using patient-reported and wearable device measures, in free-living circumstances during the DST switch. Estimated sleep period duration, subjective restedness, and sleep quality were compared before and after the DST transition during specified timeframes.
Results
Of the total PBHS population of 2502 participants, 912 participants received an invitation and 607 responded by March 6th. Among those, 420 participants opted into the Sleep Mission (69.2%). The transition to DST resulted in both acute and lingering impacts on sleep. Acute effects included a 29.6 min reduction in sleep period (p = 0.03), increases in the proportion of patients who reported ‘sleeping poorly’ (from 1.7 to 13.6% [p < 0.01]), and with scores falling into the ‘unrested’ category (from 1.7 to 8.5% [p = 0.046]). There was also a downward trend in the proportion of participants reporting being rested in the morning following the DST transition (from 62.7% on March 7 to 49.2% on March 14 [p = 0.10]). Lingering effects included a 18.7% relative decrease in the daily likelihood of participants reporting restedness (from 49.2% in the week prior to the DST transition to 40.0% in the week after [p < 0.01]).
Conclusion
The DST transition is associated with an acute reduction in sleep period, as well as an increased proportion of individuals reporting poor sleep and unrestedness. The DST transition also resulted in lingering impacts on self-reported restedness, lasting into the week following the transition. This work adds to a growing understanding of the persistence of impacts on sleep health metrics due to the DST transition.
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Chatterjee R, Kwee LC, Pagidipati N, Koweek LH, Mettu PS, Haddad F, Maron DJ, Rodriguez F, Mega JL, Hernandez A, Mahaffey K, Palaniappan L, Shah SH. Multi-dimensional characterization of prediabetes in the Project Baseline Health Study. Cardiovasc Diabetol 2022; 21:134. [PMID: 35850765 PMCID: PMC9295520 DOI: 10.1186/s12933-022-01565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background We examined multi-dimensional clinical and laboratory data in participants with normoglycemia, prediabetes, and diabetes to identify characteristics of prediabetes and predictors of progression from prediabetes to diabetes or reversion to no diabetes. Methods The Project Baseline Health Study (PBHS) is a multi-site prospective cohort study of 2502 adults that conducted deep clinical phenotyping through imaging, laboratory tests, clinical assessments, medical history, personal devices, and surveys. Participants were classified by diabetes status (diabetes [DM], prediabetes [preDM], or no diabetes [noDM]) at each visit based on glucose, HbA1c, medications, and self-report. Principal component analysis (PCA) was performed to create factors that were compared across groups cross-sectionally using linear models. Logistic regression was used to identify factors associated with progression from preDM to DM and for reversion from preDM to noDM. Results At enrollment, 1605 participants had noDM; 544 had preDM; and 352 had DM. Over 4 years of follow-up, 52 participants with preDM developed DM and 153 participants reverted to noDM. PCA identified 33 factors composed of clusters of clinical variables; these were tested along with eight individual variables identified a priori as being of interest. Six PCA factors and six a priori variables significantly differed between noDM and both preDM and DM after false discovery rate adjustment for multiple comparisons (q < 0.05). Of these, two factors (one comprising glucose measures and one of anthropometry and physical function) demonstrated monotonic/graded relationships across the groups, as did three a priori variables: ASCVD risk, coronary artery calcium, and triglycerides (q < 10–21 for all). Four factors were significantly different between preDM and noDM, but concordant or similar between DM and preDM: red blood cell indices (q = 8 × 10-10), lung function (q = 2 × 10-6), risks of chronic diseases (q = 7 × 10-4), and cardiac function (q = 0.001), along with a priori variables of diastolic function (q = 1 × 10-10), sleep efficiency (q = 9 × 10-6) and sleep time (q = 6 × 10-5). Two factors were associated with progression from prediabetes to DM: anthropometry and physical function (OR [95% CI]: 0.6 [0.5, 0.9], q = 0.04), and heart failure and c-reactive protein (OR [95% CI]: 1.4 [1.1, 1.7], q = 0.02). The anthropometry and physical function factor was also associated with reversion from prediabetes to noDM: (OR [95% CI]: 1.9 [1.4, 2.7], q = 0.02) along with a factor of white blood cell indices (OR [95% CI]: 0.6 [0.4, 0.8], q = 0.02), and the a priori variables ASCVD risk score (OR [95% CI]: 0.7 [0.6, 0.9] for each 0.1 increase in ASCVD score, q = 0.02) and triglycerides (OR [95% CI]: 0.9 [0.8, 1.0] for each 25 mg/dl increase, q = 0.05). Conclusions PBHS participants with preDM demonstrated pathophysiologic changes in cardiac, pulmonary, and hematology measures and declines in physical function and sleep measures that precede DM; some changes predicted an increased risk of progression to DM. A factor with measures of anthropometry and physical function was the most important factor associated with progression to DM and reversion to noDM. Future studies may determine whether these changes elucidate pathways of progression to DM and related complications and whether they can be used to identify individuals at higher risk of progression to DM for targeted preventive interventions. Trial registration ClinicalTrials.gov NCT03154346 Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01565-x.
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Affiliation(s)
- Ranee Chatterjee
- Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd floor, NC, 27701, Durham, USA.
| | | | - Neha Pagidipati
- Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd floor, NC, 27701, Durham, USA
| | - Lynne H Koweek
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Priyatham S Mettu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Francois Haddad
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - David J Maron
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | | | | | - Adrian Hernandez
- Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd floor, NC, 27701, Durham, USA.,Duke Clinical Research Institute, Duke University School of Medicine, NC, Durham, USA
| | | | | | - Svati H Shah
- Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd floor, NC, 27701, Durham, USA.,Duke Molecular Physiology Institute, Durham, NC, USA.,Duke Clinical Research Institute, Duke University School of Medicine, NC, Durham, USA
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Young MJ, Bodien YG, Edlow BL. Ethical Considerations in Clinical Trials for Disorders of Consciousness. Brain Sci 2022; 12:211. [PMID: 35203974 PMCID: PMC8870384 DOI: 10.3390/brainsci12020211] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
As the clinical trial landscape for patients with disorders of consciousness (DoC) expands, consideration of associated ethical challenges and opportunities is of ever-increasing importance. Responsible conduct of research in the vulnerable population of persons with DoC, including those with coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), minimally conscious state (MCS), covert cortical processing (CCP), and cognitive motor dissociation (CMD), demands proactive deliberation of unique ethical issues that may arise and the adoption of robust protections to safeguard patients, surrogates, and other key stakeholders. Here we identify and critically evaluate four central categories of ethical considerations in clinical trials involving participants with DoC: (1) autonomy, respect for persons and informed consent of individuals with liminal consciousness; (2) balancing unknown benefits and risks, especially considering the epistemological gap between behavior and consciousness that complicates ordinary ascription of subjective states; (3) disclosure to surrogates and clinical teams of investigational results pertaining to consciousness; and (4) justice considerations, including equitable access to clinical trial enrollment across communities and geographies. We outline guiding principles and research opportunities for clinicians, neuroethicists, and researchers engaged in DoC clinical trials to advance ethical study design and deployment in this complex yet crucial area of investigation.
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Affiliation(s)
- Michael J. Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02114, USA
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA 02114, USA
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