1
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Chung WK, Berg JS, Botkin JR, Brenner SE, Brosco JP, Brothers KB, Currier RJ, Gaviglio A, Kowtoniuk WE, Olson C, Lloyd-Puryear M, Saarinen A, Sahin M, Shen Y, Sherr EH, Watson MS, Hu Z. Newborn screening for neurodevelopmental diseases: Are we there yet? Am J Med Genet C Semin Med Genet 2022; 190:222-230. [PMID: 35838066 PMCID: PMC9796120 DOI: 10.1002/ajmg.c.31988] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 01/01/2023]
Abstract
In the US, newborn screening (NBS) is a unique health program that supports health equity and screens virtually every baby after birth, and has brought timely treatments to babies since the 1960's. With the decreasing cost of sequencing and the improving methods to interpret genetic data, there is an opportunity to add DNA sequencing as a screening method to facilitate the identification of babies with treatable conditions that cannot be identified in any other scalable way, including highly penetrant genetic neurodevelopmental disorders (NDD). However, the lack of effective dietary or drug-based treatments has made it nearly impossible to consider NDDs in the current NBS framework, yet it is anticipated that any treatment will be maximally effective if started early. Hence there is a critical need for large scale pilot studies to assess if and how NDDs can be effectively screened at birth, if parents desire that information, and what impact early diagnosis may have. Here we attempt to provide an overview of the recent advances in NDD treatments, explore the possible framework of setting up a pilot study to genetically screen for NDDs, highlight key technical, practical, and ethical considerations and challenges, and examine the policy and health system implications.
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Affiliation(s)
- Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University, New York, New York, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey R Botkin
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Steven E Brenner
- Department of Plant and Microbial Biology, University of California, Berkeley, California, USA
| | - Jeffrey P Brosco
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Kyle B Brothers
- Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Robert J Currier
- School of Medicine, University of California, San Francisco, California, USA
| | - Amy Gaviglio
- Connetics Consulting, Minneapolis, Minnesota, USA
| | | | - Colleen Olson
- Steinhardt Graduate School of Education, New York University, New York, New York, USA
| | | | | | - Mustafa Sahin
- Rosamund Stone Zander Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yufeng Shen
- Department of Systems Biology, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Elliott H Sherr
- Department of Neurology, Weill Institute of Neurosciences, University of California, San Francisco, California, USA
| | - Michael S Watson
- Department of Pediatrics, School of Medicine, Washington University (Adjunct), St. Louis, Missouri, USA
| | - Zhanzhi Hu
- Department of Systems Biology, Columbia University, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA
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2
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Botkin JR. What Should Physician-Researchers Tell Patient-Subjects About Their Relationships With Industry? AMA J Ethics 2021; 23:E685-691. [PMID: 34710027 DOI: 10.1001/amajethics.2021.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An investigator's personal financial interest in technology under investigation or in the company sponsoring the research is a clear conflict of interest (COI). Such financial relationships are common, and ethical questions rightly emerge about COIs' capacity to compromise an investigator's approaches to research. This commentary on a case suggests that COI disclosure is appropriate during the process of facilitating patient-subjects' informed consent because it promotes informed decision making and motivates transparency. But COI disclosures are not always efficacious, nor are they sufficient to address the problem of research bias. This commentary argues that mitigation or elimination of COIs is a more effective strategy than disclosure.
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Affiliation(s)
- Jeffrey R Botkin
- Professor of pediatrics at the University of Utah in Salt Lake City
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3
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Jackson BR, Ye Y, Crawford JM, Becich MJ, Roy S, Botkin JR, de Baca ME, Pantanowitz L. The Ethics of Artificial Intelligence in Pathology and Laboratory Medicine: Principles and Practice. Acad Pathol 2021; 8:2374289521990784. [PMID: 33644301 PMCID: PMC7894680 DOI: 10.1177/2374289521990784] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/24/2020] [Accepted: 12/28/2020] [Indexed: 12/24/2022] Open
Abstract
Growing numbers of artificial intelligence applications are being developed and applied to pathology and laboratory medicine. These technologies introduce risks and benefits that must be assessed and managed through the lens of ethics. This article describes how long-standing principles of medical and scientific ethics can be applied to artificial intelligence using examples from pathology and laboratory medicine.
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Affiliation(s)
- Brian R. Jackson
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, UT, USA
| | - Ye Ye
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael J. Becich
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Somak Roy
- Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey R. Botkin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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4
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Kious BM, Docherty AR, Botkin JR, Brown TR, Francis LP, Gray DD, Keeshin BR, Stark LA, Witte B, Coon H. Correction: Ethical and public health implications of genetic testing for suicide risk: family and survivor perspectives. Genet Med 2020; 23:425. [PMID: 33353974 DOI: 10.1038/s41436-020-01059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Brent M Kious
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA. .,Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Anna R Docherty
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.,Interdisciplinary Program in Neuroscience, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey R Botkin
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.,Utah Center for Excellence in ELSI Research, University of Utah, Salt Lake City, UT, USA
| | - Teneille R Brown
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.,Utah Center for Excellence in ELSI Research, University of Utah, Salt Lake City, UT, USA.,S.J. Quinney College of Law, University of Utah, Salt Lake City, UT, USA
| | - Leslie P Francis
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.,Utah Center for Excellence in ELSI Research, University of Utah, Salt Lake City, UT, USA.,S.J. Quinney College of Law, University of Utah, Salt Lake City, UT, USA
| | - Douglas D Gray
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.,Salt Lake City Veterans Administration, Salt Lake City, UT, USA
| | - Brooks R Keeshin
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Louisa A Stark
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA.,Utah Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT, USA
| | - Brieanne Witte
- Utah Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT, USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA.,Interdisciplinary Program in Neuroscience, University of Utah, Salt Lake City, UT, USA
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5
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Jalali A, Rothwell E, Botkin JR, Anderson RA, Butterfield RJ, Nelson RE. Cost-Effectiveness of Nusinersen and Universal Newborn Screening for Spinal Muscular Atrophy. J Pediatr 2020; 227:274-280.e2. [PMID: 32659229 PMCID: PMC7686158 DOI: 10.1016/j.jpeds.2020.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of nusinersen with and without universal newborn screening for infantile-onset spinal muscular atrophy (SMA). STUDY DESIGN A Markov model using data from clinical trials with US epidemiologic and cost data was developed. The primary interventions studied were nusinersen treatment in a screening setting, nusinersen treatment in a nonscreening setting, and standard care. Analysis was conducted from a societal perspective. RESULTS Compared with no screening and no treatment, the incremental cost-effectiveness ratio (ICER) for nusinersen with screening was $330 558 per event-free life year (LY) saved, whereas the ICER for nusinersen treatment without screening was $508 481 per event-free LY saved. For nusinersen with screening to be cost-effective at a willingness-to-pay (WTP) threshold of $50 000 per event-free LY saved, the price would need to be $23 361 per dose, less than one-fifth its current price of $125 000. Preliminary data from the NURTURE trial indicated an 85.7% improvement in expected LYs saved compared with our base results. In probabilistic sensitivity analysis, nusinersen and screening was a preferred strategy 93% of the time at a $500 000 WTP threshold. CONCLUSION Universal newborn screening for SMA provides improved economic value for payers and patients when nusinersen is available.
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Affiliation(s)
- Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY.
| | - Erin Rothwell
- Department of Obstetrics and Gynecology, University of Utah School of Medicine
| | - Jeffrey R. Botkin
- Utah Center of Excellence in ELSI Research;,Department of Pediatrics, University of Utah School of Medicine
| | - Rebecca A. Anderson
- Utah Center of Excellence in ELSI Research;,Department of Pediatrics, University of Utah School of Medicine
| | | | - Richard E. Nelson
- IDEAS Center, Veterans Administration Salt Lake City Health Care System;,Division of Epidemiology, University of Utah School of Medicine
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6
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Botkin JR. Informed Consent for Genetic and Genomic Research. ACTA ACUST UNITED AC 2020; 108:e104. [PMID: 33202103 DOI: 10.1002/cphg.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Genetic research often utilizes or generates information that is potentially sensitive to individuals, families, or communities. For these reasons, genetic research may warrant additional scrutiny from investigators and governmental regulators, compared to other types of biomedical research. The informed consent process should address the range of social and psychological issues that may arise in genetic research. This article addresses a number of these issues, including recruitment of participants, disclosure of results, psychological impact of results, insurance and employment discrimination, community engagement, consent for tissue banking, and intellectual property issues. Points of consideration are offered to assist in the development of protocols and consent processes in light of contemporary debates on a number of these issues. © 2020 Wiley Periodicals LLC.
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7
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Grosse SD, Prosser LA, Botkin JR. Avoiding Harm From Hyperbilirubinemia Screening-Reply. JAMA Pediatr 2019; 173:1209-1210. [PMID: 31589244 PMCID: PMC7203610 DOI: 10.1001/jamapediatrics.2019.3762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, US
Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa A. Prosser
- Department of Health Management and Policy, University of Michigan,
Ann Arbor; Susan B. Meister Child Health Evaluation and Research Center,
Department of Pediatrics, University of Michigan, Ann Arbor
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8
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Affiliation(s)
- Jeffrey R Botkin
- Professor of Pediatrics, University of Utah, Salt Lake City, UT, USA.
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Burr JS, Johnson AR, Vasenina V, Bisping S, Coleman RW, Botkin JR, Dean JM. Implementing a Central IRB Model in a Multicenter Research Network. Ethics Hum Res 2019; 41:23-28. [PMID: 31108575 PMCID: PMC7236440 DOI: 10.1002/eahr.500016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Implementing the National Institutes of Health's (NIH's) new single institutional review board (IRB) policy has caused a paradigm shift in IRB review across the country. IRBs and human research protection programs are looking more closely at their processes for ceding review and developing procedures to handle local review when relying on a single IRB. This article describes an NIH-funded network that proactively instituted a central IRB (CIRB) in 2012, anticipating the NIH future mandate. Lessons learned are described. There was a steep learning curve for IRBs and participating sites. IRB submission workload burden shifted from study teams to the data coordinating center, which created new workflow challenges, especially preparing hundreds of consent documents centrally. Despite difficulties encountered with CIRB review, this network is now fully functioning under a CIRB model. Further review and experience are needed to determine whether this shift in IRB review has eliminated duplicative review or regulatory burden from study teams.
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Affiliation(s)
- Jeri S Burr
- Executive director of the Utah Trial Innovation Center at the University of Utah
| | - Ann R Johnson
- Director of the institutional review board at the University of Utah
| | - Valeriya Vasenina
- Business analyst for the Utah Trial Innovation Center at the University of Utah
| | - Stephanie Bisping
- Director of program services for the Utah Trial Innovation Center at the University of Utah
| | | | | | - J Michael Dean
- Principal investigator of the Utah Trial Innovation Center and the associate dean for clinical research at the University of Utah
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10
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Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa A. Prosser
- Department of Health Management and Policy, University of Michigan, Ann Arbor; and Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
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11
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Botkin JR. The Bane of "Boilerplate" Language in Research Consent Forms: Ensuring Consent Forms Promote Autonomous Authorization. Am J Bioeth 2019; 19:83-84. [PMID: 31544660 DOI: 10.1080/15265161.2019.1572827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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12
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Rothwell E, Johnson E, Wong B, Rose NC, Latendresse G, Altizer R, Zagal J, Smid M, Watson A, Botkin JR. The Use of a Game-Based Decision Aid to Educate Pregnant Women about Prenatal Screening: A Randomized Controlled Study. Am J Perinatol 2019; 36:322-328. [PMID: 30107621 PMCID: PMC6512317 DOI: 10.1055/s-0038-1667371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE This project developed and evaluated the efficacy of a game decision aid among pregnant women about prenatal screening in a randomized controlled study. STUDY DESIGN Participants were recruited from an obstetric clinic of an academic urban medical center and randomized (n = 73) to one of two study groups: the control group (n = 39) that used a brochure or the intervention group (n = 34) that also used a game decision aid. RESULT Participants who played the game had higher knowledge scores (m = 21.41, standard deviation [SD] = 1.74) than participants in the control group (m = 19.59; SD = 3.31), p = 0.004. The median time of game playing was 6:43 minutes (range: 2:17-16:44). The groups were similar in frequency of completing screening after the study, control = 6 (15%) versus intervention = 11 (32%), p = 0.087. However, the more interaction with the game resulted in more positive attitudes toward screening. CONCLUSION The addition of a game decision aid was effective in educating pregnant women about prenatal screening. As other genetic testing decisions continue to increase within clinical care, game-based decision tools may be a constructive method of informed decision-making.
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Affiliation(s)
- Erin Rothwell
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah,College of Nursing, University of Utah, Salt Lake City, Utah
| | - Erin Johnson
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah,College of Nursing, University of Utah, Salt Lake City, Utah
| | - Bob Wong
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Nancy C. Rose
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah,Division of Maternal Fetal Medicine, Intermountain Healthcare, Murray, Utah
| | - Gwen Latendresse
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah,College of Nursing, University of Utah, Salt Lake City, Utah
| | - Roger Altizer
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jose Zagal
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Marcela Smid
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Abby Watson
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jeffrey R. Botkin
- Division of Medical Ethics and Humanities, School of Medicine, University of Utah, Salt Lake City, Utah
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13
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Botkin JR. Genetic Contextualism and the Value of a Structured Process. Am J Bioeth 2019; 19:72-73. [PMID: 31307354 PMCID: PMC6768547 DOI: 10.1080/15265161.2018.1546351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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14
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Affiliation(s)
- Jeffrey R Botkin
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City
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15
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Botkin JR, Appelbaum PS, Bakken S, Brown C, Burke W, Fabsitz R, Gamble VN, Gonsalves G, Kost R, Leonard DGB, McGuire A, Nichols JH, Patrick-Lake B, Wilkins CH, Zikmund-Fisher BJ. Standardizing return of participant results. Science 2018; 362:759-760. [DOI: 10.1126/science.aav8095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Jeffrey R. Botkin
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84112, USA
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, USA
| | - Suzanne Bakken
- School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY 10032, USA
| | - Chester Brown
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Richard Fabsitz
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA
| | | | - Gregg Gonsalves
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06511, USA
| | - Rhonda Kost
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Debra G. B. Leonard
- Department of Pathology, University of Vermont Medical Center, Burlington, VT 05401, USA
| | - Amy McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77401, USA
| | - James H. Nichols
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Bray Patrick-Lake
- Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA
| | - Consuelo H. Wilkins
- Department of Medicine, Vanderbilt University Medical Center and Meharry Medical College, Nashville, TN 37208, USA
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
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16
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Rothwell E, Botkin JR, Cheek-O'Donnell S, Wong B, Case GA, Johnson E, Matheson T, Wilson A, Robinson NR, Rawlings J, Horejsi B, Lopez AM, Byington CL. An empirical assessment of the short-term impacts of a reading of Deborah Zoe Laufer's drama Informed Consent on attitudes and intentions to participate in genetic research. AJOB Empir Bioeth 2018; 9:69-76. [PMID: 29513089 PMCID: PMC6092928 DOI: 10.1080/23294515.2018.1449771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study assessed the short-term impact of the play "Informed Consent" by Deborah Zoe Laufer (a fictionalized look at the controversy over specimens collected from the Havasupai Tribe for diabetes research in 1989) on perceptions of trust, willingness to donate biospecimens, and attitudes toward harm and privacy among the medical and undergraduate students, faculty, and the public in the Intermountain West. METHODS Surveys were administered before and after a staged reading of the play by professional actors. Survey items included the short form Trust in Medical Researchers, and single-item questions about group identity, ethics of genetic testing in children, and willingness to donate biospecimens. In addition, respondents were given the option to answer open-ended questions through e-mail. RESULTS Out of the 481 who attended the play, 421 completed both the pre and post surveys, and 166 participants completed open-ended questions online approximately 1 week after the play. Across all participants, there were significant declines for trust in medical researchers and for the survey item "is it ethical for investigators to test children for adult onset diseases" (p < .001 for both) following the play. There was a significant increase in agreement to improve group identity protections (p < .001) and there were no differences on willingness to donate biospecimens to research (p = .777). Qualitative data provided extensive contextual data supporting these perspectives. DISCUSSION This is one of the first studies to document short-term impacts of a theatrical performance on both attitudes and behavioral intentions toward research ethics and clinical research participation. Future research should continue to explore the impact of theatrical performances among public and investigators on the ethical issues and complexities in clinical research.
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Affiliation(s)
| | | | | | - Bob Wong
- a University of Utah , Salt Lake City , Utah , USA
| | | | - Erin Johnson
- a University of Utah , Salt Lake City , Utah , USA
| | | | - Alena Wilson
- a University of Utah , Salt Lake City , Utah , USA
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Abstract
Learning healthcare systems rely on potentially sensitive data and biospecimens from patients who typically have no knowledge of secondary uses of these resources for research. While this failure to inform patients of these practices is consistent with human subject regulations for research, these practices risk controversy and a loss of trust in the integrity of healthcare institutions. This article reviews recent controversies in this domain and argues for new institutional practices that entail patient education about secondary uses of data and biospecimens and the opportunity for patient choice in the form of an opt-out system. This approach would enhance transparency and reduce the risk of a loss of public trust in the research enterprise.
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18
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Rothwell E, Goldenberg A, Johnson E, Riches N, Tarini B, Botkin JR. An Assessment of a Shortened Consent Form for the Storage and Research Use of Residual Newborn Screening Blood Spots. J Empir Res Hum Res Ethics 2017; 12:335-342. [PMID: 29073807 DOI: 10.1177/1556264617736199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
As state newborn screening programs develop approaches to parental permission for the storage and use of residual dried newborn screening samples, it is important to understand how the public comprehends the consent elements. Focus groups in Utah, California, and Michigan ( n = 7 groups, 69 participants) were conducted to evaluate the language on a shortened consent form. Outcomes from the analysis included barriers to conceptualizing biospecimen research, the overly cautious tone and awkwardness of the consent form, and perceptions of community versus individual benefit. This research offers insight on public response to, and comprehension of, commonly used consent language for the storage and use of dried blood spot research in a shortened consent form.
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Affiliation(s)
| | | | | | | | - Beth Tarini
- 3 The University of Iowa, Iowa City, IA, USA
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20
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Goldenberg AJ, Comeau AM, Grosse SD, Tanksley S, Prosser LA, Ojodu J, Botkin JR, Kemper AR, Green NS. Evaluating Harms in the Assessment of Net Benefit: A Framework for Newborn Screening Condition Review. Matern Child Health J 2016; 20:693-700. [PMID: 26833040 DOI: 10.1007/s10995-015-1869-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Department of Health and Human Services (HHS) Advisory Committee on Heritable Disorders in Newborns and Children ("Advisory Committee") makes recommendations to the HHS Secretary regarding addition of new conditions to the national Recommended Uniform Screening Panel for newborns. The Advisory Committee's decision-making process includes assessing the net benefit of screening for nominated conditions, informed by systematic evidence reviews generated by an independent Condition Review Workgroup. The evidence base regarding harms associated with screening for specific conditions is often more limited than that for benefits. PROCEDURES The process for defining potential harms from newborn screening reviewed the frameworks from other public health evidence-based review processes, adapted to newborn screening by experts in systematic review, newborn screening programs and bioethics, with input from and approval by the Advisory Committee. MAIN FINDINGS To support the Advisory Committee's review of nominated conditions, the Workgroup has developed a standardized approach to evaluation of harms and relevant gaps in the evidence. Types of harms include the physical burden to infants; psychosocial and logistic burdens to families from screening or diagnostic evaluation; increased risk of medical treatment for infants diagnosed earlier than children with clinical presentation; delayed diagnosis from false negative results; psychosocial harm from false positive results; uncertainty of clinical diagnosis, age of onset or clinical spectrum; and disparities in access to diagnosis or therapy. CONCLUSIONS Estimating the numbers of children at risk, the magnitude, timing and likelihood of harms will be integrated into Workgroup reports to the Advisory Committee.
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Affiliation(s)
- Aaron J Goldenberg
- Department of Bioethics, Case Western Reserve University, School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106-4976, USA
| | - Anne Marie Comeau
- New England Newborn Screening Program, University of Massachusetts Medical School, 305 South St., Jamaica Plain, MA, 02130, USA
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA, 30341, USA
| | - Susan Tanksley
- Laboratory Services Section, Newborn Screening Laboratory, Texas Department of State Health Services, PO Box 149347, MC 1947, Austin, TX, 78714-9347, USA
| | - Lisa A Prosser
- CHEAR Unit, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.,Health Management and Policy, SPH CHEAR Unit, Pediatrics, University of Michigan Health System, 300 N Ingalls St, Rm 6E14, SPC 5456, Ann Arbor, MI, 48109, USA
| | - Jelili Ojodu
- Association of Public Health Laboratories, 8515 Georgia Avenue, Suite 700, Silver Spring, MD, 20910, USA
| | - Jeffrey R Botkin
- Department of Pediatrics, University of Utah, 75 South 2000 East #108, Salt Lake City, UT, 84112-8930, USA
| | - Alex R Kemper
- Department of Pediatrics, Duke University/Duke Clinical Research Institute, 2400 Pratt Street Rm 0311, Terrace Level, NP, Durham, NC, 27705, USA
| | - Nancy S Green
- Department of Pediatrics, Columbia University Medical Center, 630 West 168 St, Black Building 2-241, Box 168, New York, NY, 10032, USA.
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21
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Abstract
PURPOSE OF REVIEW Developments in genetic test technologies enable a detailed analysis of the genomes of individuals across the range of human development from embryos to adults with increased precision and lower cost. These powerful technologies raise a number of ethical issues in pediatrics, primarily because of the frequent lack of clinical utility of genetic information, the generation of secondary results and questions over the proper scope of parental authority for testing. RECENT FINDINGS Several professional organizations in the fields of genetics and pediatrics have published new guidance on the ethical, legal, and policy issues relevant to genetic testing in children. The roles of predictive testing for adult-onset conditions, the management of secondary findings and the role of informed consent for newborn screening remain controversial. However, research and experience are not demonstrating serious adverse psychosocial impacts from genetic testing and screening in children. The use of these technologies is expanding with the notion that the personal utility of test results, rather than clinical utility, may be sufficient to justify testing. SUMMARY The use of microarray and genome sequencing technologies is expanding in the care of children. More deference to parental decision-making is evolving in contexts wherein information and counseling can be made readily available.
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Affiliation(s)
- Jeffrey R Botkin
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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22
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Rothwell E, Johnson E, Mathiesen A, Golden K, Metcalf A, Rose NC, Botkin JR. Experiences among Women with Positive Prenatal Expanded Carrier Screening Results. J Genet Couns 2016; 26:690-696. [PMID: 27796679 DOI: 10.1007/s10897-016-0037-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 10/14/2016] [Indexed: 11/29/2022]
Abstract
The offering and acceptance of expanded carrier screening is increasing among pregnant women including women without an increased risk based on race, ethnicity or family history. The chances of a positive screening test have been reported to be as high as 24 % when multiple conditions are screened. Yet, little is known about the way these tests are offered and how patients are affected by a positive test result. To explore this area of genetic testing, interviews (n = 17) were conducted among women who received positive expanded carrier results in the context of obstetric care. A content analysis was conducted on the transcript data from the interviews. Outcomes of this research suggest that educational interventions are needed to improve maternal understanding of positive carrier screening results. Most of the participants in this study confused the results with other prenatal screening test options. In addition, the way the results were discussed varied greatly, and influenced participants' thoughts about reproductive decisions that led to a range of emotional uncertainty. Our data suggests that genetic counseling improved participants' understanding of positive results. More research is needed to further understand if our results are consistent within a larger, more diverse sample, and to explore how to best provide education about expanded carrier screening.
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Affiliation(s)
- Erin Rothwell
- Division of Health Systems and Community-Based Care, College of Nursing, School of Medicine, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA. .,Division of Medical Ethics and Humanities, University of Utah, Salt Lake City, UT, USA.
| | - Erin Johnson
- Division of Health Systems and Community-Based Care, College of Nursing, School of Medicine, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Amber Mathiesen
- Division of Maternal Fetal Medicine, Department of ObGyn, University of Utah, Salt Lake City, UT, USA
| | - Kylie Golden
- Division of Health Systems and Community-Based Care, College of Nursing, School of Medicine, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Audrey Metcalf
- Division of Health Systems and Community-Based Care, College of Nursing, School of Medicine, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Nancy C Rose
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey R Botkin
- Division of Medical Ethics and Humanities, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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23
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Rothwell E, Wong B, Anderson RA, Botkin JR. The Influence of Education on Public Trust and Consent Preferences With Residual Newborn Screening Dried Blood spots. J Empir Res Hum Res Ethics 2016; 11:231-6. [PMID: 27387457 PMCID: PMC4990497 DOI: 10.1177/1556264616656976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to evaluate the impact of educational interventions during prenatal care on public trust for newborn screening and consent preferences for the retention and use of leftover newborn screening dried blood spots. Women who were 30 to 36 weeks pregnant were recruited, and outcomes were measured by telephone survey 2 to 4 weeks postpartum (n = 901). Approximately 40% of the sample chose the opt-out approach but those who watched educational interventions delivered during prenatal care were significantly associated with higher levels of trust and support for an opt-out consent approach. Providing education during prenatal care about newborn screening and the storage and use of leftover dried blood spots along with brochure-based education provided in the hospital when the baby is born is associated with improved trust for the program and support for research with the leftover blood spots.
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Affiliation(s)
| | - Bob Wong
- University of Utah, Salt Lake City, USA
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24
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Botkin JR, Rothwell E, Anderson RA, Rose NC, Dolan SM, Kuppermann M, Stark LA, Goldenberg A, Wong B. Prenatal Education of Parents About Newborn Screening and Residual Dried Blood Spots: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:543-9. [PMID: 27043416 PMCID: PMC7755042 DOI: 10.1001/jamapediatrics.2015.4850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Research clearly indicates that current approaches to newborn blood spot screening (NBS) education are ineffective. Incorporating NBS education into prenatal care is broadly supported by lay and professional opinion. OBJECTIVE To determine the efficacy and effect of prenatal education about newborn screening and use of residual dried blood spots (DBS) in research on parental knowledge, attitudes, and behaviors. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial of prenatal educational interventions, with outcomes measured by survey at 2 to 4 weeks postpartum. Participants were recruited from obstetric clinics in Salt Lake City, Utah; San Francisco, California; and the Bronx, New York. Eligible women were English- or Spanish-speaking adults and did not have a high-risk pregnancy. A total of 901 women were enrolled. Participants who completed the follow-up survey included 212 women in the usual care group (70% retention), 231 in the NBS group (77% retention), and 221 women in the NBS + DBS group (75% retention). Those who completed the survey were similar across the 3 groups with respect to age, ethnicity, race, education, marital status, income, obstetric history, and language. INTERVENTIONS Participants were randomized into 1 of 3 groups: usual care (n = 305), those viewing an NBS movie and brochure (n = 300), and those viewing both the NBS and DBS movies and brochures (n = 296). MAIN OUTCOMES AND MEASURES Two to four weeks postpartum, women completed a 91-item survey by telephone, addressing knowledge, attitudes, and behavior with respect to opting out of NBS or DBS for their child. RESULTS A total of 901 women (mean age, 31 years) were randomized and 664 completed the follow-up survey. The total correct responses on the knowledge instrument in regard to NBS were 69% in the usual care group, 79% in the NBS group, and 75% in the NBS + DBS group, a significant between-group difference (P < .05). Although all groups showed strong support for NBS, the percentage of women who were "very supportive" was highest in the NBS group (94%), followed by the NBS + DBS group (86%) and was lowest in the usual care group (73%) (P < .001). The interventions were not associated with decisions to decline newborn screening or withdraw residual DBS. Nine women stated that they had declined NBS (all the usual care group; P < .001). With respect to DBS, 5 participants indicated that they contacted the health department to have their child's sample withdrawn after testing: 3 in the NBS + DBS group and 2 in the usual care group (P = .25). CONCLUSIONS AND RELEVANCE Educational interventions can be implemented in the prenatal clinic, using multimedia tools and electronic platforms. Prenatal education is effective in increasing postnatal knowledge and support for these programs. These results are relevant to other contexts in which residual clinical specimens and data are used for research purposes. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02676245.
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Affiliation(s)
| | | | | | - Nancy C. Rose
- University of Utah, Salt Lake City2Intermountain Healthcare, Salt Lake City, Utah
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | | | | | | | - Bob Wong
- University of Utah, Salt Lake City
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25
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Abstract
This article discusses a new approach for the conduct of focus groups in health research. Identifying ways to educate and inform participants about the topic of interest prior to the focus group discussion can promote more quality data from informed opinions. Data on this deliberative discussion approach are provided from research within three federally funded studies. As healthcare continues to improve from scientific and technological advancements, educating the research participants prior to data collection about these complexities is essential to gather quality data.
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26
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27
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Botkin JR, Belmont JW, Berg JS, Berkman BE, Bombard Y, Holm IA, Levy HP, Ormond KE, Saal HM, Spinner NB, Wilfond BS, McInerney JD. Points to Consider: Ethical, Legal, and Psychosocial Implications of Genetic Testing in Children and Adolescents. Am J Hum Genet 2015; 97:6-21. [PMID: 26140447 DOI: 10.1016/j.ajhg.2015.05.022] [Citation(s) in RCA: 297] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/29/2015] [Indexed: 12/12/2022] Open
Abstract
In 1995, the American Society of Human Genetics (ASHG) and American College of Medical Genetics and Genomics (ACMG) jointly published a statement on genetic testing in children and adolescents. In the past 20 years, much has changed in the field of genetics, including the development of powerful new technologies, new data from genetic research on children and adolescents, and substantial clinical experience. This statement represents current opinion by the ASHG on the ethical, legal, and social issues concerning genetic testing in children. These recommendations are relevant to families, clinicians, and investigators. After a brief review of the 1995 statement and major changes in genetic technologies in recent years, this statement offers points to consider on a broad range of test technologies and their applications in clinical medicine and research. Recommendations are also made for record and communication issues in this domain and for professional education.
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Affiliation(s)
| | | | - Jonathan S Berg
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Yvonne Bombard
- University of Toronto, Toronto, ON M5B 1T8, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | | | | | | | - Howard M Saal
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nancy B Spinner
- Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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28
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Goldenberg AJ, Maschke KJ, Joffe S, Botkin JR, Rothwell E, Murray TH, Anderson R, Deming N, Rosenthal BF, Rivera SM. IRB practices and policies regarding the secondary research use of biospecimens. BMC Med Ethics 2015; 16:32. [PMID: 25953109 PMCID: PMC4426182 DOI: 10.1186/s12910-015-0020-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 04/23/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND As sharing and secondary research use of biospecimens increases, IRBs and researchers face the challenge of protecting and respecting donors without comprehensive regulations addressing the human subject protection issues posed by biobanking. Variation in IRB biobanking policies about these issues has not been well documented. METHODS This paper reports on data from a survey of IRB Administrative Directors from 60 institutions affiliated with the Clinical and Translation Science Awards (CTSAs) about their policies and practices regarding secondary use and sharing of biospecimens. Specifically, IRB ADs were asked about consent for future use of biospecimens, assignment of risk for studies using biobanked specimens, and sharing of biospecimens/data. RESULTS Our data indicate that IRBs take varying approaches to protocol review, risk assessment, and data sharing, especially when specimens are not anonymized. CONCLUSION Unclear or divergent policies regarding biospecimen research among IRBs may constitute a barrier to advancing genetic studies and to inter-institutional collaboration, given different institutional requirements for human subjects protections.
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Affiliation(s)
- Aaron J Goldenberg
- Department of Bioethics, TA212 School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Karen J Maschke
- The Hastings Center and the Centre for Biomedical Ethics, Garrison, New York, USA.
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Jeffrey R Botkin
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
| | - Erin Rothwell
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
| | - Thomas H Murray
- The Hastings Center and the Centre for Biomedical Ethics, Garrison, New York, USA.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Rebecca Anderson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
| | - Nicole Deming
- Department of Bioethics, TA212 School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Beth F Rosenthal
- Department of Bioethics, TA212 School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Suzanne M Rivera
- Department of Bioethics, TA212 School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
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29
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Rothwell E, Maschke KJ, Botkin JR, Goldenberg A, Murray TH, Rivera SM. Biobanking Research and Human Subjects Protections: Perspectives of IRB Leaders. IRB 2015; 37:8-13. [PMID: 26331182 PMCID: PMC5854323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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30
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31
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He S, Botkin JR, Hurdle JF. An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States. J Empir Res Hum Res Ethics 2014; 10:31-6. [DOI: 10.1177/1556264614560146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards’ (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application.
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Affiliation(s)
- Shan He
- Intermountain Healthcare, Salt Lake City, UT, USA
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32
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Abstract
A pilot study assessed an electronic informed consent model within a randomized controlled trial (RCT). Participants who were recruited for the parent RCT project were randomly selected and randomized to either an electronic consent group (n = 32) or a simplified paper-based consent group (n = 30). Results from the electronic consent group reported significantly higher understanding of the purpose of the study, alternatives to participation, and who to contact if they had questions or concerns about the study. However, participants in the paper-based control group reported higher mean scores on some survey items. This research suggests that an electronic informed consent presentation may improve participant understanding for some aspects of a research study.
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Affiliation(s)
| | - Bob Wong
- University of Utah, Salt Lake City, USA
| | - Nancy C Rose
- University of Utah, Salt Lake City, USA Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Beth Fedor
- Intermountain Healthcare, Salt Lake City, UT, USA
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33
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Botkin JR, Rothwell E, Anderson RA, Goldenberg A, Kuppermann M, Dolan SM, Rose NC, Stark L. What parents want to know about the storage and use of residual newborn bloodspots. Am J Med Genet A 2014; 164A:2739-44. [PMID: 25131714 DOI: 10.1002/ajmg.a.36694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 06/27/2014] [Indexed: 11/08/2022]
Abstract
Many state newborn screening programs retain residual newborn screening bloodspots for a variety of purposes including quality assurance, biomedical research, and forensic applications. This project was designed to determine the information that prospective parents want to know about this practice. Eleven focus groups were conducted in four states. Pregnant women and their partners and parents of young children (N = 128) were recruited from the general public. Focus group participants viewed two educational movies on newborn screening and DBS retention and use. Transcripts were analyzed with qualitative methods and the results were synthesized to identify key information items. We identified 14 categories of information from the focus groups that were synthesized into seven items prospective parents want to know about residual DBS. The items included details about storage, potential uses, risks and burdens, safeguards, anonymity, return of results, and parental choice. For those state programs that retain residual dried bloodspots, inclusion of the seven things parents want to know about residual dried bloodspots in educational materials may improve parental understanding, trust, and acceptance of the retention and use of stored bloodspots.
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34
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Forster D, Nelson DK, Borasky D, Botkin JR. The irregular terrain of human subjects research regulations. Commentary. Hastings Cent Rep 2014; 44:S29-30. [PMID: 25043469 DOI: 10.1002/hast.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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35
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Nagaraj CB, Rothwell E, Hart K, Latimer S, Schiffman JD, Botkin JR. Attitudes of parents of children with serious health conditions regarding residual bloodspot use. Public Health Genomics 2014; 17:141-8. [PMID: 24713606 DOI: 10.1159/000360251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES Studies have shown that the general public is supportive of newborn screening (NBS) and supportive of the storage and use of residual bloodspots for quality assurance and biomedical research. However, the attitudes of parents of children with serious health conditions have not been assessed. In this study, we assessed attitudes of parents with children who have phenylketonuria (PKU) and leukemia towards NBS and storage and use of residual bloodspots for research. METHODS A total of 49 individuals were recruited and responded to a validated 41-item survey regarding NBS and the retention and use of residual bloodspots. Of these participants, 22 had a child with PKU and 27 had a child with leukemia. We compared their responses to those of 1,927 individuals from the general public obtained in a previous study using the same survey instrument. RESULTS/CONCLUSIONS We found that parents of children with a serious health condition had higher levels of support than the general public towards the use of residual NBS samples for research but similar attitudes regarding choice and privacy protections. It is important to assess the attitudes of various stakeholders for policy development.
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Affiliation(s)
- Chinmayee B Nagaraj
- Graduate Program of Genetic Counseling, University of Utah, Salt Lake City, Utah, USA
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36
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Botkin JR, Lewis MH, Watson MS, Swoboda KJ, Anderson R, Berry SA, Bonhomme N, Brosco JP, Comeau AM, Goldenberg A, Goldman E, Therrell B, Levy-Fisch J, Tarini B, Wilfond B. Parental permission for pilot newborn screening research: guidelines from the NBSTRN. Pediatrics 2014; 133:e410-7. [PMID: 24394680 PMCID: PMC3904278 DOI: 10.1542/peds.2013-2271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/24/2022] Open
Abstract
There is broad recognition of the need for population-based research to assess the safety and efficacy of newborn screening (NBS) for conditions that are not on current panels. However, prospective population-based research poses significant ethical, regulatory, and logistical challenges. In the context of NBS, there have been a variety of approaches that address parental decision-making in pilot studies of new screening tests or conditions. This article presents an ethical and legal analysis of the role of parental permission by the Bioethics and Legal Work Group of the Newborn Screening Translational Research Network created under a contract from the National Institute of Child Health and Human Development to the American College of Medical Genetics and Genomics. Circumstances are outlined in which a waiver of documentation of permission or a waiver of permission may be ethically and legally appropriate in the NBS context. These guidelines do not constitute American Academy of Pediatrics policy.
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Affiliation(s)
| | | | - Michael S. Watson
- The American College of Medical Genetics and Genomics, Bethesda, Maryland
| | | | | | | | | | | | - Anne M. Comeau
- University of Massachusetts Medical School, Worcester, Massachusetts
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37
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Botkin JR, Anderson R, Murray T, Beskow LM, Maschke K, Cuttler L. Proposed regulations for research with biospecimens: responses from stakeholders at CTSA consortium institutions. Am J Med Genet A 2014; 164A:892-7. [PMID: 24459038 DOI: 10.1002/ajmg.a.36365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/20/2013] [Indexed: 01/07/2023]
Abstract
Secondary research with biospecimens acquired through clinical care and through research is often conducted without the informed consent of individuals from whom the specimens were acquired. While such uses are consistent with the current federal regulations, surveys of the general public suggest that many individuals would prefer more information and choice regarding research use of biospecimens. The federal government issued an Advance Notice of Proposed Rulemaking (ANPRM) in 2011 that proposed a number of potential changes in the regulations governing human subjects. These proposed regulations are particularly pertinent to institutions committed to research involving human subjects-including institutions in the NIH-funded Clinical and Translational Science Awards (CTSA) consortium. In this study, we reviewed public responses by CTSA-funded institutions and CTSA-affiliated organizations and groups regarding the proposed changes in the ANPRM with respect to research with biospecimens. Our results indicate that the majority of responses to the ANPRM from CTSA institutions were not supportive of the proposed changes. While many responses acknowledge a need to change current research practices regarding biospecimens, the proposed changes in the ANPRM received only limited support from this subgroup of academic research institutions.
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Affiliation(s)
- Jeffrey R Botkin
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Botkin JR, Rothwell E, Anderson R, Stark LA, Mitchell J. Public attitudes regarding the use of electronic health information and residual clinical tissues for research. J Community Genet 2013; 5:205-13. [PMID: 24307509 DOI: 10.1007/s12687-013-0175-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 11/15/2013] [Indexed: 11/29/2022] Open
Abstract
Use of electronic medical records (EMR) and residual clinical biospecimens have become important for the conduct of biomedical research. Currently, human subjects' protection regulations permit much of this research to be conducted without individual informed consent, posing a risk to biomedical research from public objection. We sought to understand public attitudes regarding access to EMRs and residual clinical biospecimens. This article reports the results of 12 focus groups with 131 participants conducted in Utah, Washington, Arizona, and Minnesota. Results indicate strong support for biomedical and genetic research in general and clear support for improved patient education regarding research access to individual data and biospecimens. Our participants were supportive of an opt-out approach to patient decision-making regarding research access to clinical data and biospecimens for research in general.
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Affiliation(s)
- Jeffrey R Botkin
- Department of Pediatrics and Medical Ethics, University of Utah, Salt Lake City, UT, USA
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39
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Rothwell E, Clark L, Anderson R, Botkin JR. Residual newborn screening samples for research: parental information needs for decision-making. J SPEC PEDIATR NURS 2013; 18:115-22. [PMID: 23560583 PMCID: PMC7799500 DOI: 10.1111/jspn.12017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 11/16/2012] [Accepted: 12/29/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this research was to identify what types of information expectant parents want to make a decision about the use of their babies' residual dried blood specimens for research. DESIGN AND METHODS Three focus groups were conducted with pregnant women and their partners and one focus group with prenatal healthcare providers and educators. RESULTS Eleven categories of information needs were identified within each focus group. PRACTICE IMPLICATIONS Providing sufficient information for parents to make informed choices will be essential to future research with residual dried blood specimens and to maintain public trust with the growing applications of this important public health program.
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Affiliation(s)
- Erin Rothwell
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Rothwell E, Anderson RA, Swoboda KJ, Stark L, Botkin JR. Public attitudes regarding a pilot study of newborn screening for spinal muscular atrophy. Am J Med Genet A 2013; 161A:679-86. [PMID: 23443997 DOI: 10.1002/ajmg.a.35756] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 10/11/2012] [Indexed: 11/12/2022]
Abstract
A population-based pilot study of newborns screening for a rare genetic condition, spinal muscular atrophy (SMA), is being conducted with funding from the National Institutes of Health. The first component of the study is to assess the ethical, legal, and social implications of population-based pilot studies with a focus on public engagement and parental decision-making for the proposed opt-out approach in this research. We conducted focus groups with members of the general public to ascertain attitudes about the pilot study and acceptability of an opt-out approach in two states, Colorado and Utah, where the pilot screening is being proposed (N = 70). We developed an informational video for the project and showed it to the groups prior to the discussion in order to inform participants about population-based research, newborn screening (NBS), permission/consent models, and SMA. Results indicated support for the conduct of pilot studies that is consistent with the current standard of practice for similar population-based programs. There was support for an opt-out approach for parental decision-making; however there was limited parental knowledge about population-based research, NBS and SMA. In general, our participants considered this pilot study to be low risk and of potential benefit to infants and families. The majority of participants were supportive of an opt-out approach with information delivered through various avenues
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Affiliation(s)
- Erin Rothwell
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA.
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Abstract
The storage and use of residual newborn screening dried blood specimens has generated significant controversy in the past 5 years, primarily because of public concerns over the lack of parental knowledge and consent for these activities. State policies addressing the management of these specimens vary widely, and there is currently little guidance to aid new state policy development to address the concerns of program professionals, investigators, and the general public. This article offers guidance for state policy based on multiple sources of data, including public attitudes, professional statements, state experience, and an analysis of the ethical, social, legal, and biomedical issues from a multidisciplinary group of scholars. This guidance will be useful for state programs that seek to develop policies that are informed by a contemporary analysis of the key ethical, legal, and social aspects of this practice. This article represents the work of the authors and does not represent American Academy of Pediatrics policy.
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Botkin JR. Informed consent for biobank-dependent research. AMA J Ethics 2012; 14:610-5. [PMID: 23351314 DOI: 10.1001/virtualmentor.2012.14.8.ecas2-1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jeffrey R Botkin
- pediatrics and medical ethics at University of Utah in Salt Lake City, USA
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Rothwell E, Anderson R, Goldenberg A, Lewis MH, Stark L, Burbank M, Wong B, Botkin JR. Assessing public attitudes on the retention and use of residual newborn screening blood samples: a focus group study. Soc Sci Med 2012. [PMID: 22398141 DOI: 10.1016/j.socs-cimed.2011.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This paper discusses attitudes and opinions of a diverse group of participants toward the retention and use of residual newborn blood samples for research. Data were drawn from focus groups based in six states in the USA, and results provide support for the retention and use of residual newborn blood samples for research when parental permission is asked beforehand. However, there were a number of concerns that also warrant attention for the development of policy and maintaining trust with the public, such as timing of permission, use of samples already stored, level of personal control of sample use and education. The results demonstrate the complexity of the topic and the ethical ambiguities associated with the retention and use of residual newborn blood samples.
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Affiliation(s)
- Erin Rothwell
- University of Utah, Nursing, Salt Lake City, UT, USA.
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Rothwell E, Anderson R, Goldenberg A, Lewis MH, Stark L, Burbank M, Wong B, Botkin JR. Assessing public attitudes on the retention and use of residual newborn screening blood samples: a focus group study. Soc Sci Med 2012; 74:1305-9. [PMID: 22398141 DOI: 10.1016/j.socscimed.2011.12.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/24/2011] [Accepted: 12/16/2011] [Indexed: 11/16/2022]
Abstract
This paper discusses attitudes and opinions of a diverse group of participants toward the retention and use of residual newborn blood samples for research. Data were drawn from focus groups based in six states in the USA, and results provide support for the retention and use of residual newborn blood samples for research when parental permission is asked beforehand. However, there were a number of concerns that also warrant attention for the development of policy and maintaining trust with the public, such as timing of permission, use of samples already stored, level of personal control of sample use and education. The results demonstrate the complexity of the topic and the ethical ambiguities associated with the retention and use of residual newborn blood samples.
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Affiliation(s)
- Erin Rothwell
- University of Utah, Nursing, Salt Lake City, UT, USA.
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Botkin JR, Rothwell E, Anderson R, Stark L, Goldenberg A, Lewis M, Burbank M, Wong B. Public attitudes regarding the use of residual newborn screening specimens for research. Pediatrics 2012; 129:231-8. [PMID: 22250018 PMCID: PMC3269111 DOI: 10.1542/peds.2011-0970] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many state newborn screening (NBS) programs retain residual NBS bloodspots after the completion of screening. Potential uses for residual specimens include laboratory quality assurance, biomedical research, and, rarely, forensic applications. Our objective was to evaluate public opinion about the policies and practices relevant to the retention and use of residual bloodspots for biomedical research. METHODS A total of 3855 respondents were recruited using 3 methods: focus groups (n = 157), paper or telephone surveys (n = 1418), and a Knowledge Networks panel (n = 2280). Some participants (n = 1769) viewed a 22-minute movie about the retention and use of residual specimens while other participants were provided only written information about this practice. All participants were surveyed using a 38-item questionnaire. RESULTS A diverse set of participants was recruited. Respondents were very supportive of NBS in general and accepting of the use of residual bloodspots for important research activities. Respondents were evenly divided on the acceptability of NBS without parental permission, but the majority of respondents supported the use of an "opt-in" process for parental permission for residual bloodspot retention and use. Viewing the educational movie was associated with greater support for bloodspot retention and use. CONCLUSIONS Our results show that the general public surveyed here was supportive of NBS and residual sample retention and research use. However, there was a clear preference for an informed permission process for parents regarding these activities. Education about NBS was associated with a higher level of support and may be important to maintain public trust in these important programs.
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Affiliation(s)
| | | | | | | | | | | | | | - Bob Wong
- University of Utah, Salt Lake City, Utah
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Botkin JR. The value of evidence-based risk assessments. Clin Trials 2011; 8:685-6. [PMID: 22167107 DOI: 10.1177/1740774511427751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Jeffrey R Botkin
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA.
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Rothwell EW, Anderson RA, Burbank MJ, Goldenberg AJ, Lewis MH, Stark LA, Wong B, Botkin JR. Concerns of newborn blood screening advisory committee members regarding storage and use of residual newborn screening blood spots. Am J Public Health 2011; 101:2111-6. [PMID: 21330580 DOI: 10.2105/ajph.2010.200485] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed attitudes and opinions of members of newborn blood screening (NBS) advisory committees regarding the storage and secondary research use of residual specimens from NBS. METHODS We conducted focus groups in 2008 and 2009 with NBS advisory committees (4 focus groups; n = 39 participants) in the Mountain States region (i.e., AZ, CO, MT, NM, NV, TX, UT, and WY). RESULTS Participants identified several challenges to implementing policies for storage of and research on residual newborn blood specimens. Themes that emerged from the data were public health relevancy; improvement of parental knowledge; impact of enhanced parental involvement; concerns over ownership, privacy, and confidentiality; identification of secondary research uses; and role of advisory committees. CONCLUSIONS Participants indicated that secondary uses of residual specimens entailed opportunities for improvements in NBS programs but also carried significant risks for their programs. Addressing concerns from stakeholders will be necessary for state-level adoption of national recommendations.
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Affiliation(s)
- Erin W Rothwell
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA.
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He S, Hurdle JF, Botkin JR, Narus SP. Integrating a Federated Healthcare Data Query Platform With Electronic IRB Information Systems. AMIA Annu Symp Proc 2010; 2010:291-295. [PMID: 21346987 PMCID: PMC3041360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Human subjects are indispensable for clinical and translational research. Federal and local agencies issue regulations governing the conduct of research involving human subjects in order to properly protect study participants. Institutional Review Boards (IRBs) have the authority to review human subject research to ensure concordance with these regulations. One of the primary goals of the IRB oversight is to protect research participants' privacy by carefully reviewing the data used and disclosed during a study. However, there are major challenges for IRBs in the typical research process. Due to the information disconnect between the data providers (e.g., a clinical data warehouse) and the IRB, it is often impossible to tell exactly what data has been disclosed to investigators. This causes time-consuming, inefficient, and often ineffective monitoring of clinical studies. This paper proposes an integrated architecture that interconnects a federated healthcare data query platform with an electronic IRB system.
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Affiliation(s)
- Shan He
- Department of Biomedical Informatics
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