1
|
Platt J, Nong P, Smiddy R, Hamasha R, Carmona Clavijo G, Richardson J, Kardia SLR. Public comfort with the use of ChatGPT and expectations for healthcare. J Am Med Inform Assoc 2024; 31:1976-1982. [PMID: 38960730 PMCID: PMC11339496 DOI: 10.1093/jamia/ocae164] [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: 12/15/2023] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVES To examine whether comfort with the use of ChatGPT in society differs from comfort with other uses of AI in society and to identify whether this comfort and other patient characteristics such as trust, privacy concerns, respect, and tech-savviness are associated with expected benefit of the use of ChatGPT for improving health. MATERIALS AND METHODS We analyzed an original survey of U.S. adults using the NORC AmeriSpeak Panel (n = 1787). We conducted paired t-tests to assess differences in comfort with AI applications. We conducted weighted univariable regression and 2 weighted logistic regression models to identify predictors of expected benefit with and without accounting for trust in the health system. RESULTS Comfort with the use of ChatGPT in society is relatively low and different from other, common uses of AI. Comfort was highly associated with expecting benefit. Other statistically significant factors in multivariable analysis (not including system trust) included feeling respected and low privacy concerns. Females, younger adults, and those with higher levels of education were less likely to expect benefits in models with and without system trust, which was positively associated with expecting benefits (P = 1.6 × 10-11). Tech-savviness was not associated with the outcome. DISCUSSION Understanding the impact of large language models (LLMs) from the patient perspective is critical to ensuring that expectations align with performance as a form of calibrated trust that acknowledges the dynamic nature of trust. CONCLUSION Including measures of system trust in evaluating LLMs could capture a range of issues critical for ensuring patient acceptance of this technological innovation.
Collapse
Affiliation(s)
- Jodyn Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Paige Nong
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, United States
| | - Renée Smiddy
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Reema Hamasha
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Gloria Carmona Clavijo
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Joshua Richardson
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Sharon L R Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States
| |
Collapse
|
2
|
Richter G, Krawczak M. How to Elucidate Consent-Free Research Use of Medical Data: A Case for "Health Data Literacy". JMIR Med Inform 2024; 12:e51350. [PMID: 38889087 PMCID: PMC11196244 DOI: 10.2196/51350] [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: 07/28/2023] [Revised: 01/19/2024] [Accepted: 04/21/2024] [Indexed: 06/20/2024] Open
Abstract
Unlabelled The extensive utilization of personal health data is one of the key success factors of modern medical research. Obtaining consent to the use of such data during clinical care, however, bears the risk of low and unequal approval rates and risk of consequent methodological problems in the scientific use of the data. In view of these shortcomings, and of the proven willingness of people to contribute to medical research by sharing personal health data, the paradigm of informed consent needs to be reconsidered. The European General Data Protection Regulation gives the European member states considerable leeway with regard to permitting the research use of health data without consent. Following this approach would however require alternative offers of information that compensate for the lack of direct communication with experts during medical care. We therefore introduce the concept of "health data literacy," defined as the capacity to find, understand, and evaluate information about the risks and benefits of the research use of personal health data and to act accordingly. Specifically, health data literacy includes basic knowledge about the goals and methods of data-rich medical research and about the possibilities and limits of data protection. Although the responsibility for developing the necessary resources lies primarily with those directly involved in data-rich medical research, improving health data literacy should ultimately be of concern to everyone interested in the success of this type of research.
Collapse
Affiliation(s)
- Gesine Richter
- Institute of Experimental Medicine, Division of Biomedical Ethics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany
| | - Michael Krawczak
- Institute of Medical Informatics und Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
3
|
Smith CL, Fisher G, Dharmayani PNA, Wijekulasuriya S, Ellis LA, Spanos S, Dammery G, Zurynski Y, Braithwaite J. Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems' responses to pandemics and climate change. BMC Med 2024; 22:131. [PMID: 38519952 PMCID: PMC10960489 DOI: 10.1186/s12916-024-03345-8] [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: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to determine how these health systems have used LHS frameworks to both address the challenges posed by the COVID-19 pandemic and climate change, and to prepare for future disturbances, and thus transition towards the LHS2.0. METHODS Three databases (Embase, Scopus, and PubMed) were searched for peer-reviewed literature published in English in the five years to March 2023. Publications were included if they described a real-world LHS's response to one or more of the following: the COVID-19 pandemic, future pandemics, current climate events, future climate change events. Data were extracted and thematically analyzed using the five dimensions of the Institute of Medicine/Zurynski-Braithwaite's LHS framework: Science and Informatics, Patient-Clinician Partnerships, Continuous Learning Culture, Incentives, and Structure and Governance. RESULTS The search yielded 182 unique publications, four of which reported on LHSs and climate change. Backward citation tracking yielded 13 additional pandemic-related publications. None of the climate change-related papers met the inclusion criteria. Thirty-two publications were included after full-text review. Most were case studies (n = 12, 38%), narrative descriptions (n = 9, 28%) or empirical studies (n = 9, 28%). Science and Informatics (n = 31, 97%), Continuous Learning Culture (n = 26, 81%), Structure and Governance (n = 23, 72%) were the most frequently discussed LHS dimensions. Incentives (n = 21, 66%) and Patient-Clinician Partnerships (n = 18, 56%) received less attention. Twenty-nine papers (91%) discussed benefits or opportunities created by pandemics to furthering the development of an LHS, compared to 22 papers (69%) that discussed challenges. CONCLUSIONS An LHS 2.0 approach appears well-suited to responding to the rapidly changing and uncertain conditions of a pandemic, and, by extension, to preparing health systems for the effects of climate change. LHSs that embrace a continuous learning culture can inform patient care, public policy, and public messaging, and those that wisely use IT systems for decision-making can more readily enact surveillance systems for future pandemics and climate change-related events. TRIAL REGISTRATION PROSPERO pre-registration: CRD42023408896.
Collapse
Affiliation(s)
- Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia.
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia.
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Putu Novi Arfirsta Dharmayani
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Shalini Wijekulasuriya
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, 75 Talavera Road, North Ryde 2113, Sydney, Australia
| |
Collapse
|
4
|
Baines R, Stevens S, Austin D, Anil K, Bradwell H, Cooper L, Maramba ID, Chatterjee A, Leigh S. Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review. J Med Internet Res 2024; 26:e50421. [PMID: 38441944 PMCID: PMC10951832 DOI: 10.2196/50421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses. OBJECTIVE This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses. METHODS A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach. RESULTS Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level. CONCLUSIONS There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized.
Collapse
Affiliation(s)
- Rebecca Baines
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Sebastian Stevens
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
| | - Daniela Austin
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Hannah Bradwell
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Leonie Cooper
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Arunangsu Chatterjee
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon Leigh
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
- Warwick Medical School, University of Warwick, Conventry, United Kingdom
| |
Collapse
|
5
|
Mahajan P, Macias C, Barda A, Fung CM. Federated data health networks hold potential for accelerating emergency research. J Am Coll Emerg Physicians Open 2023; 4:e12968. [PMID: 37220474 PMCID: PMC10200260 DOI: 10.1002/emp2.12968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023] Open
Abstract
Multi-center research networks often supported by centralized data centers are integral in generating high-quality evidence needed to address the gaps in emergency care. However, there are substantial costs to maintain high-functioning data centers. A novel distributed or federated data health networks (FDHN) approach has been used recently to overcome the shortcomings of centralized data approaches. A FDHN in emergency care is comprised of a series of decentralized, interconnected emergency departments (EDs) where each site's data is structured according to a common data model that allows data to be queried and/or analyzed without the data leaving the site's institutional firewall. To best leverage FDHNs for emergency care research networks, we propose a stepwise, 2-level development and deployment process-creating a lower resource requiring Level I FDHN capable of basic analyses, or a more resource-intense Level II FDHN capable of sophisticated analyses such as distributed machine learning. Importantly, existing electronic health records-based analytical tools can be leveraged without substantial cost implications for research networks to implement a Level 1 FDHN. Fewer regulatory barriers associated with FDHN have a potential for diverse, non-network EDs to contribute to research, foster faculty development, and improve patient outcomes in emergency care.
Collapse
Affiliation(s)
- Prashant Mahajan
- Departments of Emergency Medicine and PediatricsUniversity of MichiganAnn ArborMichiganUSA
| | - Charles Macias
- Department of Pediatric Emergency MedicineUniversity Hospitals Rainbow Babies and Children's HospitalClevelandOhioUSA
| | - Amie Barda
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | |
Collapse
|
6
|
Raj M, Ryan K, Amara PS, Nong P, Calhoun K, Trinidad MG, Thiel D, Spector-Bagdady K, De Vries R, Kardia S, Platt J. Policy Preferences Regarding Health Data Sharing Among Patients With Cancer: Public Deliberations. JMIR Cancer 2023; 9:e39631. [PMID: 36719719 PMCID: PMC9929721 DOI: 10.2196/39631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Precision health offers the promise of advancing clinical care in data-driven, evidence-based, and personalized ways. However, complex data sharing infrastructures, for-profit (commercial) and nonprofit partnerships, and systems for data governance have been created with little attention to the values, expectations, and preferences of patients about how they want to be engaged in the sharing and use of their health information. We solicited patient opinions about institutional policy options using public deliberation methods to address this gap. OBJECTIVE We aimed to understand the policy preferences of current and former patients with cancer regarding the sharing of health information collected in the contexts of health information exchange and commercial partnerships and to identify the values invoked and perceived risks and benefits of health data sharing considered by the participants when formulating their policy preferences. METHODS We conducted 2 public deliberations, including predeliberation and postdeliberation surveys, with patients who had a current or former cancer diagnosis (n=61). Following informational presentations, the participants engaged in facilitated small-group deliberations to discuss and rank policy preferences related to health information sharing, such as the use of a patient portal, email or SMS text messaging, signage in health care settings, opting out of commercial data sharing, payment, and preservation of the status quo. The participants ranked their policy preferences individually, as small groups by mutual agreement, and then again individually in the postdeliberation survey. RESULTS After deliberation, the patient portal was ranked as the most preferred policy choice. The participants ranked no change in status quo as the least preferred policy option by a wide margin. Throughout the study, the participants expressed concerns about transparency and awareness, convenience, and accessibility of information about health data sharing. Concerns about the status quo centered around a lack of transparency, awareness, and control. Specifically, the patients were not aware of how, when, or why their data were being used and wanted more transparency in these regards as well as greater control and autonomy around the use of their health data. The deliberations suggested that patient portals would be a good place to provide additional information about data sharing practices but that over time, notifications should be tailored to patient preferences. CONCLUSIONS Our study suggests the need for increased disclosure of health information sharing practices. Describing health data sharing practices through patient portals or other mechanisms personalized to patient preferences would minimize the concerns expressed by patients about the extent of data sharing that occurs without their knowledge. Future research and policies should identify ways to increase patient control over health data sharing without reducing the societal benefits of data sharing.
Collapse
Affiliation(s)
- Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, Champaign, IL, United States
| | - Kerry Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Philip Sahr Amara
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Paige Nong
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Karen Calhoun
- Michigan Institute for Clinical & Health Research, Ann Arbor, MI, United States
| | - M Grace Trinidad
- National Hemophilia Program Coordinating Center, Ann Arbor, MI, United States
| | - Daniel Thiel
- Lyman Briggs College, Michigan State University, East Lansing, MI, United States
| | - Kayte Spector-Bagdady
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sharon Kardia
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Jodyn Platt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
7
|
Leung T, Verheij RA, Francke AL, Tomassen M, Houtzager M, Joling KJ, Oosterveld-Vlug MG. Setting up a Governance Framework for Secondary Use of Routine Health Data in Nursing Homes: Development Study Using Qualitative Interviews. J Med Internet Res 2023; 25:e38929. [PMID: 36696162 PMCID: PMC9909520 DOI: 10.2196/38929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/07/2022] [Accepted: 11/25/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In the nursing home sector, reusing routinely recorded data from electronic health records (EHRs) for knowledge development and quality improvement is still in its infancy. Trust in appropriate and responsible reuse is crucial for patients and nursing homes deciding whether to share EHR data for these purposes. A data governance framework determines who may access the data, under what conditions, and for what purposes. This can help obtain that trust. Although increasing attention is being paid to data governance in the health care sector, little guidance is available on development and implementation of a data governance framework in practice. OBJECTIVE This study aims to describe the development process of a governance framework for the "Registry Learning from Data in Nursing Homes," a national registry for EHR data on care delivered by nursing home physicians (in Dutch: specialist ouderengeneeskunde) in Dutch nursing homes-to allow data reusage for research and quality improvement of care. METHODS Relevant stakeholders representing practices, policies, and research in the nursing home sector were identified. Semistructured interviews were conducted with 20 people from 14 stakeholder organizations. The main aim of the interviews was to explore stakeholders' perspectives regarding the Registry's aim, data access criteria, and governing bodies' tasks and composition. Interview topics and analyses were guided by 8 principles regarding governance for reusing health data, as described in the literature. Interview results, together with legal advice and consensus discussions by the Registry's consortium partners, were used to shape the rules, regulations, and governing bodies of the governance framework. RESULTS Stakeholders valued the involvement of nursing home residents and their representatives, nursing home physicians, nursing homes' boards of directors, and scientists and saw this as a prerequisite for a trustworthy data governance framework. For the Registry, involvement of these groups can be achieved through a procedure in which residents can provide their consent or objection to the reuse of the data, transparency about the decisions made, and providing them a position in a governing body. In addition, a data request approval procedure based on predefined assessment criteria indicates that data reuse by third parties aligns with the aims of the Registry, benefits the nursing home sector, and protects the privacy of data subjects. CONCLUSIONS The stakeholders' views, expertise, and knowledge of other frameworks and relevant legislation serve to inform the application of governance principles to the contexts of both the nursing home sector and the Netherlands. Many different stakeholders were involved in the development of the Registry Learning from Data in Nursing Homes' governance framework and will continue to be involved. Engagement of the full range of stakeholders in an early stage of governance framework development is important to generate trust in appropriate and responsible data reuse.
Collapse
Affiliation(s)
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Tranzo, School of Social Sciences and Behavioural Research, Tilburg University, Tilburg, Netherlands
| | - Anneke L Francke
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Public and Occupational Health, Location Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Marit Tomassen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Max Houtzager
- Department of Medicine for Older People, Location Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Aging & Later Life, Amsterdam Public Health, Amsterdam, Netherlands
| | - Karlijn J Joling
- Department of Medicine for Older People, Location Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Aging & Later Life, Amsterdam Public Health, Amsterdam, Netherlands
| | | |
Collapse
|
8
|
Richter G, Borzikowsky C, Hoyer BF, Laudes M, Krawczak M. Secondary research use of personal medical data: patient attitudes towards data donation. BMC Med Ethics 2021; 22:164. [PMID: 34911502 PMCID: PMC8672332 DOI: 10.1186/s12910-021-00728-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background The SARS-CoV-2 pandemic has highlighted once more the great need for comprehensive access to, and uncomplicated use of, pre-existing patient data for medical research. Enabling secondary research-use of patient-data is a prerequisite for the efficient and sustainable promotion of translation and personalisation in medicine, and for the advancement of public-health. However, balancing the legitimate interests of scientists in broad and unrestricted data-access and the demand for individual autonomy, privacy and social justice is a great challenge for patient-based medical research. Methods We therefore conducted two questionnaire-based surveys among North-German outpatients (n = 650) to determine their attitude towards data-donation for medical research, implemented as an opt-out-process. Results We observed a high level of acceptance (75.0%), the most powerful predictor of a positive attitude towards data-donation was the conviction that every citizen has a duty to contribute to the improvement of medical research (> 80% of participants approving data-donation). Interestingly, patients distinguished sharply between research inside and outside the EU, despite a general awareness that universities and public research institutions cooperate with commercial companies, willingness to allow use of donated data by the latter was very low (7.1% to 29.1%, depending upon location of company). The most popular measures among interviewees to counteract reservations against commercial data-use were regulation by law (61.4%), stipulating in the process that data are not sold or resold (84.6%). A majority requested control of both the use (46.8%) and the protection (41.5%) of the data by independent bodies. Conclusions In conclusion, data-donation for medical research, implemented as a combination of legal entitlement and easy-to-exercise-right to opt-out, was found to be widely supported by German patients and therefore warrants further consideration for a transposition into national law. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00728-x.
Collapse
Affiliation(s)
- Gesine Richter
- Institute of Experimental Medicine, Division of Biomedical Ethics, Kiel University, University Hospital Schleswig-Holstein, Niemannsweg 11, Haus 1, 24105, Kiel, Germany.
| | - Christoph Borzikowsky
- Institute of Medical Informatics und Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Bimba Franziska Hoyer
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Laudes
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Michael Krawczak
- Institute of Medical Informatics und Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
9
|
Ellis LA, Sarkies M, Churruca K, Dammery G, Meulenbroeks I, Smith CL, Pomare C, Mahmoud Z, Zurynski Y, Braithwaite J. The science of learning health systems: A scoping review of the empirical research (Preprint). JMIR Med Inform 2021; 10:e34907. [PMID: 35195529 PMCID: PMC8908194 DOI: 10.2196/34907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/07/2021] [Accepted: 01/02/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Genevieve Dammery
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | | | - Carolynn L Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
10
|
Raj M, De Vries R, Nong P, Kardia SLR, Platt JE. Do people have an ethical obligation to share their health information? Comparing narratives of altruism and health information sharing in a nationally representative sample. PLoS One 2020; 15:e0244767. [PMID: 33382835 PMCID: PMC7774955 DOI: 10.1371/journal.pone.0244767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the emergence of new health information technologies, health information can be shared across networks, with or without patients' awareness and/or their consent. It is often argued that there can be an ethical obligation to participate in biomedical research, motivated by altruism, particularly when risks are low. In this study, we explore whether altruism contributes to the belief that there is an ethical obligation to share information about one's health as well as how other health care experiences, perceptions, and concerns might be related to belief in such an obligation. METHODS We conducted an online survey using the National Opinion Research Center's (NORC) probability-based, nationally representative sample of U.S. adults. Our final analytic sample included complete responses from 2069 participants. We used multivariable logistic regression to examine how altruism, together with other knowledge, attitudes, and experiences contribute to the belief in an ethical obligation to allow health information to be used for research. RESULTS We find in multivariable regression that general altruism is associated with a higher likelihood of belief in an ethical obligation to allow one's health information to be used for research (OR = 1.22, SE = 0.14, p = 0.078). Trust in the health system and in care providers are both associated with a significantly higher likelihood of believing there is an ethical obligation to allow health information to be used (OR = 1.48, SE = 0.76, p<0.001; OR = 1.58, SE = 0.26, p<0.01, respectively). CONCLUSIONS Belief that there is an ethical obligation to allow one's health information to be used for research is shaped by altruism and by one's experience with, and perceptions of, health care and by general concerns about the use of personal information. Altruism cannot be assumed and researchers must recognize the ways encounters with the health care system influence (un)willingness to share one's health information.
Collapse
Affiliation(s)
- Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, United States of America
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Paige Nong
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Sharon L. R. Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Jodyn E. Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States of America
| |
Collapse
|
11
|
Broes S, Verbaanderd C, Casteels M, Lacombe D, Huys I. Sharing of Clinical Trial Data and Samples: The Cancer Patient Perspective. Front Med (Lausanne) 2020; 7:33. [PMID: 32118017 PMCID: PMC7026937 DOI: 10.3389/fmed.2020.00033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Today, many initiatives and papers are devoted to clinical trial data (and to a lesser extent sample) sharing. Journal editors, pharmaceutical companies, funding agencies, governmental organizations, regulators, and clinical investigators have been debating the legal, ethical, and social implications of clinical data and sample sharing for several years. However, only little research has been conducted to unveil the patient perspective. Aim: To substantiate the current debate, we aimed to explore the attitudes of patients toward the re-use of clinical trial samples and data and to determine how they would prefer to be involved in this process. Materials and Methods: Sixteen in-depth interviews were conducted with cancer patients currently participating in a clinical trial. Results: This study indicates a general willingness of cancer patients participating in a clinical trial to allow re-use of their clinical trial data and/or samples by the original research team, and a generally open approach to share data and/or samples with other research teams, but some would like to be informed in this case. Despite divergent opinions about how patients prefer to be engaged, ranging from passive donors up to those explicitly wanting more control, participants expressed positive opinions toward technical solutions that allow indicating their preferences. Conclusion: Patients were open to sharing and re-use of data and samples to advance medical research but opinions varied on the level of patient involvement and the need for re-consent. A stratified approach for consent that allows individualization of data and sample sharing preferences may be useful, yet the implementation of such an approach warrants further research.
Collapse
Affiliation(s)
- Stefanie Broes
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Ciska Verbaanderd
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Anticancer Fund, Strombeek-Bever, Belgium
| | - Minne Casteels
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|