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Aikin KJ, Boudewyns V, Betts KR, Giombi KC, Paquin RS, Brewington M, Malik R. Implied Claims in Drug Advertising: A Review of Recent Literature and Regulatory Actions. Health Commun 2024; 39:652-665. [PMID: 36825849 DOI: 10.1080/10410236.2023.2179717] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Federal agencies and self-regulatory bodies help to ensure prescription and nonprescription drug promotion contains accurate information; however, false or misleading claims may cause people to have inaccurate perceptions of a drug and inhibit their ability to make informed decisions. We conducted a systematic review assessing evidence from 2012-2021 on how consumers and healthcare providers (HCPs) interpret claims made indirectly or through inference (implied or implicit claims) as well as synthesizing prescription and nonprescription drug advertising claims that have been the subject of regulatory actions from 2017-2021. Our search identified 16 studies from the peer-reviewed literature and 26 letters or case reports issued by the Food and Drug Administration (FDA) or National Advertising Division (NAD). Results from peer-reviewed studies suggest that implied claims can result in inferences that may not be warranted by the material facts about the drug. Perceptions of a drug's efficacy and, to a lesser extent, risk, are influenced by implied and explicitly false claims in prescription drug promotion. Claims related to implied superiority and overstatement of efficacy were the most prevalent claims flagged for review and examined in the literature. These types of claims were also the subject of many of the compliance actions by the FDA and case reports from the NAD. More research is needed to understand how people interpret varying types of implied claims and the impact of such claims on key outcomes. From a policy standpoint, understanding how people interpret implied claims can inform how the FDA approaches these claims in the marketplace.
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Affiliation(s)
- Kathryn J Aikin
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion
| | | | - Kevin R Betts
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion
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2
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Sullivan HW, O'Donoghue AC, Boudewyns V, Paquin RS, Ferriola-Bruckenstein K. Patient Understanding of Oncology Clinical Trial Endpoints in Direct-to-Consumer Television Advertising. Oncologist 2023:7133647. [PMID: 37079495 DOI: 10.1093/oncolo/oyad064] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/09/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND This study examined how people interpret overall survival (OS), overall response rate (ORR), and progression-free survival (PFS) endpoints in the context of direct-to-consumer television ads. Although there is little research on this topic, initial evidence suggests that people can misinterpret these endpoints. We hypothesized that understanding of ORR and PFS would be improved by adding a disclosure ("We currently do not know if [Drug] helps patients live longer") to ORR and PFS claims. METHODS We conducted 2 online studies with US adults examining television ads for fictional prescription drugs indicated to treat lung cancer (N = 385) or multiple myeloma (N = 406). The ads included claims about OS, ORR with and without a disclosure, or PFS with and without a disclosure. In each experiment, we randomized participants to view 1 of 5 versions of a television ad. After viewing the ad twice, participants completed a questionnaire that measured understanding, perceptions, and other outcomes. RESULTS In both studies, participants correctly differentiated between OS, ORR, and PFS via open-ended responses; however, participants in the PFS conditions (versus ORR conditions) were more likely to make incorrect inferences about OS. Supporting the hypothesis, adding a disclosure made expectations around living longer and quality-of-life improvements more accurate. CONCLUSION Disclosures could help reduce the extent to which people misinterpret endpoints like ORR and PFS. More research is needed to establish best-practice recommendations for using disclosures to improve patient understanding of drug efficacy without changing their perception of the drug in unintended ways.
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Affiliation(s)
- Helen W Sullivan
- Office or Prescription Drug Promotion, US Food and Drug Administration, Silver Spring, MD, USA
| | - Amie C O'Donoghue
- Office or Prescription Drug Promotion, US Food and Drug Administration, Silver Spring, MD, USA
| | - Vanessa Boudewyns
- Center for Communication & Media Impact, RTI International, Research Triangle Park, NC, USA
| | - Ryan S Paquin
- Center for Communication & Media Impact, RTI International, Research Triangle Park, NC, USA
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Betts KR, O’Donoghue AC, Johnson M, Boudewyns V, Paquin RS. Detecting and Reporting Deceptive Prescription Drug Promotion: Differences Across Consumer and Physician Audiences and by Number and Type of Deceptive Claims and Tactics. Health Commun 2022; 37:1609-1621. [PMID: 33840305 PMCID: PMC9511828 DOI: 10.1080/10410236.2021.1909264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The U.S. Food and Drug Administration's (FDA) Bad Ad program provides an avenue for healthcare providers to report false or misleading prescription drug promotion. Yet, whether healthcare providers can detect such promotion, and whether they believe it should be reported to FDA, remain open questions. Consumer audiences may also be capable of detecting such promotion and believe it should be reported, but even less is known about capability and belief in this population. Across two experiments using mock pharmaceutical websites, this research investigated capability to detect and inclination to report deceptive prescription drug promotion among a sample of primary care physicians and consumers. Study 1 varied the number of deceptive claims and tactics on a website for a chronic pain medication, operationalized as none, two, or five. Study 2 varied the type of deceptive content on a website for a weight loss medication, operationalized as none, implicit, or explicit. Findings reveal that, in line with expectations from FDA's Bad Ad program, physicians can detect deceptive promotion and tend to believe it should be reported. Consumers are also capable of detecting deceptive promotion and tend to believe it should be reported, but their capabilities and beliefs regarding reporting are generally lower.
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Affiliation(s)
- Kevin R. Betts
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion, 10903 New Hampshire Ave., Silver Spring, MD, USA 20993
| | - Amie C. O’Donoghue
- U.S. Food and Drug Administration, Office of Prescription Drug Promotion, 10903 New Hampshire Ave., Silver Spring, MD, USA 20993
| | - Mihaela Johnson
- RTI International, Center for Communication Science, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA 27709
| | - Vanessa Boudewyns
- RTI International, Center for Communication Science, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA 27709
| | - Ryan S. Paquin
- RTI International, Center for Communication Science, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA 27709
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4
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Gehtland LM, Paquin RS, Andrews SM, Lee AM, Gwaltney A, Duparc M, Pfaff ER, Bailey DB. Using a Patient Portal to Increase Enrollment in a Newborn Screening Research Study: Observational Study. JMIR Pediatr Parent 2022; 5:e30941. [PMID: 35142618 PMCID: PMC8874929 DOI: 10.2196/30941] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/12/2021] [Accepted: 12/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many research studies fail to enroll enough research participants. Patient-facing electronic health record applications, known as patient portals, may be used to send research invitations to eligible patients. OBJECTIVE The first aim was to determine if receipt of a patient portal research recruitment invitation was associated with enrollment in a large ongoing study of newborns (Early Check). The second aim was to determine if there were differences in opening the patient portal research recruitment invitation and study enrollment by race and ethnicity, age, or rural/urban home address. METHODS We used a computable phenotype and queried the health care system's clinical data warehouse to identify women whose newborns would likely be eligible. Research recruitment invitations were sent through the women's patient portals. We conducted logistic regressions to test whether women enrolled their newborns after receipt of a patient portal invitation and whether there were differences by race and ethnicity, age, and rural/urban home address. RESULTS Research recruitment invitations were sent to 4510 women not yet enrolled through their patient portals between November 22, 2019, through March 5, 2020. Among women who received a patient portal invitation, 3.6% (161/4510) enrolled their newborns within 27 days. The odds of enrolling among women who opened the invitation was nearly 9 times the odds of enrolling among women who did not open their invitation (SE 3.24, OR 8.86, 95% CI 4.33-18.13; P<.001). On average, it took 3.92 days for women to enroll their newborn in the study, with 64% (97/161) enrolling their newborn within 1 day of opening the invitation. There were disparities by race and urbanicity in enrollment in the study after receipt of a patient portal research invitation but not by age. Black women were less likely to enroll their newborns than White women (SE 0.09, OR 0.29, 95% CI 0.16-0.55; P<.001), and women in urban zip codes were more likely to enroll their newborns than women in rural zip codes (SE 0.97, OR 3.03, 95% CI 1.62-5.67; P=.001). Black women (SE 0.05, OR 0.67, 95% CI 0.57-0.78; P<.001) and Hispanic women (SE 0.07, OR 0.73, 95% CI 0.60-0.89; P=.002) were less likely to open the research invitation compared to White women. CONCLUSIONS Patient portals are an effective way to recruit participants for research studies, but there are substantial racial and ethnic disparities and disparities by urban/rural status in the use of patient portals, the opening of a patient portal invitation, and enrollment in the study. TRIAL REGISTRATION ClinicalTrials.gov NCT03655223; https://clinicaltrials.gov/ct2/show/NCT03655223.
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Affiliation(s)
- Lisa M Gehtland
- RTI International, Research Triangle Park, NC, United States
| | - Ryan S Paquin
- RTI International, Research Triangle Park, NC, United States
| | - Sara M Andrews
- RTI International, Research Triangle Park, NC, United States
| | - Adam M Lee
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Angela Gwaltney
- RTI International, Research Triangle Park, NC, United States
| | - Martin Duparc
- RTI International, Research Triangle Park, NC, United States
| | - Emily R Pfaff
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Donald B Bailey
- RTI International, Research Triangle Park, NC, United States
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Abstract
The US Food and Drug Administration developed the Breakthrough Therapy designation to expedite the development and review of drugs that show a clear advantage over available therapy for serious conditions. Prior research has shown that physicians tend to misunderstand that a drug may receive a Breakthrough Therapy designation based on preliminary clinical evidence (eg, effect on a surrogate endpoint or intermediate clinical endpoint that is likely to predict clinical benefit). The objective of this article is to examine whether physicians’ familiarity with and interpretation of the Breakthrough Therapy designation have changed since a survey on the topic was published in 2016. We replicated three of the questions in that study and explored beliefs that a Breakthrough Therapy designation automatically qualifies a drug for accelerated approval. We also draw comparisons by specialization (oncologists vs. primary care physicians). In general, physicians remain more likely than not to misunderstand the Breakthrough Therapy designation.
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Affiliation(s)
- Ryan S Paquin
- Corresponding author: Ryan S. Paquin, Center for Communication Science, RTI International, 100 South Fifth Street, Suite 1900, Minneapolis, MN 55402, USA;
| | | | - Amie C O’Donoghue
- Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, US Food and Drug Administration, Silver Spring, MD, USA
| | - Kathryn J Aikin
- Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, US Food and Drug Administration, Silver Spring, MD, USA
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Boudewyns V, O'Donoghue AC, Paquin RS, Aikin KJ, Ferriola-Bruckenstein K, Scott VM. Physician Interpretation of Data of Uncertain Clinical Utility in Oncology Prescription Drug Promotion. Oncologist 2021; 26:1071-1078. [PMID: 34510619 DOI: 10.1002/onco.13972] [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] [Received: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Little is known about how physicians interpret data displays that depict preliminary or exploratory clinical data in physician-targeted sales aids for oncology drugs. Using three factorial experiments, we examined whether disclosures of data limitations and clinical uncertainty adequately communicate the limitations and practical utility of this type of data. SUBJECTS, MATERIALS, AND METHODS The studies used a 2 (disclosure of data limitations: technical, nontechnical) × 2 (disclosure of clinical uncertainty: present, absent) + 1 (control: no disclosure) between-subjects experimental design to examine the impact of disclosures as they relate to presentations of preliminary or exploratory data in promotional communications for oncology products. In each experiment, we randomized oncologists and primary care physicians with oncology experience to view one version of a two-page sales aid. Following this exposure, physicians completed a web-based survey. The design was replicated in three concurrently conducted experiments using sales aids for different fictitious oncology drugs, each featuring one of three common data displays: a forest plot (n = 495), a Kaplan-Meier curve (n = 504), or a bar chart (n = 532). RESULTS Results provide initial evidence that in some contexts disclosures can improve understanding of the clinical utility of certain information about a drug and the limitations of results presented in a data display. Disclosures can also temper perceptions of how much evidence is presented that supports a conclusion that the drug is an appropriate treatment. In terms of the language used in the disclosure of data limitations, physicians in all three experiments strongly preferred the nontechnical disclosures. CONCLUSION The findings from the three experiments in this study suggest that disclosures have the potential to increase relevant knowledge, but more research is needed to establish best practice recommendations for using disclosures to convey contextual information relevant for interpreting data displays in promotional communications. IMPLICATIONS FOR PRACTICE This article reports the results from three large, online experimental studies that address a growing concern that drug companies often share favorable clinical trial results with physicians in promotional materials that lack important context for physicians to interpret the data. This series of studies investigates whether strategic use of two types of disclosures (disclosure of data limitations and a disclosure of clinical uncertainty) improves understanding and reduces misinterpretations among physicians. The results from these studies help identify communication factors that impact how physicians critically appraise preliminary or exploratory clinical trial data to inform policy and regulatory efforts.
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Affiliation(s)
| | - Amie C O'Donoghue
- Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Kathryn J Aikin
- Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, US Food and Drug Administration, Silver Spring, Maryland, USA
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Peay HL, Fischer R, Mange B, Paquin RS, Smith EC, Sadosky A, Russo L, Ricotti V, Rensch C, Morris C, Martin AS, Ganot A, Beaverson K, Mansfield C. Patients' and caregivers' maximum acceptable risk of death for non-curative gene therapy to treat Duchenne muscular dystrophy. Mol Genet Genomic Med 2021; 9:e1664. [PMID: 33755338 PMCID: PMC8172191 DOI: 10.1002/mgg3.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/27/2019] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Gene therapy offers an etiologically targeted treatment for genetic disorders. Little is known about the acceptance of mortality risk among patients with progressive, fatal conditions. We assessed patients' and caregivers' maximum acceptable risk (MAR) of mortality for gene therapy when used to treat Duchenne muscular dystrophy (DMD). METHODS The threshold technique was used to assess tolerance for mortality risks using a hypothetical vignette. Gene therapy was described as non-curative and resulting in a slowing of progression and with a 10-year benefit duration. MAR was analyzed using interval regression for gene therapy initiated "now"; in the last year of walking well; in the last year of being able to bring arms to mouth; and in newborns (for caregivers only). RESULTS Two hundred eighty-five caregivers and 35 patients reported the greatest MAR for gene therapy initiated in last year of being able to lift arms (mean MAR 6.3%), followed by last year of walking well (mean MAR 4.4%), when used "now" (mean MAR 3.5%), and when used in the newborn period (mean MAR 2.1%, caregivers only). About 35% would accept ≥200/2000 risk in the last year of being able to lift arms. Non-ambulatory status predicted accepting 1.8 additional points in MAR "now" compared with ambulatory status (p = 0.010). Respondent type (caregiver or patient) did not predict MAR. CONCLUSION In this first quantitative study to assess MAR associated with first-generation DMD gene therapy, we find relatively high tolerance for mortality risk in response to a non-curative treatment scenario. Risk tolerance increased with disease progression. Patients and caregivers did not have significantly different MAR. These results have implications for protocol development and shared decision making.
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Affiliation(s)
- Holly L Peay
- RTI International, Research Triangle Park, NC, USA
| | - Ryan Fischer
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | | | | | | | - Colin Rensch
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
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Paquin RS, Lewis MA, Harper BA, Moultrie RR, Gwaltney A, Gehtland LM, Peay HL, Duparc M, Raspa M, Wheeler AC, Powell CM, King NMP, Shone SM, Bailey DB. Outreach to new mothers through direct mail and email: recruitment in the Early Check research study. Clin Transl Sci 2021; 14:880-889. [PMID: 33382929 PMCID: PMC8212727 DOI: 10.1111/cts.12950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/26/2022] Open
Abstract
Abstract Meeting recruitment targets for clinical trials and health research studies is a notable challenge. Unsuccessful efforts to recruit participants from traditionally underserved populations can limit who benefits from scientific discovery, thus perpetuating inequities in health outcomes and access to care. In this study, we evaluated direct mail and email outreach campaigns designed to recruit women who gave birth in North Carolina for a statewide research study offering expanded newborn screening for a panel of rare health conditions. Of the 54,887 women who gave birth in North Carolina from September 28, 2018, through March 19, 2019, and were eligible to be included on the study’s contact lists, we had access to a mailing address for 97.9% and an email address for 6.3%. Rural women were less likely to have sufficient contact information available, but this amounted to less than a one percentage point difference by urbanicity. Native American women were less likely to have an email address on record; however, we did not find a similar disparity when recruitment using direct‐mail letters and postcards was concerned. Although we sent letters and emails in roughly equal proportion by urbanicity and race/ethnicity, we found significant differences in enrollment across demographic subgroups. Controlling for race/ethnicity and urbanicity, we found that direct‐mail letters and emails were effective recruitment methods. The enrollment rate among women who were sent a recruitment letter was 4.1%, and this rate increased to 5.0% among women who were also sent an email invitation. Study Highlights WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?
Under‐representation by traditionally underserved populations in clinical trials and health research is a challenge that may in part reflect inequitable opportunities to participate.
WHAT QUESTION DID THIS STUDY ADDRESS?
Are direct‐mail and email outreach strategies effective for reaching and recruiting women from traditionally underserved and rural populations to participate in large‐scale, population‐based research?
WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?
Despite sending recruitment letters and email invitations in roughly equal proportion by urbanicity and race/ethnicity, women living in rural areas were less likely to enroll (2.8%) than women from urban areas (4.2%). Additionally, enrollment rates decreased as the probability that women were members of a racial or ethnic minority group increased.
HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?
Results from this study might encourage researchers to take a holistic and participant‐centered view of barriers to study enrollment that may disproportionately affect underserved communities, including differences in willingness to participate, trust, and access to resources needed for uptake.
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Affiliation(s)
- Ryan S Paquin
- RTI International, Research Triangle Park, North Carolina, USA
| | - Megan A Lewis
- RTI International, Research Triangle Park, North Carolina, USA
| | - Blake A Harper
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Angela Gwaltney
- RTI International, Research Triangle Park, North Carolina, USA
| | - Lisa M Gehtland
- RTI International, Research Triangle Park, North Carolina, USA
| | - Holly L Peay
- RTI International, Research Triangle Park, North Carolina, USA
| | - Martin Duparc
- RTI International, Research Triangle Park, North Carolina, USA
| | - Melissa Raspa
- RTI International, Research Triangle Park, North Carolina, USA
| | - Anne C Wheeler
- RTI International, Research Triangle Park, North Carolina, USA
| | - Cynthia M Powell
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Nancy M P King
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Scott M Shone
- North Carolina State Laboratory of Public Health, Raleigh, North Carolina, USA
| | - Donald B Bailey
- RTI International, Research Triangle Park, North Carolina, USA
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9
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Raspa M, Paquin RS, Brown DS, Andrews S, Edwards A, Moultrie R, Wagner L, Frisch M, Turner-Brown L, Wheeler AC. Preferences for Accessing Electronic Health Records for Research Purposes: Views of Parents Who Have a Child With a Known or Suspected Genetic Condition. Value Health 2020; 23:1639-1652. [PMID: 33248520 PMCID: PMC7701359 DOI: 10.1016/j.jval.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The purpose of this study was to examine parental preferences for researchers accessing their child's electronic health record across 3 groups: those with a child with (1) a known genetic condition (fragile X syndrome FXS), (2) a suspected genetic condition (autism spectrum disorder [ASD]), and (3) no known genetic condition (typically developing). METHODS After extensive formative work, a discrete choice experiment was designed consisting of 5 attributes, each with 2 or 3 levels, including (1) type of researcher, (2) the use of personally identifiable information, (3) the use of sensitive information, (4) personal importance of research, and (5) return of results. Stratified mixed logit and latent class conditional logit models were examined. RESULTS Parents of children with FXS or ASD had relatively higher preferences for research conducted by nonprofits than parents of typically developing children. Parents of children with ASD also preferred research using non-identifiable and nonsensitive information. Parents of children with FXS or ASD also had preferences for research that was personally important and returned either summary or individual results. Although a few child and family characteristics were related to preferences, they did not overall define the subgroups of parents. CONCLUSIONS Although electronic health record preference research has been conducted with the general public, this is the first study to examine the opinions of parents who have a child with a known or suspected genetic condition. These parents were open to studies using their child's electronic health record because they may have more to gain from this type of research.
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Affiliation(s)
| | | | - Derek S Brown
- Brown School, Washington University, St. Louis, MO, USA
| | - Sara Andrews
- RTI International, Research Triangle Park, NC, USA
| | - Anne Edwards
- RTI International, Research Triangle Park, NC, USA
| | | | - Laura Wagner
- RTI International, Research Triangle Park, NC, USA
| | - MaryKate Frisch
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Roman TS, Crowley SB, Roche MI, Foreman AKM, O'Daniel JM, Seifert BA, Lee K, Brandt A, Gustafson C, DeCristo DM, Strande NT, Ramkissoon L, Milko LV, Owen P, Roy S, Xiong M, Paquin RS, Butterfield RM, Lewis MA, Souris KJ, Bailey DB, Rini C, Booker JK, Powell BC, Weck KE, Powell CM, Berg JS. Genomic Sequencing for Newborn Screening: Results of the NC NEXUS Project. Am J Hum Genet 2020; 107:596-611. [PMID: 32853555 PMCID: PMC7536575 DOI: 10.1016/j.ajhg.2020.08.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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] [Received: 02/27/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023] Open
Abstract
Newborn screening (NBS) was established as a public health program in the 1960s and is crucial for facilitating detection of certain medical conditions in which early intervention can prevent serious, life-threatening health problems. Genomic sequencing can potentially expand the screening for rare hereditary disorders, but many questions surround its possible use for this purpose. We examined the use of exome sequencing (ES) for NBS in the North Carolina Newborn Exome Sequencing for Universal Screening (NC NEXUS) project, comparing the yield from ES used in a screening versus a diagnostic context. We enrolled healthy newborns and children with metabolic diseases or hearing loss (106 participants total). ES confirmed the participant's underlying diagnosis in 15 out of 17 (88%) children with metabolic disorders and in 5 out of 28 (∼18%) children with hearing loss. We discovered actionable findings in four participants that would not have been detected by standard NBS. A subset of parents was eligible to receive additional information for their child about childhood-onset conditions with low or no clinical actionability, clinically actionable adult-onset conditions, and carrier status for autosomal-recessive conditions. We found pathogenic variants associated with hereditary breast and/or ovarian cancer in two children, a likely pathogenic variant in the gene associated with Lowe syndrome in one child, and an average of 1.8 reportable variants per child for carrier results. These results highlight the benefits and limitations of using genomic sequencing for NBS and the challenges of using such technology in future precision medicine approaches.
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Affiliation(s)
- Tamara S Roman
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephanie B Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Myra I Roche
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - Ann Katherine M Foreman
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Julianne M O'Daniel
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bryce A Seifert
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristy Lee
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Alicia Brandt
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Chelsea Gustafson
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Daniela M DeCristo
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Natasha T Strande
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lori Ramkissoon
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Laura V Milko
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Phillips Owen
- Renaissance Computing Institute, Chapel Hill, NC 27517, USA
| | - Sayanty Roy
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mai Xiong
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ryan S Paquin
- Center for Communication Science, RTI International, Research Triangle Park, NC 27709, USA
| | - Rita M Butterfield
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27705, USA
| | - Megan A Lewis
- Center for Communication Science, RTI International, Research Triangle Park, NC 27709, USA
| | - Katherine J Souris
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Donald B Bailey
- Genomics, Bioinformatics and Translational Research Center, RTI International, Research Triangle Park, NC 27709, USA
| | - Christine Rini
- Feinberg School of Medicine, Department of Medical Social Sciences, and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
| | - Jessica K Booker
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bradford C Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen E Weck
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Cynthia M Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Peinado S, Paquin RS, Rini C, Roche M, Butterfield RM, Berg JS, Powell CM, Bailey DB, Lewis MA. Values clarification and parental decision making about newborn genomic sequencing. Health Psychol 2020; 39:335-344. [PMID: 31886693 PMCID: PMC7078054 DOI: 10.1037/hea0000829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/08/2022]
Abstract
OBJECTIVE Using an online decision aid developed to support parental decision making about newborn genomic sequencing, we tested whether adding a values clarification exercise to educational content would improve decision making outcomes and influence intention to pursue genomic sequencing. We also examined whether the effect of values clarification varied depending on one's health literacy level. METHOD In an online experiment, women and men aged 18 to 44 who were either pregnant or had a pregnant partner, were currently trying to get pregnant, or were preparing for a pregnancy within the next 2 years were randomly assigned to complete either a decision aid with educational information about newborn genomic sequencing or a decision aid with the same educational information and a values clarification exercise. RESULTS Of the 1,000 participants who completed the decision aid, those who completed the values clarification exercise reported less decision regret, F(1, 995) = 6.19, p = .01, and were clearer about their personal values, F(1, 995) = 6.39, p = .01. Moderation analyses revealed that the benefit of values clarification on decisional conflict was particularly evident among participants with lower health literacy, B = -3.94, SE = 1.67, t = -2.36, p = .018. There was not a significant moderation effect of health literacy and decision aid condition on decision regret. CONCLUSIONS Adding a values clarification exercise to decision aids for parents making decisions about genomic sequencing may improve the decision-making experience and provide some benefit to individuals with lower health literacy. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Susana Peinado
- Center for Communication Science, RTI International,
Research Triangle Park, NC
| | - Ryan S. Paquin
- Center for Communication Science, RTI International,
Research Triangle Park, NC
| | - Christine Rini
- John Theurer Cancer Center, Hackensack University Medical
Center, Hackensack, NJ and Georgetown University School of Medicine, Washington,
DC
| | - Myra Roche
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rita M. Butterfield
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jonathan S. Berg
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cynthia M. Powell
- University of North Carolina School of Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donald B. Bailey
- Center for Newborn Screening, Ethics, and Disability
Studies, RTI International, Research Triangle Park, NC, USA
| | - Megan A. Lewis
- Center for Communication Science, RTI International,
Research Triangle Park, NC
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12
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Bailey DB, Gehtland LM, Lewis MA, Peay H, Raspa M, Shone SM, Taylor JL, Wheeler AC, Cotten M, King NMP, Powell CM, Biesecker B, Bishop CE, Boyea BL, Duparc M, Harper BA, Kemper AR, Lee SN, Moultrie R, Okoniewski KC, Paquin RS, Pettit D, Porter KA, Zimmerman SJ. Early Check: translational science at the intersection of public health and newborn screening. BMC Pediatr 2019; 19:238. [PMID: 31315600 PMCID: PMC6636013 DOI: 10.1186/s12887-019-1606-4] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background Newborn screening (NBS) occupies a unique space at the intersection of translational science and public health. As the only truly population-based public health program in the United States, NBS offers the promise of making the successes of translational medicine available to every infant with a rare disorder that is difficult to diagnose clinically, but for which strong evidence indicates that presymptomatic treatment will substantially improve outcomes. Realistic NBS policy requires data, but rare disorders face a special challenge: Screening cannot be done without supportive data, but adequate data cannot be collected in the absence of large-scale screening. The magnitude and scale of research to provide this expanse of data require working with public health programs, but most do not have the resources or mandate to conduct research. Methods To address this gap, we have established Early Check, a research program in partnership with a state NBS program. Early Check provides the infrastructure needed to identify conditions for which there have been significant advances in treatment potential, but require a large-scale, population-based study to test benefits and risks, demonstrate feasibility, and inform NBS policy. Discussion Our goal is to prove the benefits of a program that can, when compared with current models, accelerate understanding of diseases and treatments, reduce the time needed to consider inclusion of appropriate conditions in the standard NBS panel, and accelerate future research on new NBS conditions, including clinical trials for investigational interventions. Trial registration Clinicaltrials.gov registration #NCT03655223. Registered on August 31, 2018.
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Affiliation(s)
- Donald B Bailey
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA.
| | - Lisa M Gehtland
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | | | - Holly Peay
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Melissa Raspa
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Scott M Shone
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Jennifer L Taylor
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Anne C Wheeler
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | | | | | - Cynthia M Powell
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | | | - Beth Lincoln Boyea
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Martin Duparc
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Blake A Harper
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | | | - Stacey N Lee
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | | | - Katherine C Okoniewski
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | | | - Denise Pettit
- North Carolina State Laboratory of Public Health, Raleigh, NC, USA
| | - Katherine Ackerman Porter
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
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13
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Paquin RS, Fischer R, Mansfield C, Mange B, Beaverson K, Ganot A, Martin AS, Morris C, Rensch C, Ricotti V, Russo LJ, Sadosky A, Smith EC, Peay HL. Priorities when deciding on participation in early-phase gene therapy trials for Duchenne muscular dystrophy: a best-worst scaling experiment in caregivers and adult patients. Orphanet J Rare Dis 2019; 14:102. [PMID: 31072340 PMCID: PMC6509771 DOI: 10.1186/s13023-019-1069-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/27/2018] [Accepted: 04/17/2019] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Several gene therapy trials for Duchenne muscular dystrophy initiated in 2018. Trial decision making is complicated by non-curative, time-limited benefits; the progressive, fatal course; and high unmet needs. Here, caregivers and patients prioritize factors influencing decision making regarding participation in early-phase gene therapy trials. METHODS We conducted a best-worst scaling experiment among U.S. caregivers and adults with Duchenne (N = 274). Participants completed 11 choice sets, choosing features they cared about most and least when deciding whether to participate in a hypothetical gene therapy trial. We analyzed the data using sequential conditional logistic regression. RESULTS Participants prioritized improved muscle function in trial decision making. Concerns about participation limiting later use of gene transfer and editing were also important, as were improved lung and heart function. Low risk of death fell near the middle. Participants cared least about muscle biopsies and potential for randomization to placebo. Adults with Duchenne and caregivers of non-ambulatory children significantly prioritized improved lung function compared to caregivers of ambulatory children. CONCLUSION Our data demonstrate prioritization of anticipated benefits and opportunity costs relative to potential harms and procedures in gene therapy trial decision making. Such data inform protocol development, education and advocacy efforts, and informed consent.
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Affiliation(s)
- Ryan S Paquin
- RTI International, Research Triangle Park, North Carolina, USA
| | - Ryan Fischer
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Carol Mansfield
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | | | | | | | | | - Colin Rensch
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | | | | | | | | | - Holly L Peay
- RTI International, Research Triangle Park, North Carolina, USA.
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14
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Paquin RS, Mittendorf KF, Lewis MA, Hunter JE, Lee K, Berg JS, Williams MS, Goddard KAB. Expert and lay perspectives on burden, risk, tolerability, and acceptability of clinical interventions for genetic disorders. Genet Med 2019; 21:2561-2568. [PMID: 31028355 DOI: 10.1038/s41436-019-0524-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/11/2018] [Accepted: 04/15/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The Clinical Genome Resource (ClinGen) Actionability Working Group (AWG) developed a semiquantitative scoring metric to rate clinical actionability of genetic disorders and associated genes in four domains: (1) severity of the outcome, (2) likelihood of the outcome, (3) effectiveness of the intervention to prevent/minimize the outcome, and (4) nature of the intervention with respect to burden, risk, tolerability, and acceptability to the patient. This study aimed to assess whether nature of the intervention scores assigned by AWG experts reflected lay perceptions of intervention burden, risk, tolerability, and acceptability given the subjectivity of this domain. METHODS In July 2017, a general population sample of 1344 adults completed the study. Each participant was asked to read 1 of 24 plain language medical intervention synopses and answer questions related to its burden, risk, tolerability, and acceptability. We conducted three multilevel mixed model analyses predicting the perceived burden, perceived risk, and perceived overall nature of the intervention. RESULTS As AWG nature of the intervention scores increased, lay perceptions of intervention burden and risk decreased, and perceptions of tolerability and acceptability increased. CONCLUSION The findings show alignment between the ClinGen actionability scoring metric and lay perceptions of the nature of the intervention.
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Affiliation(s)
- Ryan S Paquin
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA.
| | | | - Megan A Lewis
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | | | - Kristy Lee
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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15
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Paquin RS, Peinado S, Lewis MA, Biesecker BB, Rini C, Roche M, Butterfield RM, Powell CM, Berg JS, Bailey DB. A behavior-theoretic evaluation of values clarification on parental beliefs and intentions toward genomic sequencing for newborns. Soc Sci Med 2018; 271:112037. [PMID: 30448267 DOI: 10.1016/j.socscimed.2018.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Received: 02/23/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022]
Abstract
Decision aids commonly include values clarification exercises to help people consider which aspects of a choice matter most to them, and to help them make decisions that are congruent with their personal values and preferences. Using a randomized online experiment, we examined the influence of values clarification on parental beliefs and intentions about having genomic sequencing for newborns. We recruited 1186 women and men ages 18-44 who were pregnant or whose partner was pregnant or planning to become pregnant in the next two years. Participants (N = 1000) completed one of two versions of an online decision aid developed as part of a larger project examining the technical, clinical, and social aspects of using exome sequencing to screen newborns for rare genetic conditions. The education-only version provided information about using genomic sequencing to screen newborns for medically treatable conditions. The education-plus-values-clarification version included the same information, along with a values clarification exercise in which participants classified as important or unimportant five reasons in support of having and five reasons against having their newborn undergo genomic sequencing. We conducted partial correlations, regression analysis, and MANCOVAs with sex, health literacy, and experience with genetic testing as covariates. Participants who completed the decision aid with the values clarification exercise agreed less strongly with four of the five statements against sequencing compared to participants who viewed the education-only decision aid. The groups did not differ on agreement with reasons in support of sequencing. Agreement with four of five reasons against genomic sequencing was negatively associated with intentions to have their newborn sequenced, whereas agreement with all five reasons in support of sequencing were positively associated with intentions.
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Affiliation(s)
- Ryan S Paquin
- RTI International, Research Triangle Park, NC, United States.
| | - Susana Peinado
- RTI International, Research Triangle Park, NC, United States
| | - Megan A Lewis
- RTI International, Research Triangle Park, NC, United States
| | | | - Christine Rini
- Hackensack University Medical Center, Hackensack, NJ and Georgetown University School of Medicine, Washington, DC, United States
| | - Myra Roche
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rita M Butterfield
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cynthia M Powell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jonathan S Berg
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Donald B Bailey
- RTI International, Research Triangle Park, NC, United States
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16
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Boudewyns V, Paquin RS, Uhrig JD, Badal H, August E, Stryker JE. An Interrupted Time Series Evaluation of the Testing Makes Us Stronger HIV Campaign for Black Gay and Bisexual Men in the United States. J Health Commun 2018; 23:865-873. [PMID: 30307784 DOI: 10.1080/10810730.2018.1528318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Black gay, bisexual, and other men who have sex with men (BMSM) are the subpopulation most disproportionately affected by HIV in the United States. Testing Makes Us Stronger (TMUS), a communication campaign designed to increase HIV testing rates among BMSM ages 18 to 44, was implemented in the United States from December 2011 through September 2015. We used interrupted time series analysis (ITSA) to compare pre- and post-campaign trends in monthly HIV testing events among the priority audience in six of the implementation cities from January 2011 through December 2014. In the 11 months prior to the launch of TMUS, HIV testing events among BMSM in the six campaign implementation cities decreased by nearly 35 tests per month (p = .021). After the introduction of TMUS, the number of HIV testing events among BMSM in the same cities increased by more than 6 tests per month (p = .002). ITSA represents a quasi-experimental technique for investigating campaign effects beyond underlying time trends when serial outcome data are available. Future evaluations can be further strengthened by incorporating a comparison group to account for the effects of history and maturation on pre- and post-campaign trends.
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Affiliation(s)
- Vanessa Boudewyns
- a Center for Communication Science , RTI International , Minneapolis , MN , USA
| | - Ryan S Paquin
- a Center for Communication Science , RTI International , Minneapolis , MN , USA
| | - Jennifer D Uhrig
- b Center for Communication Science , RTI International , NC , USA
| | - Hannah Badal
- c Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Euna August
- c Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Jo Ellen Stryker
- c Division of HIV/AIDS Prevention , National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Centers for Disease Control and Prevention , Atlanta , GA , USA
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Milko LV, Rini C, Lewis MA, Butterfield RM, Lin FC, Paquin RS, Powell BC, Roche MI, Souris KJ, Bailey DB, Berg JS, Powell CM. Evaluating parents' decisions about next-generation sequencing for their child in the NC NEXUS (North Carolina Newborn Exome Sequencing for Universal Screening) study: a randomized controlled trial protocol. Trials 2018; 19:344. [PMID: 29950170 PMCID: PMC6022715 DOI: 10.1186/s13063-018-2686-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/14/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Using next-generation sequencing (NGS) in newborn screening (NBS) could expand the number of genetic conditions detected pre-symptomatically, simultaneously challenging current precedents, raising ethical concerns, and extending the role of parental decision-making in NBS. The NC NEXUS (Newborn Exome Sequencing for Universal Screening) study seeks to assess the technical possibilities and limitations of NGS-NBS, devise and evaluate a framework to convey various types of genetic information, and develop best practices for incorporating NGS-NBS into clinical care. The study is enrolling both a healthy cohort and a cohort diagnosed with known disorders identified through recent routine NBS. It uses a novel age-based metric to categorize a priori the large amount of data generated by NGS-NBS and interactive online decision aids to guide parental decision-making. Primary outcomes include: (1) assessment of NGS-NBS sensitivity, (2) decision regret, and (3) parental decision-making about NGS-NBS, and, for parents randomized to have the option of requesting them, additional findings (diagnosed and healthy cohorts). Secondary outcomes assess parents' reactions to the study and to decision-making. METHODS/DESIGN Participants are parents and children in a well-child cohort recruited from a prenatal clinic and a diagnosed cohort recruited from pediatric clinics that treat children with disorders diagnosed through traditional NBS (goal of 200 children in each cohort). In phase 1, all parent participants use an online decision aid to decide whether to accept NGS-NBS for their child and provide consent for NGS-NBS. In phase 2, parents who consent to NGS-NBS are randomized to a decision arm or control arm (2:1 allocation) and learn their child's NGS-NBS results, which include conditions from standard (non-NGS) NBS plus other highly actionable childhood-onset conditions. Parents in the decision arm use a second decision aid to make decisions about additional results from their child's sequencing. In phase 3, decision arm participants learn additional results they have requested. Online questionnaires are administered at up to five time points. DISCUSSION NC NEXUS will use a rigorous interdisciplinary approach designed to collect rich data to inform policy, practice, and future research. TRIAL REGISTRATION clinicaltrials.gov, NCT02826694 . Registered on 11 July, 2016.
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Affiliation(s)
- Laura V. Milko
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Christine Rini
- Department of Biomedical Research, Hackensack University Medical Center, Hackensack, NJ 07601 USA
| | - Megan A. Lewis
- Center for Communication Science, RTI International, Research Triangle Park, NC 27709 USA
| | - Rita M. Butterfield
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599 USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ryan S. Paquin
- Center for Communication Science, RTI International, Research Triangle Park, NC 27709 USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Myra I. Roche
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599 USA
| | - Katherine J. Souris
- Department of Heath Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Donald B. Bailey
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC 27709 USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Cynthia M. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599 USA
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18
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Lewis MA, Stine A, Paquin RS, Mansfield C, Wood D, Rini C, Roche MI, Powell CM, Berg JS, Bailey DB. Parental preferences toward genomic sequencing for non-medically actionable conditions in children: a discrete-choice experiment. Genet Med 2018; 20:181-189. [PMID: 28771249 PMCID: PMC5868968 DOI: 10.1038/gim.2017.93] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/16/2017] [Indexed: 01/12/2023] Open
Abstract
PurposeApplication of whole-exome and whole-genome sequencing is likely to increase in clinical practice, public health contexts, and research. We investigated how parental preference for acquiring information from genome-scale testing is influenced by the characteristics of non-medically actionable genetic disorders in children, as well as whether the preferences differed by gender and between African-American and white respondents.MethodsWe conducted a Web-based discrete-choice experiment with 1,289 parents of young children. Participants completed "choice tasks" based on pairs of profiles describing sequencing results for hypothetical genetic disorders, selected the profile in each pair that they believed represented the information that would be more important to know, and answered questions that measured their level of distress.ResultsKnowing the likelihood that the disorder would develop given a true-positive test result was most important to parents. Parents showed greater interest in learning sequencing results for disease profiles with more severe manifestations. This was associated with greater distress. Differences by gender and race reflected small differences in magnitude, but not direction.ConclusionParents preferred to learn results about genetic disorders with more severe manifestations, even when this knowledge was associated with increased distress. These results may help clinicians support parental decision making by revealing which types of sequencing results parents are interested in learning.
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Affiliation(s)
- Megan A Lewis
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Alex Stine
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Ryan S Paquin
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Carol Mansfield
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Dallas Wood
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Christine Rini
- Department of Health Behavior and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Myra I Roche
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Cynthia M Powell
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Donald B Bailey
- RTI International, Research Triangle Park, Durham, North Carolina, USA
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Moultrie RR, Lewis MA, Paquin RS, Lucas A, Jarecki J, Peay HL. An Evidence-Based, Community-Engaged Approach to Develop an Interactive Deliberation Tool for Pediatric Neuromuscular Trials. J Genet Couns 2017; 27:416-425. [PMID: 29260486 DOI: 10.1007/s10897-017-0190-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/28/2017] [Indexed: 01/09/2023]
Abstract
Duchenne/Becker muscular dystrophy (DBMD) and spinal muscular atrophy (SMA) are rare neuromuscular disorders that present challenges to therapeutic and clinical trial decision making. We developed an interactive, evidence-based online tool designed to encourage thoughtful deliberation of the pros and cons of trial participation and to inform meaningful discussions with healthcare providers. Prior research demonstrates the importance of tool availability at the time each family is considering trial participation, which may be prior to the informed consent process. The tool is intended to be easily modified to other pediatric disease communities. Tool development was informed by prior qualitative research, literature reviews, and stakeholder input. Specific items were derived based on an online exploratory questionnaire of parents whose children participated in a trial for DBMD or SMA to understand motivations for participation. Parent participants in the exploratory survey reported strong impact of altruistic and individual benefit motivations and placed much greater emphasis on anticipated trial benefits than on harms when making participation decisions. We used this data to develop the evidence-based deliberation tool using a community-engaged approach. We initially targeted the tool for DBMD while using SMA survey data to evaluate ease of transition to that population. We conducted two iterative sets of activities to inform development and refinement of the tool: (1) community engagement of key stakeholders and (2) user experience testing. These activities suggest that the tool may increase deliberation and the weighing of benefits and harms. Ongoing evaluation will determine the acceptability and efficacy of this online intervention.
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Affiliation(s)
- Rebecca R Moultrie
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | - Megan A Lewis
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Ryan S Paquin
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Ann Lucas
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | | | - Holly L Peay
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
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Aikin KJ, Southwell BG, Paquin RS, Rupert DJ, O'Donoghue AC, Betts KR, Lee PK. Correction of misleading information in prescription drug television advertising: The roles of advertisement similarity and time delay. Res Social Adm Pharm 2017; 13:378-388. [DOI: 10.1016/j.sapharm.2016.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 11/28/2022]
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Paquin RS, Peay HL, Gehtland LM, Lewis MA, Bailey DB. Parental intentions to enroll children in a voluntary expanded newborn screening program. Soc Sci Med 2016; 166:17-24. [PMID: 27526258 DOI: 10.1016/j.socscimed.2016.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/25/2016] [Revised: 07/16/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Nearly all babies in the United States are tested at birth for rare, serious, and treatable disorders through mandatory state newborn screening (NBS). Recently, there have been calls for an expanded, voluntary model to facilitate early diagnosis and treatment of a wider range of disorders. We applied the reasoned action framework to examine parental intentions to participate in voluntary expanded screening. METHODS We recruited a national cohort of recent and expectant parents living in the U.S. who completed a self-administered online survey (N = 1001). Using a mixed-level fractional factorial experiment, we studied parental participation intentions and preferences for timing of consent, cost, consent format, and testing options. RESULTS We conducted a hierarchical regression analysis assessing parental intentions to participate in voluntary expanded NBS. Attitudes, perceived normative influence, and perceived behavioral control explained substantial variance in intention, with perceived normative influence emerging as the strongest predictor. We found no evidence that the manipulated program features altered mean levels of intention, but timing of parental permission, cost, and permission format moderated the relative importance of reasoned action constructs on intention. CONCLUSION Program design features may impact the psychological mechanisms underlying parental decision making for voluntary expanded screening. These results have important implications for parent education, outreach, and informed parental permission procedures.
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Affiliation(s)
- Ryan S Paquin
- Center for Communication Science, RTI International, Research Triangle Park, NC, United States.
| | - Holly L Peay
- Center for P-12 Education, RTI International, Research Triangle Park, NC, United States
| | - Lisa M Gehtland
- Center for P-12 Education, RTI International, Research Triangle Park, NC, United States
| | - Megan A Lewis
- Center for Communication Science, RTI International, Research Triangle Park, NC, United States
| | - Donald B Bailey
- Education and Workforce Development, RTI International, Research Triangle Park, NC, United States
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Abrams LR, Koehly LM, Hooker GW, Paquin RS, Capella JN, McBride CM. Media Exposure and Genetic Literacy Skills to Evaluate Angelina Jolie's Decision for Prophylactic Mastectomy. Public Health Genomics 2016; 19:282-9. [PMID: 27427958 DOI: 10.1159/000447944] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 06/23/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine public preparedness to evaluate and respond to Angelina Jolie's well-publicized decision to have a prophylactic mastectomy. METHODS A consumer panel (n = 1,008) completed an online survey in November 2013, reporting exposure to Jolie's story, confidence applying genomic knowledge to evaluate her decision, and ability to interpret provided genetic risk information (genetic literacy skills). Linear and logistic regressions tested mediating/moderating models of these factors in association with opinions regarding mastectomies. RESULTS Confidence with genomics was associated with increased genetic literacy skills and increased media exposure, with a significant interaction between the two. Confidence was also associated with favoring mastectomies for women with BRCA mutations, mediating the relationship with media exposure. Respondents were more likely to form opinions about mastectomies if they had high genetic literacy skills. CONCLUSION These findings suggest that having higher genetic literacy skills may increase the public's ability to form opinions about clinical applications of genomic discovery. However, repeated media exposure to high-profile stories may artificially inflate confidence among those with low genetic literacy.
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Affiliation(s)
- Leah R Abrams
- University of Michigan School of Public Health, Ann Arbor, Mich., USA
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Paquin RS, Keating DM. Fitting identity in the reasoned action framework: A meta-analysis and model comparison. The Journal of Social Psychology 2016; 157:47-63. [DOI: 10.1080/00224545.2016.1152217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lewis MA, Paquin RS, Roche MI, Furberg RD, Rini C, Berg JS, Powell CM, Bailey DB. Supporting Parental Decisions About Genomic Sequencing for Newborn Screening: The NC NEXUS Decision Aid. Pediatrics 2016; 137 Suppl 1:S16-23. [PMID: 26729698 PMCID: PMC4922487 DOI: 10.1542/peds.2015-3731e] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 11/24/2022] Open
Abstract
Advances in genomic sequencing technology have raised fundamental challenges to the traditional ways genomic information is communicated. These challenges will become increasingly complex and will affect a much larger population in the future if genomics is incorporated into standard newborn screening practice. Clinicians, public health officials, and other stakeholders will need to agree on the types of information that they should seek and communicate to parents. Currently, few evidence-based and validated tools are available to support parental informed decision-making. These tools will be necessary as genomics is integrated into clinical practice and public health systems. In this article we describe how the North Carolina Newborn Exome Sequencing for Universal Screening study is addressing the need to support parents in making informed decisions about the use of genomic testing in newborn screening. We outline the context for newborn screening and justify the need for parental decision support. We also describe the process of decision aid development and the data sources, processes, and best practices being used in development. By the end of the study, we will have an evidenced-based process and validated tools to support parental informed decision-making about the use of genomic sequencing in newborn screening. Data from the study will help answer important questions about which genomic information ought to be sought and communicated when testing newborns.
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Affiliation(s)
- Megan A. Lewis
- Center for Communication Science, and,Address correspondence to Megan A. Lewis, PhD, 3040 Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709-2194. E-mail:
| | | | - Myra I. Roche
- Department of Pediatrics, and,Department of Genetics, and
| | | | - Christine Rini
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Paquin RS, Richards AS, Koehly LM, McBride CM. Exploring dispositional tendencies to seek online information about direct-to-consumer genetic testing. Transl Behav Med 2012; 2:392-400. [PMID: 24073142 PMCID: PMC3717920 DOI: 10.1007/s13142-012-0159-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Varying perspectives exist regarding the implications of genetic susceptibility testing for common disease, with some anticipating adverse effects and others expecting positive outcomes; however, little is known about the characteristics of people who are most likely to be interested in direct-to-consumer genetic testing. To that end, this study examines the association of individual dispositional differences with health risk perceptions and online information seeking related to a free genetic susceptibility test. Healthy adults enrolled in a large health maintenance organization were surveyed by telephone. Eligible participants (N = 1,959) were given access to a secure website that provided risk and benefit information about a genetic susceptibility test and given the option to be tested. Neuroticism was associated with increased perceptions of disease risk but not with logging on. Those scoring high in conscientiousness were more likely to log on. We found no evidence that neuroticism, a dispositional characteristic commonly linked to adverse emotional response, was predictive of online genetic information seeking in this sample of healthy adults.
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Affiliation(s)
- Ryan S Paquin
- />Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Room B1B54, 31 Center Drive, Bethesda, MD 20892 USA
- />Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA USA
| | - Adam S Richards
- />Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Room B1B54, 31 Center Drive, Bethesda, MD 20892 USA
- />Department of Communication, University of Maryland, College Park, MD USA
| | - Laura M Koehly
- />Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Room B1B54, 31 Center Drive, Bethesda, MD 20892 USA
| | - Colleen M McBride
- />Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Room B1B54, 31 Center Drive, Bethesda, MD 20892 USA
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Abstract
Although sexually transmitted diseases (STDs) are common among college students, there have been few studies that examine the psychological determinants of STD testing. To help address this gap in the literature, we drew on the reasoned action framework to gain insight into the cognitive processes underlying STD-testing intentions for two samples of college students (n = 181 and n = 160). More generally, we demonstrate how behavioral theory can be applied in formative research to generate recommendations for developing communication interventions. Our findings suggest that attitudes toward getting tested for STDs were the strongest determinant of intentions for the college students in our samples. Further, results of a belief analysis indicate that students who did not intend to get tested for STDs might change their mind if they could be persuaded that getting tested would show that they respect their sexual partner or that getting tested would prevent them from spreading an STD to someone else.
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Affiliation(s)
- Vanessa Boudewyns
- Department of Communication, University of Maryland, College Park, 20742, USA.
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