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Charles WM, van der Waal MB, Flach J, Bisschop A, van der Waal RX, Es-Sbai H, McLeod CJ. Blockchain-Based Dynamic Consent and its Applications for Patient-Centric Research and Health Information Sharing: Protocol for an Integrative Review. JMIR Res Protoc 2024; 13:e50339. [PMID: 38315514 PMCID: PMC10877491 DOI: 10.2196/50339] [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: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Blockchain has been proposed as a critical technology to facilitate more patient-centric research and health information sharing. For instance, it can be applied to coordinate and document dynamic informed consent, a procedure that allows individuals to continuously review and renew their consent to the collection, use, or sharing of their private health information. Such has been suggested to facilitate ethical, compliant longitudinal research, and patient engagement. However, blockchain-based dynamic consent is a relatively new concept, and it is not yet clear how well the suggested implementations will work in practice. Efforts to critically evaluate implementations in health research contexts are limited. OBJECTIVE The objective of this protocol is to guide the identification and critical appraisal of implementations of blockchain-based dynamic consent in health research contexts, thereby facilitating the development of best practices for future research, innovation, and implementation. METHODS The protocol describes methods for an integrative review to allow evaluation of a broad range of quantitative and qualitative research designs. The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) framework guided the review's structure and nature of reporting findings. We developed search strategies and syntax with the help of an academic librarian. Multiple databases were selected to identify pertinent academic literature (CINAHL, Embase, Ovid MEDLINE, PubMed, Scopus, and Web of Science) and gray literature (Electronic Theses Online Service, ProQuest Dissertations and Theses, Open Access Theses and Dissertations, and Google Scholar) for a comprehensive picture of the field's progress. Eligibility criteria were defined based on PROSPERO (International Prospective Register of Systematic Reviews) requirements and a criteria framework for technology readiness. A total of 2 reviewers will independently review and extract data, while a third reviewer will adjudicate discrepancies. Quality appraisal of articles and discussed implementations will proceed based on the validated Mixed Method Appraisal Tool, and themes will be identified through thematic data synthesis. RESULTS Literature searches were conducted, and after duplicates were removed, 492 articles were eligible for screening. Title and abstract screening allowed the removal of 312 articles, leaving 180 eligible articles for full-text review against inclusion criteria and confirming a sufficient body of literature for project feasibility. Results will synthesize the quality of evidence on blockchain-based dynamic consent for patient-centric research and health information sharing, covering effectiveness, efficiency, satisfaction, regulatory compliance, and methods of managing identity. CONCLUSIONS The review will provide a comprehensive picture of the progress of emerging blockchain-based dynamic consent technologies and the rigor with which implementations are approached. Resulting insights are expected to inform best practices for future research, innovation, and implementation to benefit patient-centric research and health information sharing. TRIAL REGISTRATION PROSPERO CRD42023396983; http://tinyurl.com/cn8a5x7t. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50339.
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Affiliation(s)
- Wendy M Charles
- Health Administration Program, Business School, University of Colorado, Denver, Denver, CO, United States
- Healthcare Informatics Program, University of Denver, Denver, CO, United States
| | - Mark B van der Waal
- Triall, Maarssen, Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | | | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
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Middleton A, Adams A, Aidid H, Atutornu J, Boraschi D, Borra J, Bircan T, Burch C, Costa A, Dickinson A, Enticknap A, Galloway C, Gale F, Garlick E, Haydon E, Henriques S, Mitchell M, Milne R, Monaghan J, Morley KI, Muella Santos M, Olivares Boldu L, Olumogba F, Orviss K, Parry V, Patch C, Robarts L, Shingles S, Smidt C, Tomlin B, Parkinson S. Public engagement with genomics. Wellcome Open Res 2023; 8:310. [PMID: 37928209 PMCID: PMC10624956 DOI: 10.12688/wellcomeopenres.19473.2] [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] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
As detailed in its flagship report, Genome UK, the UK government recognises the vital role that broad public engagement across whole populations plays in the field of genomics. However, there is limited evidence about how to do this at scale. Most public audiences do not feel actively connected to science, are oftenunsure of the relevance to their lives and rarely talk to their family and friends about; we term this dis-connection a 'disengaged public audience'. We use a narrative review to explore: (i) UK attitudes towards genetics and genomics and what may influence reluctance to engage with these topics; (ii) innovative public engagement approaches that have been used to bring diverse public audiences into conversations about the technology. Whilst we have found some novel engagement methods that have used participatory arts, film, social media and deliberative methods, there is no clear agreement on best practice. We did not find a consistently used, evidence-based strategy for delivering public engagement about genomics across diverse and broad populations, nor a specific method that is known to encourage engagement from groups that have historically felt (in terms of perception) and been (in reality) excluded from genomic research. We argue there is a need for well-defined, tailor-made engagement strategies that clearly articulate the audience, the purpose and the proposed impact of the engagement intervention. This needs to be coupled with robust evaluation frameworks to build the evidence-base for population-level engagement strategies.
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Affiliation(s)
- Anna Middleton
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Hugbaad Aidid
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Jerome Atutornu
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
- School of Health and Sport Sciences, University of Suffolk, Ipswich, England, UK
| | - Daniela Boraschi
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Tuba Bircan
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Claudette Burch
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | | | | | - Catherine Galloway
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Emma Garlick
- Wellcome Connecting Science, Hinxton, England, UK
| | - Em Haydon
- Wellcome Connecting Science, Hinxton, England, UK
| | - Sasha Henriques
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
- Clinical Genetics Department, Guy's and St Thomas' Hospital, London, England, UK
| | - Marion Mitchell
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Richard Milne
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Katherine I Morley
- RAND Europe, Cambridge, England, UK
- Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | - Vivienne Parry
- Genomics England, Queen Mary University of London, London, England, UK
| | | | | | - Sam Shingles
- Wellcome Connecting Science, Hinxton, England, UK
| | - Cindy Smidt
- Wellcome Connecting Science, Hinxton, England, UK
| | - Ben Tomlin
- Wellcome Connecting Science, Hinxton, England, UK
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Anik FI, Sakib N, Shahriar H, Xie Y, Nahiyan HA, Ahamed SI. Unraveling a blockchain-based framework towards patient empowerment: A scoping review envisioning future smart health technologies. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2023; 29:100401. [PMID: 37200573 PMCID: PMC10102703 DOI: 10.1016/j.smhl.2023.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/15/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic shows us how crucial patient empowerment can be in the healthcare ecosystem. Now, we know that scientific advancement, technology integration, and patient empowerment need to be orchestrated to realize future smart health technologies. In that effort, this paper unravels the Good (advantages), Bad (challenges/limitations), and Ugly (lacking patient empowerment) of the blockchain technology integration in the Electronic Health Record (EHR) paradigm in the existing healthcare landscape. Our study addresses four methodically-tailored and patient-centric Research Questions, primarily examining 138 relevant scientific papers. This scoping review also explores how the pervasiveness of blockchain technology can help to empower patients in terms of access, awareness, and control. Finally, this scoping review leverages the insights gleaned from this study and contributes to the body of knowledge by proposing a patient-centric blockchain-based framework. This work will envision orchestrating three essential elements with harmony: scientific advancement (Healthcare and EHR), technology integration (Blockchain Technology), and patient empowerment (access, awareness, and control).
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Affiliation(s)
- Fahim Islam Anik
- Department of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Nazmus Sakib
- Department of Information Technology, Kennesaw State University, GA, USA
| | - Hossain Shahriar
- Department of Information Technology, Kennesaw State University, GA, USA
| | - Yixin Xie
- Department of Information Technology, Kennesaw State University, GA, USA
| | - Helal An Nahiyan
- Department of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
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Silva P, Janjan N, Ramos KS, Udeani G, Zhong L, Ory MG, Smith ML. External control arms: COVID-19 reveals the merits of using real world evidence in real-time for clinical and public health investigations. Front Med (Lausanne) 2023; 10:1198088. [PMID: 37484840 PMCID: PMC10359981 DOI: 10.3389/fmed.2023.1198088] [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: 03/31/2023] [Accepted: 05/31/2023] [Indexed: 07/25/2023] Open
Abstract
Randomized controlled trials are considered the 'gold standard' to reduce bias by randomizing patients to an experimental intervention, versus placebo or standard of care cohort. There are inherent challenges to enrolling a standard of care or cohorts: costs, site engagement logistics, socioeconomic variability, patient willingness, ethics of placebo interventions, cannibalizing the treatment arm population, and extending study duration. The COVID-19 pandemic has magnified aspects of constraints in trial recruitment and logistics, spurring innovative approaches to reducing trial sizes, accelerating trial accrual while preserving statistical rigor. Using data from medical records and databases allows for construction of external control arms that reduce the costs of an external control arm (ECA) randomized to standard of care. Simultaneously examining covariates of the clinical outcomes in ECAs that are being measured in the interventional arm can be particularly useful in phase 2 trials to better understand social and genetic determinants of clinical outcomes that might inform pivotal trial design. The FDA and EMA have promulgated a number of publicly available guidance documents and qualification reports that inform the use of this regulatory science tool to streamline clinical development, of phase 4 surveillance, and policy aspects of clinical outcomes research. Availability and quality of real-world data (RWD) are a prevalent impediment to the use of ECAs given such data is not collected with the rigor and deliberateness that characterizes prospective interventional control arm data. Conversely, in the case of contemporary control arms, a clinical trial outcome can be compared to a contemporary standard of care in cases where the standard of care is evolving at a fast pace, such as the use of checkpoint inhibitors in cancer care. Innovative statistical methods are an essential aspect of an ECA strategy and regulatory paths for these innovative approaches have been navigated, qualified, and in some cases published.
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Affiliation(s)
- Patrick Silva
- Institute of Bioscience and Technology and Department of Translational Medical Sciences, College Station, TX, United States
| | - Nora Janjan
- Center for Community Health and Aging, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Kenneth S. Ramos
- Institute of Bioscience and Technology and Department of Translational Medical Sciences, College Station, TX, United States
| | - George Udeani
- Department of Clinical Pharmacy, School of Pharmacy, Texas A&M University, College Station, TX, United States
| | - Lixian Zhong
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas A&M University, College Station, TX, United States
| | - Marcia G. Ory
- Center for Community Health and Aging, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Matthew Lee Smith
- Center for Community Health and Aging, School of Public Health, Texas A&M University, College Station, TX, United States
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Ory MG, Adepoju OE, Ramos KS, Silva PS, Vollmer Dahlke D. Health equity innovation in precision medicine: Current challenges and future directions. Front Public Health 2023; 11:1119736. [PMID: 36875406 PMCID: PMC9975548 DOI: 10.3389/fpubh.2023.1119736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- Marcia G Ory
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States.,Center for Community Health and Aging, Texas A&M School of Public Health, College Station, TX, United States
| | - Omolola E Adepoju
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, United States.,Humana Institute, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, United States
| | - Kenneth S Ramos
- Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, United States.,Texas A&M Health Science Center, Houston, TX, United States
| | - Patrick S Silva
- Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, United States.,Texas A&M Health Science Center, Houston, TX, United States
| | - Deborah Vollmer Dahlke
- Center for Community Health and Aging, Texas A&M School of Public Health, College Station, TX, United States.,DVD Associates, LLC, Austin, TX, United States
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